New jobs leaves me feeling incompetent and nonconfident

JKL33 · Mar 26, 2018

Ugh. The ED (well I guess orienting to any unit, really) deserves an organized/systematic approach to learning. This idea of throwing people into things has got to stop. This is not safe patient care, #1, and secondly it is certainly not how people lay down a foundation and then build upon it.

I'm sorry for your experience.

It's not unusual to feel overwhelmed, but if you aren't being given much guidance you need to speak to the NM about how things might be re-tooled. In the ED I favor starting with ESI 4s and 5s. You learn the flow, the paperwork, the charting expectations, the locations of supplies, etc., in a low-risk environment. Next, add in the 3s, then the 2s, and then 1s. Spend the remainder of the time learning to juggle a full assignment after you're already familiar with the basic acuities.

To do it any other way is to keep (most) people in perpetual "task" mode instead of thinking mode. IMVHO one should be able to do the assessments and skills and manage a general assignment flow blindfolded with one hand tied behind one's back before being "thrown into" anything too terrifying.

You need to talk to your NM. Choose your words carefully (i.e. don't criticize/blame others) - try to frame it positively.

If by chance you are being thrown into things because of overall staffing issues (why wasn't your preceptor at the trauma with you?) then there are big problems and for your own career and your personal well-being you should start thinking about alternatives.

Otherwise, I do think you can get a handle on this. Do your best, communicate, ask for help/ask questions, etc.

Best of luck ~

allnurses Guide · Mar 26, 2018

My experience has been that every time you switch up specialties, you are essentially a new grad all over again and that it will take about a year to feel comfortable and competent, particularly when the change is a big one, like going from the floor to the OR or the ED or NICU or ICU etc.

I hope things get better. Hang in there.

llg, PhD, RN · Mar 26, 2018

For a lot of people, their 2nd job is the hardest to adjust to because it casts doubt on your competence just as you described. Your first job as a new grad was on a med/surg unit -- the type of job school prepared you for. You developed competence and confidence there. Now, you are not only working for a different employer (who has different ways of doing things) -- you are working in an entirely different specialty.

The foundation that you rely on for your competence/confidence is shifting. The "rules" are different, the people are different, etc. That shakes your confidence. By the time a nurse reaches for 3rd, 4th, 5th, etc. job -- her confidence is not based on "knowing the rules" of the place she works in. It's based on her ability to assess the patient and meet the patient's needs regardless of the setting. It's that 2nd job that throws a lot of people -- the first time they encounter the fact that their competence was partly resting on a foundation of familiarity with their old work setting. Change the setting -- and your confidence wanes.

Is it ED as a specialty you don't like? Would you be happier going to a med/surg unit more similar to the one you left?

Bnw684 · Mar 26, 2018

I have tried to like the ED but I don't think I fit in with the people and the vibe at the new hospital. It's very very clicky. I'm still a fairly new nurse so the fact that they just throw me into things I'm not comfortable with scared me. And the trauma on Saturday my preceptor was there but wasn't giving me direction just observing. She then followed this by talking to the CN and saying it was a train wreck. There doesn't seem to be a systematic way for orientation.. I will say I miss my old hospital and my coworkers, not exactly the job itself, it wasn't terrible but not something I wanna do forever. I'm just upset and shook up.

Accolay · Apr 2, 2018

You're a newer nurse, in a completely new role. It's going to suck for a while.

The best skill in a more critical care area is the ability to tell your coworkers that you don't know what you're doing so you can get some help.

Also, you're the new guy. You don't fit in yet. You don't feel confident because you don't know what you're doing. I'm afraid that sometimes these places are trial by fire... You're either going to survive with only a few scars, or you're going to be burnt up.

Remember that your coworkers have all been in the same place you have, they just forgot what it was like. Also, there is more often than not a dark, sardonic humor that accompanies jobs such as this. If you keep pining for your last job and coworkers, your definitely not going to enjoy your time there. Good luck.

Concerto_in_C, BSN, RN · Apr 2, 2018

I think you have unrealistic expectations as a new nurse. You are operating in an environment where it's normal for a floor nurse to have 20 years of experience. I've been a nurse for 10 years but some of my fellow nurses have been on the floor since the early 1970s. This means they have 40+ of experience. I love them to death, they are your greatest asset. Look to them for guidance.

You are too green to take on those people and impress them. Hang in there. I mean hang in there for 5 years and lets have this conversation again. When you have several years of experience try to specialize so you can get off the general hospital floor. You can specialize in anything you want--cath lab, midwife, IR radiology nurse inserting PICC lines, anything you want. On a general medical floor you will forever work with management that believes floor nurses are stupid. Stupid nurses who are a liability more than an asset. It's the sandbox mode where you learn the basics. I've been learning the basics for 10 years now and I still need more practice to improve.

Been there,done that, ASN, RN · Apr 2, 2018

I get it. No direction during a trauma is dangerous for all involved.

You are still in orientation, it is a trial period for you and the unit. You can call off the arrangement without repercussions.

You will find something that doesn't make you cry.

Best wishes, let us know how it's going.