Self esteem in nursing

I'm not a bit shy and I'm only inhibited in dancing but I've always had high expectations of myself and been my worst critic. I don't think its a bad trait unless it's crippling and/or you become so self deprecating or demonstrative in your self flagellation to the point of annoyance. I've had to recognize the self absorption/egotism and curb it. (That in itself would make me feel bad) Time and experience also helps.

I have confidence issues, too.

I've been a nurse for 7 years and I still have moments where I feel insecure. I have found I thrive in environments that are not as fast paced as a hospital. You sound like a devoted nurse.

I think time and experience helps. Have you thought about talking to a counselor?

There is a really good, somewhat similar thread, under Nursing Issues Patient Safety under the heading anxiety about a mistake. It has some really good advice.

I don't know that your co-workers "are not phased." I have had many co-workers tell me "nothing bothers you". I am just very good (which isn't always a good trait to have) about hiding my feelings! I can be dying inside but "act" so cool and calm outside!

I just wanted to say that I am so proud of you. I also have extreme anxieties when it comes to being in pubic. I am also painfully shy, and I have reconsidered the possibility of going to nursing school because of that. So to read your post, and see that you have conquered your shyness in many ways, makes me happy and hopeful :)

"I'm a little OCD in my practice and if one little thing goes wrong during a shift or everything isn't perfect.........Let's just say I'm very hard on myself. I go over it in my head over and over to think what I could have done better or different. Similar situations could happen to my coworkers and they don't even seem phased."

If the need for perfection is interfering with your ability to get the work done, causing you discomfort, taking up more time than you'd like (at work or outside of work), I'd suggest talking to a therapist. Short-term CBT has been helpful for many people, especially when they have a clear-cut objective, like you do. In many cases, just 3-4 sessions help build a tool-box of skills that you can use to get a handle on the performance anxiety and manage any intrusive thoughts after "non perfect" events.

The best thing is this: you recognize that you're not comfortable with these thoughts, and you want to do something about it. That means you're half-way there.

Nursing itself NEEDs a hint of "doubt"; meaning, having a questioning attitude can be healthy when it comes to questioning plan of care, bouncing off ideas and collaborating with experts in your work milieu; however, it is healthy when there is a comfortable amount of confidence when having those doubts; meaning, you are confident in what you see and hear and have the confidence to question in order to get outcomes, especially in critical care.

These things will get sharper and better over time.

I will echo others who have suggested therapy or a counselor to help with any anxiety or self-doubt you may have; once you work through those challenges, you can be the best YOU in your practice.

Best wishes.

Thank you so much for all of your replies. I'm glad I am not alone. The anxiety is not necessarily getting in the way of doing my job...but it kicks in after my shift is over and I'm going over the night in my head. My original post was prompted by an incident with a physician my assessment. (And as he later found out..My correct assessment) but his questioning immediately shut me down... Self doubt instantly creeping up on me. I am already insecure and I realize speaking up in my position is entirely necessary I still sometimes find it difficult to do... But I do it. I work on this every day. I may seek out counseling to help me with this.

My original post was prompted by an incident with a physician my assessment. (And as he later found out..My correct assessment) but his questioning immediately shut me down... Self doubt instantly creeping up on me.

I totally relate with that! This gets better over time -- and what helps it get better FASTER is to completely remove your 'self' from the proceedings. "You" are not how stupid or wrong you are, or how wonderful and right you are. It's just INFORMATION.

Your information and the doctor's information was in conflict. Nothing to do with your relative 'worth' as a nurse or a person. Everyone is wrong sometimes. It's the little thoughts that go along "I am wrong, therefore, I am stupid and worthless". No, you are just wrong. No biggie. It takes practice, those darn little voices are persistent!

If some disagrees with you, start with curiosity. "Oh, why do you think so?" instead of shame and shutting down. Even if it was said in a snotty tone, curiously pursue what was 'wrong' with professionalism and self respect. This is part of respecting everyone, no matter their 'lowly' duties, seeing all personell as having an important role to fulfill, including yourself.

I have a story: We had a heroin addict in for long term Vancomycin due to MRSA in her abscesses. She'd completed her course and was getting ready for discharge. The PICC nurse was running behind and no one on the floor was 'cleared' to DC a PICC line, so the patient was getting restless. Finally, she yanked her PICC out herself, threw it in the sink, and vaporized.

I found the bloody PICC in the sink, and notified the charge nurse. She asked in horror "Was the catheter intact?" I told her it was.

