Still feeling slow and incompetent

[amzyRN]

I have always had an interest in the ED as a specialty. It was always what I dreamed of doing as a nurse. The variety, the fast pace, the impact I could have on many patients. There are many other things I am missing that I love about the ED.

I finally reached my goal, after three and a half years of tele/step down and some med surg, I made the transition. My first ED job lasted about 6 months and due to safety issues, the need to make more money to support my family and a long commute, I got a job at a really good hospital.

The reason I am concerned and feeling kind of down, like maybe I need to work on my skills is that I had my preceptor pass me off on someone else. He said I needed someone with more experience to show me the ropes and didn't tell me I was doing anything wrong, but that they didn't feel comfortable, so I got a different preceptor. She is so nice and patient, but did say that I would speed up with time, implying that I was slow. No one has directly stated that I was doing poorly, but I worry that they are trying not to hurt my feelings.

My manager asked me in a casual conversation if I was still working my old job, which I though, was weird. Part of me feels like I am doing well, my priority setting is good. The charting system is totally different from my last job, more extensive and I don't wiz through it like I am used to, nevertheless I am a good nurse with good critical thinking skills.

I want to know if I am really cut out for this, though I really enjoy the challenge, I don't want to do something that I suck at. A line and lab and meds takes me about 7 to 10 minutes because I am pretty messy with the blood draw still. I also talk with patients a little too much I think because it's hard for me to get out of the room. I also try to go over the dc instructions, enough so they understand the basics.

I want to be able to connect with my patient, even just a little because I know they are scared and I think knowing that I really care helps them. I don't want to forgo that part and I think I can include that in my practice. I want to do well at work and not worry that I will be fired though or feel like people are not telling me how they really feel about my performance.

Is my somewhat perfectionist attitude, or somewhat lower self-esteem getting the better of me or am I just not cut out for the ED? I was a strong nurse on in tele and on the floor and I want to excell in the ED. What should I do?

[CCU BSN RN]

How long have you been in your current job? Is it a new hospital system for you? (i.e. do you know the doctors, general phone numbers, policies, or are you having to learn a new set of those from scratch) Are you still on orientation?

What are the things that made you want to work in the ED over the floor?

I get that you're feeling slow, but can you elaborate on what is making you feel incompetent? Traumas? Codes? IV starts? Placing NGTs?

[Lev, MSN, RN, NP]

A couple things stuck out at me. I too am a floor nurse nurse who transitioned to the ED. It wasn't easy. However, I finally know what I'm doing. (I think).

It is important to ask for for feedback so you know what people are thinking. You are lucky that you got a new preceptor who hopefully is more experienced who can help you progress. I think you may be thinking too deeply into what she said "you will speed up with time." You will keep speeding up with time, far off orientation. Still, ask her for feedback every shift.

I think it is weird that your manager asked if you are still working your old job...Are you? Maybe she was wondering if you are working hours on top of your current hours...or maybe she wants to know if you have a job to fall back on in case you don't pass orientation...I don't know. I hope it's not the latter but I would be freaking out at this. But maybe I'm thinking too deeply into this...

You should be trying to delegate your line and labs instead of trying to do it yourself. You will have plenty of opportunities to do IVs.

The not spending too much time with patients is also hard to get used to. At this point I would try to avoid all unnecessary conversation with patients. Talk to them while treating about what brought them in them but don't ask open ended questions about things unrelated to their ED visit. If they keep talking, gradually back up to the door and say "I really need to check on my other patients now but I will be back to check on you later." Regarding d/c instructions - just go over the main teaching points and instruct them to read the discharge papers for more info.

Once you get quicker you will be able to engage with your patients and speak with them more. When patients sense your confidence they feel more comfortable. It's not only about spending time with them and speaking with them. This confidence will come with time.

One thing about the ED is that there is no room for perfection. There is a strong quality product, but there are bloody sheets and undressed wounds. But the patient is safe. They may not be happy, but they're alive and safe.

[amzyRN]

I'm done with orientation now, so I will see how I do on my own. I like the idea of delegating as much as possible. I will try to make use of my resources. It's mainly getting used to the charting system, the one I used at my old job was more simplistic and at my new job they do a lot of chart audits, so I worry about missing something. My preceptor told me I was doing fine, didn't say my work was perfect but that "there were no red flags".

I know I have the critical thinking skills of an ED nurse from my last ED job which was which was my first ED experience. I did well there actually. The turn around is faster at this new place because they have more providers. I just don't want to appear slow and incompetent due to lack of confidence.

Thank you for all of your feedback. It is very helpful.

[Sarama]

I feel the same way sometimes. I started in the ER about three months ago as a new grad with no prior experience. There are two other new grads that started a few months before me and I can't help but compare myself to them. I feel like I'm so much slower and not as competent, but I don't know if it's my perfectionist attitude as well. My preceptor is awesome and tells me I'm doing a good job, but I feel like I'm constantly asking the same questions over and over and get paranoid that other nurses think I'm incompetent.

I've spoken to some friends and some experienced nurses who gave me pretty good advice: don't compare myself to others, that it might takes years until you feel confident and find your groove, and that it's better to ask the same question 10 times in a row than to do something that can harm someone. Overall, you're not alone in how you feel. I think we just need to be patient with ourselves.