When do you stop feeling dumb and feel like a confident Nurse??

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I'm two weeks off of a 3 week orientation. First job in LTC. I LOVE the job, the facility and residents.

I have alot of support from DON and other Nurses, there is always a RN supervisor on if I have questions. I am always working with another nurse (usually a LPN with alot of experience)

The CNAs will come to me when they find something with a resident, and sometimes I'm not even sure what the right thing is to do, I have been calling the RN supervisor with my questions, but when will I feel confindent to make the decisions, how do you know what to do without the experience behind you.

for example: walking by a resident, hear her coughing sounds really congested, I took her vitals, listened to her lung sounds (which I'm still not good at) she sounded course but cleared with coughing, she had no temp... but I wasn't sure If I should give her something, call the doctor, just keep monitoring her....

another resident (has MS bedbound) refused all his bowel medication, later that night asked for kaopectate. He is on alot of narcotics, he didn't have a order for it. So technically I couldn't give it anyway, but the lpn med nurse wasn't comfortable giving it with all the meds he was on, I didn't think this would have any reaction... called the RN supervisor AGAIN, she said don't give it without the order anyway....

Another CNA called me in the room found a small amount of blood coming from resident foley. There was not blood in the bag, bleeding stopped.. I assumed he probably yanked on the foley. I told her to call me in when the did rounds later and I would assess again, but I'm never sure what to do. ( it wasnt bleeding, made a note in the nurses note for the next shift)

When will I feel confindent to make these decisions and know what to do. I neve worked in healthcare and havent been around alot of situations.

I want to be the best confident nurse I can be. Is there anything else I can do? More classes, books...ect

Thanks,

Bea

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Specializes in Cardiac.

Sounds like you're doing a great job! Confidence comes with time and experience! Keep up the good work!

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

After nearly six years as a bedside nurse, I still sometimes feel like the dumb novice who lacks confidence. People do not become experts overnight. Don't worry! You are a continual work in progress. :)

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Specializes in Psychiatry, ICU, ER.

I didn't notice that this was in the geriatric nurses section until after I wrote this, but maybe you will find this applicable to you.

I had a 3 month orientation in ICU, didn't feel "confident" till about 6 months, and (looking back on it) I was confident but still occasionally dangerous until about 9 months. And over 2 years later, I learn new things every day!

I think your concern is not so much confidence as competence. Continue to study your patho and labs, especially for cardiac, respiratory, renal, neuro, and the most common diagnoses you see. Identify your problem areas. When you have incidents, step back for a minute and think about what is going on with the patient (e.g. if a patient has a small amount of bleeding, are they on anticoagulants for afib or dvt that would heighten your concern?)

Trust that you will get to the point that you won't to call the doctor every time something happens; and if a situation is not potentially life-threatening, use your supervisor or another RN as another set of eyes if you're really worried about something. A-B-Cs and patient safety are always your priority, whether you're in LTC or ICU or psych! If you feel the need to call the doctor, even if it he tells you it's nothing to worry about, just remember you're dealing with lives and it's better to be safe than sorry.

You're new, you can't be expected to have the answers all the time. Don't beat yourself up. Confidence will come with experience, every patient is potentially a learning experience for every nurse. This is even more true when you don't have much clinical experience.

Hang in there!

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Specializes in psychiatry, community health, wellness.

I think it sounds like you are doing a great job. Asking for help when you are not 100% sure is always the best idea. I always told people; if I do not know the answer I am going to find it out by asking someone who does. People want you to do what is right and what is best. Just be honest that you have to ask for help and with time you will see that you are asking less and less help because you will know what to do in your heart and in your gut. Trust your intuition and you will do great. Keep up the good work! I am proud of you!!

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Sounds like your doing a fine job. Alot of nursing is observation and you seem to have that.

1 - monitor the congestion, if it goes on for 1-2 more days, fax the MD with your concerns - mabye a sputem sample? MD may want Atropine started to clear up the secreations, still first step is to monitor.

