Nenners

I graduated in Dec 08 and have been working since then on a very busy 60 bed Cardiac Tele unit. Initially out of school I had the expected insecurities, but had been feeling more and more confident in the last few months. Over the last month or so I have been becoming increasingly insecure in my abilities and knowledge. Nothing has happened that brought this about. I just don't feel that I know when a patient's change in condition or vitals is serious, and when it is no big deal. I'm scared every shift that I'm going to miss something or underreact to some detail. The unit I work on is fantastic. The nurses are very supportive of each other and I can always bounce things off of them. However, we also act as a step down unit as our ICU and AMCU are generally full and we get patients who need a higher level of care (such as my recent 70/30 B/P on dopamine gtts). I don't know if my new insecurities are coming about as a I'm growing from more of a task based nurse to a role based nurse, or if I have just been out of school long enough that I feel that my knowledge is fading. Did/does anyone else feel this way? Any tips? Thanks! Jen