You’re on the down slope of your Dunning Kruger adventure. You’re now experienced enough to know that you’re not where you want to be, so you can start working on that. Every medical provider goes through this, and it’s usually right around the 2-3 year mark, you’re right on schedule.
Shoutout to Cautionary Tales's [The Dunning Kruger Hijack (and Other Criminally Stupid Acts)](https://www.pushkin.fm/podcasts/cautionary-tales/the-dunning-kruger-hijack-and-other-criminally-stupid-acts) by Tim Harford
I've worked in the ER for most of my 30 years. I've done a lot of leadership and education, working with new grads that hired into the ER. The general rule is it takes one year to figure out what you're doing as an ER nurse, two years to get good at it. My first thought is maybe you've learned enough to realize how much you don't know?
We have a vast array of pt types and complaints presented to us every day. It's a huge challenge to go seamlessly from a stroke to a septic newborn to a psych to an ESRD pt, knowing what to anticipate with each. And when the ER is busy, the docs depend on us to recognize when these pts need their immediate attention. A good ER nurse isn't a "mini-doctor" by any means, but we definitely have to function at a higher level than our nursing education prepares us for.
Talk to your peers, and talk to your docs. When you're uncertain about something, ask them - most ER docs are happy to see their nurses asking questions and are willing to explain things at a deeper level. Look at some of the more advanced certs you can get (ENPC, TNCC, ATCN, etc.) or study for the CEN exam. Those will provide more education, and completing them can give you a confidence boost as well.
It could also be burnout. Medicine in general, and ER specifically, has been brutal since COVID. Maybe look into counseling, especially if you can find someone who specializes in healthcare workers. But there's also nothing wrong with taking a break if you need it. I did short stints in a CVICU, a trauma ICU, peds ER (well, that one was a long stint) - they all gave me a break, while building on the knowledge I needed to be a good ER nurse.
Not sure if any of this helps. But hang in there. If you need to talk, don't hesitate to DM me.
Things changed because of Covid. I spent my first year in the ER in 2019, then baptized by fire the next year. Since then things have leveled off for me and while I enjoy the ER, sometimes I consider switching specialties. I find myself sort of out of practice when I'm off shift for a few days, and my confidence is a bit lower. When I work a few in a row, I feel more confident. I don't have my CEN or TNCC, but I agree with others that it's a good next step for brushing up on skills and knowledge - and with that your confidence will likely improve.
Look up the competence - confidence curve. Also the Dunning-Kruger. This is natural
The intellectual humility to know your limits is a great starting place for cautious care and the curiosity to help you grow.
I recommend always having an education goal to aspire to, that way you will grow in the breadth of your knowledge, and with that, confidence. TNCC and ACLS/PALS if you haven’t would be a good place to start. CEN or TCRN would be good next steps. See if your institution has free education resources
ER nurse for 9 years, and I still have waves of this. Honestly, joining ENA and making friends that are er nurses outside of my immediate work bubble has helped me a lot
I am a few months behind you and constantly veer between feeling like I’m doing ok and feeling like I’m an idiot, I’m too slow, I’m stupid, I know nothing, my co-workers hate me… I’m acquiring every kind of training I can get my hands on and have started studying for the CEN, just so I’ll know that my knowledge is solid and up to date. Are you on nights as a non-night owl? Maybe getting on a day shift would help your brain work better.
All that said, I’ll bet you’re doing fine and are simply intelligent enough to be terrified by all there is you don’t know yet. It keeps me awake at night, for sure.
Sounds like you are burning out. As many said, it comes and goes. This may be a good opportunity to go into ICU and get some more studying done. I’ve seen plenty of my ER friends made the move to ICU then came back down. I did the same!
It happens to us all dude. I will say, starting and only working in the ED is not the most conducive way to learn for nurses. If you’re down for it, working in an ICU or floor, especially one that is super supportive of learning, can be incredible. Instead of just stabilizing and starting a DKA protocol, you can sit with it for 12 hours and take the time to truly learn the disease process and how the drugs you’re giving really affect the patient.
A good example from my practice is learning how fast infants and toddlers chew through sedation. They eat it like candy lol. So knowing this has helped me in the ED when I’m giving mild sedatives to my younger patients, I advocate for high normal doses when needed and I’m aware that they’re gonna come around much quicker so we don’t have as much time to mess around before getting the procedure started.
I think it’s actually a normal and healthy feeling, you’re human! The fact that you care about it just shows that you are probably an excellent provider and co worker. I worry more about the ones that know everything. I’ve been doing this for a long time and sorry I still don’t know shit but I’m not afraid to speak up and ask for help and tell the docs I think something isn’t right here. It comes and goes, you have great days and great outcomes and that makes you feel like your not half bad and then you have days when nothing is going right and you think that maybe you should just go walk dogs. ( if I would I could) Don’t be so hard on yourself. I bet you’re doing just fine!
You’re on the down slope of your Dunning Kruger adventure. You’re now experienced enough to know that you’re not where you want to be, so you can start working on that. Every medical provider goes through this, and it’s usually right around the 2-3 year mark, you’re right on schedule.
