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Seasoned with Sage
When Is a Confident Nurse Dangerous?

Nurse X was the most clever nurse I've ever met. She used to work in a New York hospital, a real big trauma hospital, in the ER. Working with her was almost always an education, as she was always up to date with the latest techniques/procedures and was always happy to lend a hand. Then the incident happened.Mr. Smith was a student at a boarding school. He was 16 years old, and, fitting for his age, while wrestling with some friends he fell down a flight of stairs. Sure enough the school nurse (the one-time ER nurse, Nurse X) met Mr. Smith in the health center.

The left shoulder was dislocated--at the very least--and the patient was in absolute agony. The local doctor was on vacation, and his substitute was not answering his phone. The nearest hospital was one hour away.

Nurse X had seen the doctors back in New York relocate many shoulders, and was confident she too could do it. She performed the procedure, and the patient was hugely relieved. Nurse X said, "That was a bit out of my scope of practice; oh well, it worked out." The patient went to bed and visited the doctor the following morning.

The x-ray the next day showed the shoulder was in the right spot and there were no signs of fractures.

Nurse X no longer works with me; she missed the excitement of New York. But while working with her, I took her advice with a touch of caution.

Nurse X was too confident. Nurse X didn't know when to get help. I also found out that when Nurse X didn't know the answer to something, she made up answers as she was too proud not to know the answer.

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17 Responses to “When Is a Confident Nurse Dangerous?”

  1. SWAT Nurse Says:

    Yikes; another nurse slam.

    It is amazing how so many public people, healthcare professionals, so-called nursing commentators(bloggers), think that confident nurses are to be exiled and ridiculed.

    I’ve been an RN for 25 years; confident, self assured, and vocally abrupt with colleagues, MD’s, patients, and managers. I’m known as a great nurse; and I’ve made mistakes along the way, some good, some not so good.

    You should see the faces of patient’s when I call them on some something, chastise them, or re-correct them. They’re astounded that a nurse has so much knowledge and power. Of course, some patient’s complain. If you’re a weak and meek RN they never complain, they just get their way all the time——and learn nothing at all from miss meek nurse.

    Tying confidence to clinical mistakes is a correlation only; we know that correlations are not cause/effect; but the blogger makes good headlines with this.

    Personally, unconfident and unsure nurses are a disaster to work with, can’t keep up with high acuity clinical loads, can’t prioritize, and are actually dangerous and unorganized to be around. They cause more chaos than needed. I refuse to work side by side with those RNs whenever I get the choice, thank you very much.

    No thanks Blogger, I’ll keep my confidence, including my angry patients, complaints, and my reputation intact, thank you very much again.

    If you want weak/meek nurses, their everywhere—and that’s where most people want nurses to stay. You got my attention with your headline alright, but you’ve also got issues with the profession.

    Good luck next time you’re cared for by a weak/meek nurse who gets flustered and confused. Hope you make it out alive.

    Good luck.

  2. Pamela Says:

    I do not think that confidence is dangerous. I think that it is over-confidence and arrogance that makes a dangerous nurse. When a nurse never asks guestions or needs help it makes me wonder how safe their practice is. No one nurse knows all or can do all. Even a confident, experienced nurse needs help once in a while. I have every cinfindence in myself and my abilties as a nurse but I am the first person to admit when I cannot complete a task or need help with something.

  3. Pat Says:

    Confidence was not the problem here. Practicing outside her scope of practice was, which equals practicing medicine without a license which can result in discplinary action against her license. I’ve seen a lot of C-sections, but I am not about to do one.
    As to SWAT nurse–I think that you are using the healine of this blog to fit your agenda. I wouldn’t want to work with an over confident nurse or a meek one, but there are different personalities that we face every day, and have to work with. I just want a nurse who knows her practice and the laws that govern nursing in his/her state.

