Overcoming new nurse jitters and feelings of inadequacy

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Hi everyone,

I graduated nursing school in May and have been an RN since June. I did a apprenticeship program which consisted of 7 weeks in the classroom and 7 weeks with a preceptor. I have been on my own for 2 weeks now and the struggle is REAL.

I feel like I'm doing pretty well, but I'm struggling with feelings of inadequacy. I feel anxious before every shift. I feel like I panic during any patient emergency and can overreact to situations at times, but my preceptor said that also comes with being a new nurse. She told me that I was doing great, and I administered a blood transfusion on my own for the first time the other night.

When will the inadequate feelings go away?

When will I not panic during an emergency?

How do I build confidence in myself?

Thanks guys!!

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I've been a nurse for three years and I still encounter situations where I feel inadequate. I'm getting better with emergency situations but mostly from having been in a dozen codes or more in the past year.

It will get better with more time and experience. Celebrate your accomplishments. I like to journal - either situations where I could have done better and how I can I'm prove and what knowledge I need to do better, and situations in which I did well/ was proud of. It's amazing to read back and see how I've grown. Do you have a similar activity you could do? Or make a learning plan and check things off as you come across them?

I also recommend pretending being confident. It's funny how that act alone will help self confidence. Keep at it, it will get easier as you go further.

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I've been a nurse for three years and I still encounter situations where I feel inadequate. I'm getting better with emergency situations but mostly from having been in a dozen codes or more in the past year.

It will get better with more time and experience. Celebrate your accomplishments. I like to journal - either situations where I could have done better and how I can I'm prove and what knowledge I need to do better, and situations in which I did well/ was proud of. It's amazing to read back and see how I've grown. Do you have a similar activity you could do? Or make a learning plan and check things off as you come across them?

I also recommend pretending being confident. It's funny how that act alone will help self confidence. Keep at it, it will get easier as you go further.

I haven't tried that! Thanks!

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I graduated idk 3 years ago. I'd give you this advice. Hold onto those feeling of inadequacy but kick the anxiety to the curb. Knowing you need to be smarter, better, faster, etc. helps you keep the edge to be smarter, better, faster, etc. You are anxious about it for a reason, use it. To give an example, I had a patient that was "blowing up" (facial edma, arms and legs weeping). Everyone was looking at electrolytes and I/O, but it wasn't getting solved who ended up getting diagnosed with myxedema. I was furious that I didn't think to sit and analyze to ask for TSH (this was in my first two months of nursing btw). 8 months later I was working an extra shift on 3rd and saw a patient with similar symptoms (recurrent edema issues, facial edema, etc.) who looked puffier when I was ending the shift than when I started despite sleeping most the night and having minimal fluids. I called and got an order for TSH in addition to CMP and a few other things the doctor wanted. Turned out the patient was getting less than half the synthroid needed. Knowing you need more will help you; when you're inadequate, improve yourself. Don't know enough, learn. Not fast enough, analyze how you use your time. Not synthesizing information, stop to look for patterns. You'll never be perfect but you can be better; work to make yourself better.

Regarding emergencies and codes. Just stop. I don't mean stop having codes or stop going to codes. I mean take 10-15 seconds and ask yourself what the problem is and what it is that you need to fix the problem. It's sounds dumb. Pt with no pulse and no breathing; I need the crash cart for a mask, I need the pet to get cpr, I need more hands to help and document, etc. PT zonked out, low respirations, low vitals, etc. I need the MAR to see if narcan/romazicon, rebreather/intubate, blood sugar level, etc. "Doing something" isn't always effective; doing the right thing is effective. Stop to take a second to figure out what the right thing is.

As far as confidence goes, pretend. You will get there if you work at it in time. Until then, fake it. But like Castiela said, celebrate your wins. Even the little things; especially the little things. Learn from your losses, but celebrate your wins.

