How to Become a Confident Nurse

Throughout my nursing journey, people have always asked me how I remained composed, calm and confident. I attended an accelerated bachelors of science nursing program (ABSN). This means four years of knowledge crammed into about 2 and a half years in a quarterly school system. Every week we had to juggle between work, school exams, clinicals and our personal lives. I can honestly say that I never quite debilitating anxiety and stress. I've pondered on this idea for the longest time why that is. When nursing students ask me how I did it, I would ask them how they felt. I tend to get the same answers. They fear failing an exam, not feeling smart enough, or that maybe nursing isn't for them. It seemed that many fear feeling incompetant.

Being human, we want so much validation. In our love lives, we try to communicate our love languages. In our professional lives, we feel validated with raises, employee appreciation awards and performance reviews. In our nursing education - it comes from our test scores, recommendation letters, and words of affirmation. Now I can't sit here and say that I know how to rid of your anxieties and make you a confident person. However, I often see the same advice being thrown around to be kind to yourself, practice that skill 100 times, ask questions and that confidence will come with time.

Easier said than done. Where can I practice 100 real IVs? Yes, we all know we should be nice to ourselves. How do I know what questions to ask if I don't even know what I don't know? Of course it'll get better, but what can we do to feel less scared as we get there?

This blog post is going to cover additional skills you may incorporate into your practice to become more confident.

Let's define what exactly is confidence. A quick google search will display some definitions from Oxford dictionary.

Noun

1. "the feeling or belief that one can rely on someone or something; firm trust." 2. "the state of feeling certain about the truth of something." 3. "a feeling of self-assurance arising from one's appreciation of one's own abilities or qualities."

Despite these all being a noun, they're all used in somewhat different contexts aren't they? I imagine many nurses want number 3 by definition. The key-word being self-assurance and appreciation of your own abilities and qualities. I want you to remember that.

I've come across so many nursing students and I'm guilty of this myself - sometimes taking an exam and having my mind completely go blank. Students study so intensely to the point that their anxieties get the best of them in the middle of an examination. For some, it is a cycle of studying harder to not blank out, knowing the subject on the back of their hand just for anxiety to overcome them again at the desk. It's like a self-fulfilling prophecy. This student does not feel confident despite knowing exactly what they need to know for the exam. They are confident in their knowledge, but not in their capability to follow through with the task. Then...they fail an exam.. which only reinforces their self-doubt. Let's address that. I am currently reading a book which has really redefined confidence for me and completely encapsulates how I marched through nursing school. I recommend giving his book a read as I'll only cover some bullet points here.

Dr. Nate Zinsser, author of the "The Confident Mind" is a performance psychology expert. He is the director of the Performance Psychology Program at the United States Military Academy at West Point. He defines confidence as so,

"A sense of certainty - that feeling of having complete faith . . . . about your ability - That you can do something or that you know something . . . which allows you to bypass conscious thought - so well that you don't have to think about it. . . and execute unconsciously - so that you perform it automatically and instinctively."

In short, it is that feeling that you can do or know something so well - you don't have to think about how to do it as you're doing it. Remove that misconception that some people are innately more confident. Confidence is like a muscle, it is learned and adopted behavior. In our everyday lives, we display this confidence even if it's not reflected across all parts of our lives. Whether that is tying your shoes or brushing your teeth. Your goal here then as a nurse or nursing student is to exercise that muscle. Here are some tips you may incorporate so that you can execute nursing unconsciously, automatically and instinctively. With these tools, I hope you will soon enjoy the fruits of your labor - self assurance and appreciation for your own abilities and qualities.

1. Thought Stopping

When you find yourself having negative beliefs or thoughts about yourself. Stop engaging in them and immediately take a step back. Breathe. Mental healthcare professionals will tell you to yell "stop" out loud. But if you're like me who doesn't want to get caught out in public yelling or talking out loud to themselves, then simply redirect yourself back. Do not allow yourself to engage in self-deprecating thoughts. Take a moment to breathe and focus on the present moment. This leads to my next action.

2. Reframing Thoughts

When having any self-doubts, reframe that idea to one that is of a "growth" mindset. American psychologist Carol Dweck covers more of this in her personal research. But it's important to reframe our negative thoughts into positive and constructive ones to which we can use as a vehicle to our growth - such as our nursing practice and self-confidence. Negative thoughts can limit your potential to perform your best as with the case of my earlier test-taking example. There is so much power from stating "I can't blah blah blah" to "I can't yet". Here are some examples on how reframing thoughts can look:

"I don't think I can get this IV down. . . I'm going to fail" ---> "I will give myself two tries. My nurse will observe me, I'll improve with my next patient for sure!"

"I'm scared for my next exam.. I'm a terrible test taker!" ----> "I'll break up study sessions throughout the week and follow up with my professor on questions I missed. Then I'll definitely get those right on the final!"

"I am not ready for my clinical, I hear the professor is hard! I don't know anything.." ---> "Okay, I'm going to talk to the professor and see how I should prepare for my clinicals".

" Every hospital is different, I don't know all the policies oh my god.. I'm gonna do something wrong!" --> "There is a lot of policies I don't know, but I'll ask the charge nurse where I can find it."

Notice that with each of these examples, reframing the thought allows for a plan of action to build that confidence. By reframing your thoughts, you are also leaving a door to opportunity.

3. Mental Exercises

You accomplished and mastered so many tasks in your everyday life without much thought. Without actively thinking on that, you can forget that you are a very accomplished person! Think back to some accomplishments in your life. Whether it is hitting that PR in the gym, that first A on a nursing school exam, baking a successful chocolate chip cookie, or brushing your teeth after having a long depressive episode. Think about 5-10 wins that you experienced in nursing school. Remember that feeling. Mentally add that to your nursing confidence checking account. That is 100% going towards your practice as a nurse!

Being mindful of your everyday accomplishments help you stay in the present moment. I love to debrief with myself after every clinical, exam, work-day and regular day. It is important to have reflections to acknowledge the growth you had! Dr. Zinsser happens to cover this in his book. Note down

1. Where did you put in quality effort?

2. What small success did you achieve?

3. Where do you seem to be making progress?

If you can't think of any - replay the exercise again! Or even ask your professor/preceptor/manager - they are watching you too.

4. Remember, Confidence is an On-Going Work of Progress

You are never going to be 100% confident in your entire practice as a healthcare professional. Nursing is a life-long career of learning after all. Being a confident nurse is a practice you consistently commit to doing over the entire length of your career. It starts as early as entering nursing school! You are building that confidence unconsciously with every task, shift, clinical experiences, etc. Nursing in your career is not only about performing patient-care skills/hard skills, but it is about creating these soft-skills to thrive in both your academic and work environment. Now you have tools to make it more conscious task. Be kind to yourself and I hope these skills can help you in that journey.