Five minutes later, the PICC line was at the nurse's station in a biohazard bag with three or four RNs standing around panicking because the catheter appeared to have 'torn' and was jagged looking. It was quite the drama rama. I looked at it again, feeling abashed and stupid for my mistake . . . and it still looked intact. The charge nurse eventually had the PICC RN come and examine it. It was intact.

People can get 'funny' when something either goes wrong or appears to. There can be a lot of drama, depending on the individuals involved. This is where you can't take it personally. Being 'right' all the time is overrated, and no one buys it anyway, no matter how hard you work to manage everyone's opinion of you

I am going through that right now. It is really stressful and it feels like everybody is criticizing my work. I am taking a week off from work to cut the steak of my self-doubt. The thing helping me to survive the shift through is to keep telling myself that those emotions are not good for me and my patients. Those emotions clouds my head and do not help my patients to get my best care they deserve. At least that moment i could push those emotions out and make it all about the patients instead of focusing me trying to be perfect. I am hoping this off week I can find my balance and return to unit as a confident nurse.

Thank you so much for all of your replies. I'm glad I am not alone. The anxiety is not necessarily getting in the way of doing my job...but it kicks in after my shift is over and I'm going over the night in my head. My original post was prompted by an incident with a physician my assessment. (And as he later found out..My correct assessment) but his questioning immediately shut me down... Self doubt instantly creeping up on me. I am already insecure and I realize speaking up in my position is entirely necessary I still sometimes find it difficult to do... But I do it. I work on this every day. I may seek out counseling to help me with this.

The bit about 'shutting down', and instantly doubting yourself and wondering if you are actually incompetent is something that experience will iron out. For instance, in this experience, you didn't need to rake yourself over the coals at all, your assessment was correct. In a nutshell, you can add a notch to your belt, your confidence in your assessment skills is VALID.

Too often new-ish nurses, or those who struggle with confidence, see things in black and white. Like, "I'm either a great nurse OR I'm a pathetic excuse for a nurse" when the truth is, we are in all the areas in between. We move between the extremes of black and white all the time, over the course of a single shift. I've caught an early symptom of sepsis and saved a patient from a stint in ICU, and another patient missed an error on the MAR. So which am I, an idiot or a skilled clinician ? Both? Or somewhere moving around in between?

You can get yourself, with some practice and deliberation, to a place where it is perfectly OK to be wrong, or make an error in judgment. You won't enjoy the sensation but the automatic response to missing a call won't be "I suck!" A person striving to be proficient is always seeking to improve and be a receptive learner. A person stuck in (pretending) to be all that and a bag of chips is not receptive to learning more. Neither is a nurse drooping in self-recrimination going to be receptive to learning new things. Both extremes are unrealistic.

So if you find yourself bouncing between extremes, there IS a problem, but not with your abilities necessarily. It is with your thinking. In cognitive science, bouncing between extremes is called 'catastrophic thinking'. It is self-defeating besides being untrue. What IS true? That sometimes you rock the stage and others you have something new to learn. You and everyone else.

Thinking in extremes is a habit. Yes it is, just not one you hear about much. Your upbringing or temperament might make you vulnerable to this habit, but habits can be broken. This one should be, for the sake of your job satisfaction. Ask me how I know, OK? I was literally plagued in my first several years. I got better evals than I expected every single time. It's like I couldn't even notice my positives for how much the negatives floored me and preoccupied me.

So when a staff or physician cries 'you did that wrong!' you can PRACTICE a new way to think about that. Really, it's a simple statement. "Wrong" is just . . . not right. "Wrong" isn't "you suck!" So you proactively ask, "What was wrong about my assessment?" in a polite-toned voice, and then you listen to why you were 'wrong'. Then, you evaluate the situation. You might need more information, or it might be obvious you WERE wrong, or the other person is wrong. Still, there's no shutting down, just staying alert and being fine with yourself. You are no paragon of nursing superiority, no one is, and no one honestly expects it.

I didn't get comfy with being wrong over night, it takes practice. It takes examining yourself, and how you talk to yourself. We all carry loads of unquestioned assumptions than can cause one person to be uber defensive when they even suspect they are being criticized. That person is thinking "If someone questions me, they must think I'm stupid." That's called mind reading. That's that person's OWN internal voice, not the person questioning them. Make sense?

It's good to be a bit on the OCD side, the anxious to not make mistakes side. This can be done without shutting down or spending your hours after work bullying yourself with negative self talk :) I've done it, mostly, there are exceptions. It's good news that it really is not 'other people' dragging you down, it's your own thoughts doing it. Then you have control, if it's just 'you'.