2 - Where i work, this is the residents home, and they have rules we must follow. Residents have the right to refuse medications. You as a nurse must try to help them understand why they need it, if they still dont want to take it, its within their right. A res asking for a medication that they are not prescribed by an MD - thats impossible, you can lose your lisence for that. Fax the MD with the residents concerns, let them decide.

3 - Blood outsdie the cathater is probly from them tugging on it, so you are correct there. Monitor again, if they have urinary retention there may be a blockage, in that case im sure you are able to irrigate the cathater (im an LPN and it is within my scope) If that did not work I would then check to see if this person has an order for a cathater, generaly if its in them and you need to put in another, you can go ahead. You can ask your RN what they think, or just let them know what you found and what you did after.

Thoes are just the things I as a nurse would do, and as time goes on you will become more indipendant in your judgment calls. You honestly sound like your doing fine! keep up the good work!

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Thank you all so much for the advice and encouragement, I really appreciate it. Please keep it coming :)

Sometimes even the simple common sense stuff just needs to be reinforced. I just want to always be aware and alert of the common things I should know/do with my job in LTC. I really care about these "oldies" and think they deserve the best care.

I can't wait untill I'm in the position to give new nurses advice/guidance... I know, I know... it takes time, (and time I got!)

Thank you all. If anyone thinks of anything else important I should keep up on/ read up on...ect, please advice. I want to learn all I can.

Bea

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You are doing great,

Confidence comes in time...

I've been a nurse for 2 1/2 yrs now and I still question myself often.

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Thank you all so much for the advice and encouragement, I really appreciate it. Please keep it coming :)

Sometimes even the simple common sense stuff just needs to be reinforced. I just want to always be aware and alert of the common things I should know/do with my job in LTC. I really care about these "oldies" and think they deserve the best care.

I can't wait untill I'm in the position to give new nurses advice/guidance... I know, I know... it takes time, (and time I got!)

Thank you all. If anyone thinks of anything else important I should keep up on/ read up on...ect, please advice. I want to learn all I can.

Bea

It sounds like you are doing things correctly. My advice would be to continue to ask questions. Each nurse has a different way of doing things and a different way of thinking. I LOVE to pick the brains of nursing more experienced than I am. You find what you like, and what you dont like and eventually develop your nursing style that works for you.

In LTC you will gain a lot of experience. My recommendation to you when you get advice from a nurse is to ask WHY they do it that way. Sometimes it helps your brain to function better when you know why you are doing something. In the case of that cough/congestion, do not give a medication without an order, period. You cant make differences in lives as a nurse if you lose your license for something silly like playing doctor. CYA. However, if you feel like your patient needs something not ordered, it is your job as their advocate to push until you are comfortable with the answer.

Documentation is key in LTC. Sounds to me like you are doing great. Dont be afraid to ask questions, and dont feel stupid for doing so!!! We all do it.

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Nursing is a FOREVER LEARNING profession. It sounds like you have a lot of GREAT support. Unfortunately, we are not all that lucky. I got hired at a SNF and it was a living nightmare. The nurses gave part of morning report in Tagolog( I am not Filipino), I was "trained" by several LVN's over a period of 3 weeks and was asked to perform in the capacity of a nurse in that time span (I am a BSN carrying RN), because I was slow, and rechecking my meds and procedures,I was told that I have no confidence and need to work in a small clinic, witnessed a lot of neglect and wrongness, and was told that "When "state" comes, we do this, but when they leave, we do this." WAH??? WHAT??? I could go on for a while, yet, I feel that you get the point. It was horrible. Good luck to you!!! Support, effective training, and special attention to patient care is essential during this time...

LotusRN1972

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It takes time but it sounds like you are on the right track! Nursing means that you are forever learning and questioning what is happening...The minute that you think you know everything you become dangerous. Be confident but remember that you are a novice nurse...it takes a long time to graduate to the next step. Use your resources and keep on keeping on.

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Specializes in LTC, MDS.

One thing that helped me when I was learning was to take a list of meds I didn't know home and look them up in the drug book. Same with new diagnoses. I'm still learning everyday, too! I love nursing just for that reason :D

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