How can we stop feeling afraid?

Posted by:

12 December, 2011

I want to talk today about a phenomenon I have noticed in practice and it's something I am personally trying to overcome. I am in the first half of my second year and as such there is an expectation that I should know a fair bit about nursing and medical issues.

However I had a crisis of faith not too long ago. I was listening to a conversation between two nurses on a ward and it might as well have been in a foreign language. I managed to pick up the occasional word that I recognised but beyond that I was lost.

I know many people have spoken about the fear of not knowing enough and getting to the last year and panicking because the safety blanket of being a student will soon be ripped away.

But I think this doubting of self-confidence affects students before they even get to graduation.

I’ll give you an example, I was in a clinic sitting with my mentor in between patients and I was asked a relatively simple question. If I remember correctly it was to do with the direction of blood in the circulatory system. I knew the answer, but I hesitated and said I wasn’t sure.

Obviously my mentor was fine and continued to teach me but I was surprised at myself. I began seeing other examples, not only from myself but from my fellow students.

I know that we all have a desire not to look foolish in front of others and I can fully understand why you wouldn’t want to answer the question in a lecture but even when I was in the safest and most supportive environment to answer the simple question, I faulted and stumbled.

To end this story, towards the end of this placement I made a conscious effort to ignore my anxiety. I read, I asked questions and I learned as much as I could and it all culminated in one final day in clinic when I was able to contribute in a conversation between nurses. Everything seemed to fall into place when I was liberated from the uncertainty I had felt just a few weeks earlier.

We all know more than we think we do and whatever the circumstances student shouldn’t be afraid to try.

Readers' comments (11)

George Kuchanny | 13-Dec-2011 1:05 am
Hi Adam,
Your article brings into focus a very widespread problem. There is only one piece of advice I can offer. Become sure. A life may depend on you being sure. Easy to say and not very helpful advice some may think, so how to do this? If you have a poor memory, and let’s face it, medicine is not rocket science BUT there is a lot of it, I would suggest my own remedy - a very small pocket book with your own most often forgotten things written in it with a short memory jogging answer.

He bigger problem that comes to mind is that people tend to attempt get out of ‘showing themselves up’ to use a common term, by to best guessing their way forward and hoping that they are right. I would strongly advise that this is the single most dangerous thing that you can possibly do. Evenbtually you will most certainly incapacitate someone and quite possibly kill them. This quite widespread habit has to be avoided. For your own peace of mind and naturally for the wellbeing of your charges. If you do not know - ask. Just amazing how nice another nurse who really does know the answer willl be to you for doing just that.

Nursing is most certainly not about being seen as 'alpha nurse' in comparison to colleauges, it is about being competent to the best of your ability (but not beyond) and being a safe pair of hands. The urge to 'blag' your way through situations must be resisted. That is why I have a bit of a difference of opinion on your last sentence. Be afraid to try if you do not know young man! Ask and you shall be rewarded.

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Anonymous | 13-Dec-2011 5:26 pm
Well said, George! To Adam, I would say that the only stupid question is the one unasked. As George said, patients' lives are in our hands and you should never be afraid to check if you're unsure. I have gone to doctors and asked them to clarify a Kardex if I can't read it. I wouldn't risk my registration or a patient's life by dispensing a drug if I were not sure, To be fair, I've never had a doc question my judgement although who knows what they say behind my back? that doesn't matter - the patient's safety is unltimate.
Carry on with what you're doing, Adam and I'm sre you'll make a really good nurse
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Adam Roxby | 14-Dec-2011 5:11 pm
Hello everyone

I just want to take this opportunity to thank you for your comments, as always I thoroughly enjoyed reading them.
George – I fully understand and agree with what you say. I have in the past tended not to put myself in the position of looking foolish because of my inexperience and lack of knowledge. However, part of my training is to ready me for the responsibility of being a nurse. You are completely correct stand lights may depend on my ability to be decisive and correct and hopefully there is still time to make that ingrained in me. Thanks your comment.

Anonymous – thank you very much your comment, it means a lot. Also out the cause there are opportunities for students to gain confidence and to become more assertive. We have all of the time in practice as well as assess presentations to really switch up the heat. In fact my next assessment is a group presentation which will test my ability to become assertive.

Thanks once again.
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George Kuchanny | 14-Dec-2011 8:41 pm
Thanks for reading the my comment and taking it as intended Adam. I worried for a moment that it might come across as a bit hard.
One thing I forgot to say was this. As you get more and more on the job exposure your knowledge and confidence will expand. You are made of the right stuff for sure.

One day, sooner than you may now think, you will point out a concern (without a sneer or arrogance naturally) when a junior doctor prescribes/decides on an intervention that is inadvisable and you will be rewarded not only by the though of protecting someone from harm, you will be rewared by the doctor saying "We do not know what we would do without you Adam!" a milestone in your career. A very rewarding one I can assure you. All founded on your early work of getting anything you are unsure about set in your mind!