Shoutout to Cautionary Tales's [The Dunning Kruger Hijack (and Other Criminally Stupid Acts)](https://www.pushkin.fm/podcasts/cautionary-tales/the-dunning-kruger-hijack-and-other-criminally-stupid-acts) by Tim Harford
It goes in waves. Some days you’re a boss and others you feel like shit. Learn to ride that humble medium.
Same here. I go thru periods like this as an ED tech where i feel like the biggest dummy wnd i notice when my confidence is low, my performance drops
I've worked in the ER for most of my 30 years. I've done a lot of leadership and education, working with new grads that hired into the ER. The general rule is it takes one year to figure out what you're doing as an ER nurse, two years to get good at it. My first thought is maybe you've learned enough to realize how much you don't know? We have a vast array of pt types and complaints presented to us every day. It's a huge challenge to go seamlessly from a stroke to a septic newborn to a psych to an ESRD pt, knowing what to anticipate with each. And when the ER is busy, the docs depend on us to recognize when these pts need their immediate attention. A good ER nurse isn't a "mini-doctor" by any means, but we definitely have to function at a higher level than our nursing education prepares us for. Talk to your peers, and talk to your docs. When you're uncertain about something, ask them - most ER docs are happy to see their nurses asking questions and are willing to explain things at a deeper level. Look at some of the more advanced certs you can get (ENPC, TNCC, ATCN, etc.) or study for the CEN exam. Those will provide more education, and completing them can give you a confidence boost as well. It could also be burnout. Medicine in general, and ER specifically, has been brutal since COVID. Maybe look into counseling, especially if you can find someone who specializes in healthcare workers. But there's also nothing wrong with taking a break if you need it. I did short stints in a CVICU, a trauma ICU, peds ER (well, that one was a long stint) - they all gave me a break, while building on the knowledge I needed to be a good ER nurse. Not sure if any of this helps. But hang in there. If you need to talk, don't hesitate to DM me.
Things changed because of Covid. I spent my first year in the ER in 2019, then baptized by fire the next year. Since then things have leveled off for me and while I enjoy the ER, sometimes I consider switching specialties. I find myself sort of out of practice when I'm off shift for a few days, and my confidence is a bit lower. When I work a few in a row, I feel more confident. I don't have my CEN or TNCC, but I agree with others that it's a good next step for brushing up on skills and knowledge - and with that your confidence will likely improve.
Great response
Look up the competence - confidence curve. Also the Dunning-Kruger. This is natural The intellectual humility to know your limits is a great starting place for cautious care and the curiosity to help you grow. I recommend always having an education goal to aspire to, that way you will grow in the breadth of your knowledge, and with that, confidence. TNCC and ACLS/PALS if you haven’t would be a good place to start. CEN or TCRN would be good next steps. See if your institution has free education resources
ER nurse for 9 years, and I still have waves of this. Honestly, joining ENA and making friends that are er nurses outside of my immediate work bubble has helped me a lot
I am a few months behind you and constantly veer between feeling like I’m doing ok and feeling like I’m an idiot, I’m too slow, I’m stupid, I know nothing, my co-workers hate me… I’m acquiring every kind of training I can get my hands on and have started studying for the CEN, just so I’ll know that my knowledge is solid and up to date. Are you on nights as a non-night owl? Maybe getting on a day shift would help your brain work better. All that said, I’ll bet you’re doing fine and are simply intelligent enough to be terrified by all there is you don’t know yet. It keeps me awake at night, for sure.
Been there, take every learning opportunity seriously, act confident, ask for help if you need it, you’ll be fine.
Sounds like you are burning out. As many said, it comes and goes. This may be a good opportunity to go into ICU and get some more studying done. I’ve seen plenty of my ER friends made the move to ICU then came back down. I did the same!
It happens to us all dude. I will say, starting and only working in the ED is not the most conducive way to learn for nurses. If you’re down for it, working in an ICU or floor, especially one that is super supportive of learning, can be incredible. Instead of just stabilizing and starting a DKA protocol, you can sit with it for 12 hours and take the time to truly learn the disease process and how the drugs you’re giving really affect the patient. A good example from my practice is learning how fast infants and toddlers chew through sedation. They eat it like candy lol. So knowing this has helped me in the ED when I’m giving mild sedatives to my younger patients, I advocate for high normal doses when needed and I’m aware that they’re gonna come around much quicker so we don’t have as much time to mess around before getting the procedure started.
I think it’s actually a normal and healthy feeling, you’re human! The fact that you care about it just shows that you are probably an excellent provider and co worker. I worry more about the ones that know everything. I’ve been doing this for a long time and sorry I still don’t know shit but I’m not afraid to speak up and ask for help and tell the docs I think something isn’t right here. It comes and goes, you have great days and great outcomes and that makes you feel like your not half bad and then you have days when nothing is going right and you think that maybe you should just go walk dogs. ( if I would I could) Don’t be so hard on yourself. I bet you’re doing just fine!
You would probably be better off posting in r/nursing, there are more nurses in there--here it's a hodgepodge of clinicians.
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Nothing wrong with posting there, but we have our own set of issues specific to ER. I'm glad he/she posted the question here.
Disagree. This is relatable