Confidence v. Competence

Confidence: A feeling of self-assurance arising from one’s own appreciation of one’s own abilities or qualities. Competence: The ability to do something successfully or efficiently.

One can have either of those, without having the other. I’ve seen high levels of confidence accompany a mediocre performance. I’ve also seen experts who still harbor self- doubts. Generally speaking; however, it’s expected that increased competence leads to increased confidence. That’s the theory, anyway.

As a new nurse, my confidence in my ability to perform skills competently is somewhat . . . . shall I say, lacking? It’s not non-existent, but it’s certainly shaky. I question myself almost constantly, because I’m worried about the potential of making a mistake. I even hesitate when performing skills that I’m fairly comfortable with – like taking medications out of the system, reconstituting antibiotics, and documenting things on the computer.

I may be competent at those things, but confidence hasn’t come along, yet.

Other things, that I feel less comfortable doing or have only done with the supervision of my preceptor, are enough to make me doubt my decision to become a nurse. Those same things, once done, also make me feel positively elated.

My last two shifts were very good ones, all things considered. I got to try some new skills and I succeeded at some others without help for the first time. I hung an IV antibiotic entirely on my own. I called a doctor’s office to pass on a patient’s request. I gave report on my two patients at the end of the day and the oncoming nurse didn’t have to hunt me down for additional information. My preceptor guided me through de-accessing a port, drawing blood from a PICC line, and documenting the phone call to the doctor’s office.

I did well enough that she’s declared that I’ll have three patients during my next shift, which happens to be tomorrow. I only had two for a total of three days. That’s a good thing, because I’ve only got another seven weeks of orientation to go through before I’ll be expected to be able to handle six patients more or less on my own.

I say more or less, because even the nurses who have been on the floor for months or years still ask each other and even more experienced nurses for help. During one shift, I saw a nurse ask another whether or not it was appropriate to give a patient all three blood pressure meds that were ordered. On another, I saw two nurses reach out to a third for help starting an IV that they didn’t feel comfortable trying. Another day, a nurse on the floor asked for help starting a Foley catheter, because it’d been months since her last and she was worried that she didn’t remember all the steps.

The patient that needed blood drawn from her PICC line was also the patient I hung the IV antibiotic for. The blood draw came first and my preceptor talked me through it. I have to admit that it wasn’t as difficult as I’d imagined it would be. The steps are fairly simple, really, and I could write them out now just from memory. Hanging the IV antibiotic was actually harder for me, because I’m intimidated by the pumps and the tubing. It doesn’t feel simple to me, for some reason. Yet, it’s essential that I figure out how to work the pumps competently.

After I did get it hung and her connected and was cleaning up my mess from the process (alcohol wipes, tubing wrappers, and empty flushes), she said, “You know, you did that quite well. You’ll be a very good nurse, once your confidence goes up. You know how to do the things, you just need that confidence in yourself.”

I thanked her, sincerely, and told her I’d be back to check on her in a while. She’d been a nurse for thirty years (half of that time spent in Ireland, where she’s from) and we’d been having micro-conversations throughout the shift. She’s a fan of medical texts, wants her master’s degree in alternative medicine, and likes cats.

She thinks that, one day, I’ll be just as good a nurse as any other.

I hope she’s right. I really, really do. I’d hate to disappoint.

Words, of course, can have multiple meanings. Context and intent are important. Another definition of confidence is actually, the feeling or belief that one can rely upon something; firm trust. It’s similar to the other definition, but somehow strikes a stronger chord in me. I don’t merely want confidence insofar as it means to feel self-assured . . . I want it insofar as I want to feel that I can trust myself, rely upon myself.

Of course, trust takes time to build between people. Why should I think that it won’t take time to build with myself? I’ve already come a long way.

I haven’t been brought to tears by anything that’s happened at the hospital. I’ve learned a ton and I’m still learning a ton. I’ve made a few small “mistakes” – quotes, because my preceptor says they’re not actually mistakes – but I keep trying and am getting better.

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