I wish you the very best for the future Adam - keep asking!
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Adam Roxby | 15-Dec-2011 12:57 pm
Hi George
I read all of my comments, I may not get the time to respond to all of them in a timely manner but for me it's one of the joys of the job.
I have seen first-hand a nurse correcting a doctor and I have to say it felt really good. It was done in an assertive and professional manner but it was still satisfying.
I do look flawed to the time that I can be seen as an indispensable member of staff and while I have been thanked as a student it doesn't quite feel the same.
Thanks once again for your comment and I hope you continue to enjoy my articles.
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DH Agent - as if ! | 15-Dec-2011 1:56 pm
'If you do not know - ask' - from above.

And also, be prepared to admit that you don't know things.

This is hard to do, for many people (I was the person in lectures who used to interupt the lecturer with 'I don't understand how you got that bit') but very often once one person says 'I don't understand this' then a whole forest of other hands will shoot up with 'me neither !'.
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Adam Roxby | 15-Dec-2011 9:24 pm
I have often found myself respecting those who ask questions during a lecture.
Perhaps a New Years Resolution?
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David Francis Seelig | 16-Dec-2011 8:18 pm
It may help to ease reticence in asking questions when feeling that perhaps one ought by now to know the answer, that even the most knowledgeable and experienced practitioners have, in their time, needed to ask such questions - and may well have been just as hesitant themselves. Nothing ventured; nothing gained. Courage!!
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Adam Roxby | 18-Dec-2011 11:10 am
Hello David
Thanks for your comment, it does tie into an experience I had later on in the same practice location. I found that my mentor didn't know something and we both looked up the answer and learnt together. A very tangible example of how a nervous is always learning.
Things once again.
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tinkerbell | 19-Dec-2011 12:23 pm
Adam agree with all above comments, keep asking, what, why, how. We should never stop asking/learning. I would be concerned about students who don't ask questions, how are they going to learn? I love having students who are 'thirsty' to understand and ask questions. If it is a pride thing of being scared to look foolish then that pride, as mentioned above, will cause harm to another at some point because it is arrogant to think we know all the answers or hide the fact that we don't. Learning and teaching are a reciprocal process, we teach one another. As someone said 'the beginning of wisdom is being able to say 'I don't know'. Just spit it out, no matter how foolish you think it may sound and sit with the fear, it will pass, and nobody will think any the less of you but probably respect you more for being able to ask the question that others have been too scared to ask or even they have never known the answer to. I think it was Steve Jobs who said 'if you're not living on the edge then you are taking up too much room'. You have nothing to lose, only ignorance, and so much more to gain. Go for it!
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Anonymous | 19-Dec-2011 1:27 pm
doesn't it feel good the day you pluck up courage to ask and answer questions and realise you are no more stupid (or even less intelligent) than many of your peers. It wasn't until I read for an MSc at the ripe old age of 50 and we were taught in small groups, sometimes by my tutor, that I finally plucked up the courage to speak. Our group was made of of healthcare professionals from several disciplines, from different levels of the hierarchy and with very different levels of work experience and career paths. I felt very humble as a London teaching hospital trained SRN whose working experience was largely outside the NHS and the UK but nevertheless from a large and important European university hospital until I realised that I also had interesting and different work experiences to share with the group.

However, I grew up in an environment where one was discouraged from asking questions probably because one's superiors felt threatened by it. Firstly during childhood, perhaps for more obvious reasons as perpetual questioning from kids can be extremely tiresome, but there should be a time and place otherwise it can dampen motivation and learning. Thereafter, as a teenager and right up to my post-grad studies I was totally lacking in self-confidence and much curiosity and always sat like a mouse especially when there were what I perceived as more authoritative, knowledgeable or intelligent individuals around and was afraid of getting my questions or answers wrong and making a fool of myself.

when I thought things would be better, in my mid-30s and started nurse training, on the wards we were actually told by some of the older sisters not to ask questions, or they didn't have time to answer them or to go and look it up in the library - which of course would have to be after the shift and by which time we had moved on to other things, were probably anxious to get home and the question would have been forgotten. We were warned that, as we were the first intake of students who had A levels or work experience and were being offered a more scientifically based modular course with the third year devoted to management known as the Experimental 2+1 course, ward sisters felt threatened by us as we may ask questions they were unable to answer as if they were unable to admit they did not have the answers or seen an opportunity to work through the problem together and benefit them as well. Another thing I learned from my MSc and subsequent work experiences is never to be afraid to admit that you do not know something as even the very best cannot know everything - even though I used to believe that my parents, teachers and consultants and even some of the doctors and of course the ward sisters did!

How many wasted opportunities I lost through such ignorance! Now I am grateful for the Internet where I can make up for a little of this lost time by finding almost immediate answers to all manner of things and my curiosity in the world around me and my thirst for knowledge no longer knows any bounds. Fortunately I am now retired and have plenty of time to do this instead of merely living on memories and vegetating!

Well done Adam for raising this issue. In healthcare and in order to deliver the best possible quality of nursing to all of your patients an inquiring mind, which you clearly demonstrate, is the A and O.
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