Not Cut Out to Be a Nurse?

[wanna_be]

I just finished my first year of a two-year BSN program. I also work at an outpatient health center as a clinic assistant, where I've been for almost two years. I am absolutely, 100% certain that nursing is what I want to do with my life, and from working with nurses and healthcare professionals for several years I know what I'm getting into.

I feel like the deeper I get into clinical rotation, and observe my peers, the less confidence I have in my ability to be a nurse. It's also reflected in my job. The NPs at my work have always seemed frustrated with me; I've always gotten great feedback from clinic managers about my performance, but the providers only point out things I do wrong, and I feel like I make a lot of little mistakes every time I work.

For example, today I had a patient with a preexisting condition who wanted to do a procedure. She told me a little bit about her condition and I went and found the NP to ask how she wanted me to proceed. She seemed annoyed that I had not already anticipated asking questions about the treatment and outcome of the condition (the patient was reticent to provide more information), and sent me back into the room. The second time I asked more in depth questions and requested she get records from her specialist, then reported back to the NP, who was now REALLY annoyed because I had not educated the patient about an alternative option if the NP decided she could not do the procedure.

It's always stuff like this--little things that add up: I didn't get a clean catch because the patient's symptoms didn't clue me in to a UTI; I didn't do a pregnancy test because the patient insisted she'd been consistent with condoms, even through her period was three months late.

I feel really incompetent all the time, and think my lack of confidence just fuels my mistakes. I never do anything to jeopardize patients--if anything, I'm overly cautious. No one has ever approached me directly about it, but whenever the NP asks, "why didn't you do this"? I imagine that my coworkers think I'm slow, stupid, incapable of doing my job...and fear for my future as a nurse. What if I'm just not able to think analytically? What if I'm not cut out to be a nurse because I can't think for myself? Does everyone struggle with little things like this, or am I a hopeless case?

[Jules A, MSN]

It sounds like this is a challenging MA job which is a good thing because if you master it your first nursing job will probably be smoother and like you mentioned if you did it more often you would be more comfortable. If you aren't seeing a therapist for the anxiety please consider it as they can offer you helpful coping skills that would likely make a big difference in your mindset when things get stressful. That you don't make the same mistake twice is a great sign. With regard to unnecessary tests my thought is usually based on how invasive it is and the cost of running it. For example I'd rather someone collect a clean catch and then ask me if I want to run xyz if there is a reasonable indication. We can always toss out the plastic cup without running the lab and the cost would be minimal, right? For me when I became a provider some of my hot buttons are knowing pregnancy status, allergies, hx of stroke/dvt/pe and high alert meds the patient is on. Of course you need to figure out the philosophy of each provider you work with and sometimes asking up front is helpful also because everyone has their own style. If you definitely want to be a nurse I would attempt to get the anxiety under control first because that will just continue distracting and stressing you unnecessarily.

[Jules A, MSN]

I'm also curious if there's some way I could get feedback directly (from my lab instructors, or the NPs at work) without wasting their time or seeming overly paranoid about my abilities. Do you all think it would be okay to ask to schedule a time to meet and talk to them about my performance? Our NPs our rotating, and do not manage clinic assistants, so it's not their job to give me feedback, but when I ask my manager she tells me I'm doing a great job and always get good feedback from the other staff, so I presume she's just oblivious to how terrible I am.

Or maybe you aren't all that terrible? I would definitely ask if they have time to either sit down with your or maybe email you a brief feedback. I'd be impressed and appreciative if a co-worker who I felt wasn't getting asked me for feedback in an effort to improve.

[Libby1987]

Your manager has a different perspective, she's looking at you as a good employee who shows up on time, completes your work etc. The providers are looking at your clinical performance.

It sounds like you have some mental blocks preventing you from accepting and implementing standards. You understand them intellectually but you can't pull the trigger. Your existing anxiety could be a root cause therefore probably needs to be addressed first before trying to obtain feedback. I think your logic might be backwards. I've had that, coming from the wrong perspective and being afraid of doing the wrong thing that I didn't do the right thing. Mine were isolated and self correcting, you may benefit from some outside help with this if its widespread.

One thing you might do in the meantime is clarify the consequences of what you consider taking excessive measures. A former director of mine, back in my middle mgmt days, assured me that she just wanted me to make a decision, even if the wrong one she would support my self initiative. Of course these were of the do no harm type decisions (an extra UA isn't going to harm the patient). You build your confidence with starting to make these no harm decisions.

