new nurse feeling totally incompetent?

Editorial Team / Admin · Oct 12, 2017

First, take a deep breath and stop beating yourself up. Second, think about what you learned from the experience- to contact someone right away, right? And that's what you'll do the next time, right? Do you page directly or go through a service to contact the doc on call? We use a "medical bureau" that takes the calls from the nurses and then pages the doc on call.

And here's the biggest thing: no one is perfect. You are still learning. You will make mistakes. It will take you about a year to feel comfortable and competent as a nurse. Most of the learning to be a nurse happens after school, not during. You'll get there.

Been there,done that, ASN, RN · Oct 12, 2017

How much training did you receive to interpret rhythms? You can't be expected to know all the nuances of telemetry interpretation.

Atrial fibrillation at 110-120 is uncontrolled. Patient is at risk for CHF. Was the patient symptomatic, was the patient uncontrolled on the prior day shift?

As a new nurse, assess your patient, find someone to consult with STAT ( no matter what it takes) until you get more experience.

Best of luck, it's a jungle.

amoLucia · Oct 13, 2017

If it makes you feel any better, just know that everybody else here has pretty much BEEN THERE, DONE THAT as you.

As a NOC shift LTC RN with 35+ years exp, I learned a verrry long time back to make my own phone calls. If I were to call an on-call Doc, he could only tell me "Hey, not me", and I'd call someone else who was responsible. No one could give a better account/summary of the issue than myself, so I gave it a try to get the best info to the MD as poss. And I could get the best response as poss . Same thing applies with making the phone calls to families.

Once is a while, there would be a delay with a callback, but at least I gave it my best attempt. (I also hated to leave the next shift with any of my leftovers.)

Your pts are much more critical then mine, but the issues are the same - significant change in status needs to be communicated. And in a TIMELY FASHION.

I didn't want to leave something to chance by passing off notifications. Only on an infreq occasion would I ask someone to make my calls, and then it would only be someone I could really trust.

Your insecurity is understandable but a good rule of thumb to follow for the rest of your career is "WHEN IN DOUBT, ERR ON THE SAFE SIDE". MAKE the calls yourself. Do what YOU think is best.

I do have one question - did you have access to a shift supervisor? Even with shift change, any shift spvr should be able to assist you when you explained your dilemma. That's what they get paid for.

Irish_Mist, BSN, RN · Oct 13, 2017

First of all, take a deep breath.

What was this patient's baseline rhythm? Remember that phrase: treat the patient, not the monitor. When you assessed her, how did she look? I think that you know a physician should have been notified. If you are unsure of who to call, utilize your resources. Ask the charge nurse or the house supervisor.

You say there wasn't anyone at the nurse's station due to shift change and bedside report. Are you afraid to reach out and ask for help?

MrNurse(x2), ADN · Oct 13, 2017

Remember, this is a career, not a job. It will take you years to feel comfortable. The pressure you are feeling was constructed recently. Rather than rewrite it, I'll refer you to what you are experiencing:

https://allnurses.com/first-year-after/welcome-new-grads-1105161.html