Trusting my judgment...

[trynee]

I'm frustrated. I have all this knowledge and so little real-life experience that when I see/feel/hear what I learned about I can't help but question the validity of my instincts! I assessed my pt at the start of my shift and felt a pulsating mass in his abdomen just left of midline. My brain promptly screamed at me "Aneurysm!" Then just as promptly, it screamed back at itself, "No way. You're just jumping at shadows."

I combed the chart to try and find some suggestion that someone, somewhere had observed this finding in my pt before. I tried to pull info from his history to help clear this up in my own mind. He had several risk factors, but there was NOTHING suggesting he'd had an aneurysm dx'd in the past. After my research failed to convince me that I was onto something, I went to my supervisor and asked her for help. I don't usually feel embarrassed asking for clarification or assistance on things I'm not 100% sure about. I'd rather be safe and competent than anything! But this time I was embarrassed at the idea that the new grad nurse (I'm 10 months since graduation) thinks she found something serious (when what I wondered was if he was just so thin that it was possibly NATURAL for me to be able to observe his aorta pulsating).

My supervisor didn't make any remark about my failure of confidence and she didn't suggest I was overreacting. She palpated the very same thing I did, and instantly began searching for confirmation that this man had a AAA. The other nurses I work with have never belittled me for being unsure of policies or procedures. I LOVE my job. But I'm wondering how long I have to be doing it before I actually will start feeling like I know what the hell I'm doing. On the one hand, I am frequently told I'm a good nurse. On the other, I constantly find myself in situations where I have to improvise in order to accomplish expected care. It wasn't my supervisor who made me feel like my nursing instincts were silly. It was me.

There has to be a balance between hubris and insecurity. A "middle of the road" where I am smart enough to know what I'm doing, and smart enough still to know what I don't know....and still function in my job. How did you deal with learning to trust your instincts when you were a new nurse?

[NotReady4PrimeTime, RN]

I was exactly the same way when I first started out. I was working with premature babies and there were many times that I'd hear in report that there was no murmur. (Prems are at high risk for patent ductus arteriosus and patent foramen ovale, both of which have characteristic murmurs.) I'd assess the baby and oh... what was that? I thought there was no murmur. Sure sounds like a murmur to me! I'd go back through the nurses' notes and not find any mention of a murmur. I'd look at the physician notes and not find any mention of a murmur. I'd report it to the charge nurse, s/he'd come and listen and the next thing I knew, the baby was having an echo. Some of my coworkers would smile and tell me that I was just making work for myself.

With each such occurrence, you'll find that you're not questioning your judgment as often and that you're trusting your knowledge and instincts more. There's no timeline for that. There are times now, 19 years later, when I still wonder if I'm on the right track. I approach coworkers who have more experience than I do and say, "Okay, I'm taking a poll. This is what I'm seeing and this is what I want to do about it. Is that what you would do?" Sometimes they offer me other options and sometimes they agree with me. We're a team. We all want the same thing. And experience is the best teacher.

[HouTx, BSN, MSN, EdD]

Hey, you had me at "hubris"..... I react very well to anyone with an above-average vocabulary.

Seriously, you seem to understand exactly what is happening. You're learning to apply the knowledge you gained as a student. This is what happens in your initial transition from student to practitioner. It's all good. It also appears that you have an excellent, very supportive supervisor - KUDOS to him/her. Be sure to let your supervisor know how much you value this support and guidance.

How did it turn out? Did the patient have an AAA?