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I graduated idk 3 years ago. I'd give you this advice. Hold onto those feeling of inadequacy but kick the anxiety to the curb. Knowing you need to be smarter, better, faster, etc. helps you keep the edge to be smarter, better, faster, etc. You are anxious about it for a reason, use it. To give an example, I had a patient that was "blowing up" (facial edma, arms and legs weeping). Everyone was looking at electrolytes and I/O, but it wasn't getting solved who ended up getting diagnosed with myxedema. I was furious that I didn't think to sit and analyze to ask for TSH (this was in my first two months of nursing btw). 8 months later I was working an extra shift on 3rd and saw a patient with similar symptoms (recurrent edema issues, facial edema, etc.) who looked puffier when I was ending the shift than when I started despite sleeping most the night and having minimal fluids. I called and got an order for TSH in addition to CMP and a few other things the doctor wanted. Turned out the patient was getting less than half the synthroid needed. Knowing you need more will help you; when you're inadequate, improve yourself. Don't know enough, learn. Not fast enough, analyze how you use your time. Not synthesizing information, stop to look for patterns. You'll never be perfect but you can be better; work to make yourself better.

Regarding emergencies and codes. Just stop. I don't mean stop having codes or stop going to codes. I mean take 10-15 seconds and ask yourself what the problem is and what it is that you need to fix the problem. It's sounds dumb. Pt with no pulse and no breathing; I need the crash cart for a mask, I need the pet to get cpr, I need more hands to help and document, etc. PT zonked out, low respirations, low vitals, etc. I need the MAR to see if narcan/romazicon, rebreather/intubate, blood sugar level, etc. "Doing something" isn't always effective; doing the right thing is effective. Stop to take a second to figure out what the right thing is.

As far as confidence goes, pretend. You will get there if you work at it in time. Until then, fake it. But like Castiela said, celebrate your wins. Even the little things; especially the little things. Learn from your losses, but celebrate your wins.

Thank you!

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Thanks everyone for your input :)

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I can give a slightly different perspective, being only a few months further ahead than you are now. I graduated last December and I've been on the floor since January. Had a six-week preceptorship at that time. I remember feeling like I'd been hit by a freight train. I remember more than once walking out of a patient's room thinking: "OMG, I need a nurse. Wait--I'm a nurse! I need a NURSIER nurse." It left me feeling a little dumb, because I couldn't figure out how I'd managed to graduate and pass the NCLEX and STILL feel so unsure. The only thing that has made the biggest difference is time. How much, exactly? I'm sure it varies from person to person. But I'd say I was a good six months in before I stopped checking with other nurses if my reason was good enough to wake the dr in the middle of the night. I have thankfully had very good, understanding coworkers who have helped to support me and not feel stupid for asking questions. I hope you have that--that's been a godsend.

The other thing I'll say is this: trust your gut. Trust your gut. Trust your gut. If something in your brain clicks and says "something isn't right here," then something isn't right! I've had to ask myself, what's the worst that can happen if I say something? Somebody might be inconvenienced and/or the pt might get unnecessary testing. But I've found that to very rarely be the case. I have brought things up, but then felt unsure immediately afterwards and thought, "Oh, gees...what if I'm wrong? They're going to think I'm so dumb." But then my suspicions are confirmed and those things have helped to build my confidence. It never hurts to at least say something.

I really love the first poster's suggestion about keeping a journal and wish I'd have thought of that for my full first year of nursing! What a cool memento to have! I suppose better late than never. I will probably start something like that myself. There have been so many cool moments that I was positive I'd never forget and now I've forgotten some of them. :-/

I also liked the second poster's suggestion to fake the confidence. I fully agree. Patients want a nurse who appears confident. Like they're in good hands. I will say that is something I've been good at--appearing calm, cool, and confident even if I'm crapping myself inside. I remember the first time a patient asked me how long I'd been a nurse and when I told them just a couple months, they didn't believe me. Patients love that. Just remind yourself how much hard work you've put in to get to where you're at. You've proven you belong there. Each day is further testament to that. Just remember all the hurdles you have overcome to get here. You've got this.

Day by day, it gets a bit easier. I can't say the bit of insecurity ever fully goes away. But I also agree with those that that little bit of fear/insecurity or whatever you want to call it helps to keep us from getting complacent and pushes us to want to do better and be better. So at least to some degree, it's not a bad thing to have around.

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