[wanna_be]

Thank you both--I really appreciate the feedback. I like the idea of being more proactive in running tests/filling out extra forms, etc. Another part of it is that we see 30+ patients per day, so the pace is very quick and there's a lot of pressure to get in and out of my visits in under ten minutes, so that translates to being afraid of taking too much time. But as you've pointed out, for things like a UA it is better to go ahead and get the sample and be wrong than not do it (which in the end takes more time). I know it sounds simple, but it's good to hear strategies, because without some structure/protocol around those things I do feel lost. Hopefully it is something that will become more clear with experience. It also helps to hear it from a provider's perspective, because I often see the end result (the NP being stressed/annoyed) without knowing how I could've done things differently. I still feel afraid of "hand holding" but I guess it's better to ask directed questions than to keep getting things wrong because I don't want to seem even more incompetent.I will take your advice into consideration when I work next! Feel free to share any other thoughts.

[Soliloquy, MSN, APRN, NP]

To be honest, I think your post OP is a reflection of the state of healthcare where people come in with these huge egos and project, project, project all the time. But I don't think that has to do with you or your ability to be a good nurse. Some people just have really high expectations for everyone around them and push a lot of work and pressure onto you in addition to a poor attitude in the process.

[RNperdiem, RN]

I wonder if this practice really needs a nurse, but is unwilling/unable to hire one and is making do by expecting too much from MAs.

They seem to want nurse-level thinking and practice.

[Here.I.Stand, BSN, RN]

That ability to anticipate providers' decisions comes with time. I've been an RN for 12 years and work in a high level ICU, and usually I know what I need for my pt before I even call an MD. Did I know it as a new grad? No. Did I know it as a student? HECK no. Should you have ruled out a pregnancy test because of a client's assertion of perfect condom use, no... no method is 100%; in fact I have a relative who got pregnant after a tubal. But we all make mistakes. Learn from this one, and do differently next time.

As for a clinic assistant anticipating treatment plans and doing patient education on alternatives, those sound like things you should never be expected to do. In fact, part of legally informed consent is that the provider educates the patient on risks, benefits, and alternatives.

[brandiep1982]

Ok, I am not a nurse. I haven't even started the nursing portion of my schooling yet. Yet, this seems familiar... it almost seems like you are so scared to make the wrong decision... that you make wrong decisions.... to the point that you can't see "the problem". I have seen this... a very competent person seems to lose all of their faculties because not only are people telling them what they are doing wrong, but they are being so darned hard on themselves that it cripples them. I am probably way off base, but I was just getting this vibe.

I really don't like the way my response sounds... I guess what I really mean is that maybe things like not giving the pregnancy test are happening because you are so scared all the time. You mention being afraid a few times. It is hard to concentrate when a person is constantly scared of doing the wrong thing.

[Farawyn]

I used to work in an OBGYN clinic. You always do urines, and if a patient is 3 WEEKS late on her period we usually do a pregnancy test.

[ComeTogether, LPN]

Sometimes we don't need a specific protocol or rule in place to get something done, we just do it because it makes sense. I think that's what your missing. It sounds like you are over analyzing everything for symptoms and procedures when all you have to do is look at the reality in front of you. No, there isn't a specific rule stating to get a HCG on a woman who has missed her period, but you get the urine anyways because A) It's absolutely possible/probable that she is indeed pregnant and 2) Getting the urine certainly isn't going to hurt anything. Same with the clean catch. If the patient needs to use the bathroom, why not just get one so that it's done if it's ordered?

I just think you're not seeing the big picture, so to speak. What about your colleagues? Do they have certain ways they approach each patient?

[TheCommuter, BSN, RN]

I seem to work better at a slower pace, where I'm able to think things through rather than on my feet.

I am similar. I perform more optimally at a slower pace in low-pressure environments that do not require me to immediately act; hence, I've avoided the acute care hospital setting during the course of my entire career.

If you're fully aware that your work performance improves at a slower pace, perhaps you should consider positions outside the acute care hospital setting when you do become an RN. Hospital nursing is fast-paced, furious, and high-pressure.

[Libby1987]

I am similar. I perform more optimally at a slower pace in low-pressure environments that do not require me to immediately act; hence, I've avoided the acute care hospital setting during the course of my entire career.

If you're fully aware that your work performance improves at a slower pace, perhaps you should consider positions outside the acute care hospital setting when you do become an RN. Hospital nursing is fast-paced, furious, and high-pressure.

I don't know that I used to be like this, I left acute care so long ago I don't know how I'd perform if I'd stayed, but one of the things I like about home health is the time to muddle through conclusions and still act in a timely manner. You may work over but for a conscientious thorough newbie, it's about the safest settimg to practice and develop critical thinking.