  4. Cathy Says:

    I’m sorry but nurses must be confident it what they are doing or the patients will not feel secure in their care. Nurses who are unsure of themselves tend to be the ones that I see running around in circles not accomplishing anything or looking for someone else to do their job for them.
    Even if you feel unconfident on the inside you must never let it show to the patient, they need to feel that you know what you are doing and are giving them the best care possible. If there is something you have never done before the you must be confident enough to research out how to do it and ask for help from someone who has done it before. The danger I see in the blog mentioned is that the nurse was practicing beyond her scope of practice. As nurses we must continue to grow everyday, we will never be able to say I know everything there is to know.

  5. steubified Says:

    I agree 100% with Cathy.

  6. Mr Ian Says:

    Well if I don’t know the answers – then no one does.

    But then, I *am* that good.

  7. Paula Says:

    I would say that Nurse X was one heck of a nurse.

  8. Michelle Garrett Says:

    It’s a tough call- if the woman were not a nurse and she repositioned the shoulder because she had seen it on TV and felt confident she could do it – would this still be a topic of discussion?

  9. nursingaround Says:

    a couple of points, what if there was a fracture involved as well???

    Secondly, a few people seemed to miss my point, which sometimes I’m not good at getting across, and it is this:
    A good nurse knows when and how to get help. She knows her limit. Perhaps the title was misleading, and words other than “Confident Nurse” be used.

    In response to SWAT, confidence is good, but cockiness is not. What if there was a fracture involved? I’ve seen shoulders even experienced doctors would swear were dislocated, but x-ray shows a nasty fracture or two. How would you like someone playing with your broken pieces.

    Also SWAT, your whole comment comes across as aggressive. It doesn’t mean you lack confidence to go and seek advice. I work in a team, where each has their strengths and weaknesses. It usually makes life much easier.

  10. Doopi Says:

    In Asia, a number of people seek bonesetters when they have fractures or dislocations as well. But these bonesetters have limited medical knowledge. They learn by example, from their masters/preceptors. If the involved was a bonesetter, I doubt this would be an issue at all.

    If Nurse X was confidant, and she is prepared to face the repercussions should something adverse happen, assuming she should be able to anticipate them in her years of practice, then it’s her call. No doubt it was not within her scope of practice, but it was done with the best intentions at that time – I can only guess.

    Even if one is a good nurse, and knows when to get help, sometimes lack of manpower makes it impossible to get around the “how-to” of getting help.

    No one could know the answers to everything. And it can be hard to admit one does not know, especially when that One is someone who is often hailed as “the most clever nurse”. Wouldn’t you agree that it’s more painful to fall from a high pedestal than a lower pedestal others have set Nurse X on? Perhaps Nurse X was not, as you say, ‘proud’, but was too shy to admit she did not know the whole physiology/cause behind a phenomenon.

    If Nurse X was a clever nurse, she probably had made efforts to project that image – and she might even have tried finding out more about things she has little idea about, although she may offer some of her own answers to pass off first. Nurses are often taught not to judge their patients, but I think this should be extended to the people they work with as well. From your description of Nurse X, she sure doesn’t come across as cocky to me – just confident, and concerned about relieving the agony of the patient – though you may beg to differ.

    Lastly, even doctors can make the same mistake. So, in that case, aren’t they cocky and over-confident too? Is there any reason we should consider seeing a doctor since he cam make the same mistake then? I might as well stay home to recuperate on my own and set my own bones.

    Just as nurses eat their young, I think the young often trip up and snub the old as well. It’s a nurse-eat-nurse culture.

  11. bryn Says:

    interesting comment Doopi. To add to the story, about four months later the same situation happened, another likely dislocated shoulder. The unbelievable thing was that the doctor was again away, and had a substitute. All of us nurses didn’t like or trust the judgement of the substitute, so Nurse X relocated the shoulder herself. At the end of it she said to me “If we get another, I’ll let you have a go”.

    Now in defence of Nurse X, she really did save us a whole heap of trouble and made the patient a lot happier a whole lot quicker. I’m still in two minds about the situation, but I can defintely say she was getting a bit cocky.

  12. bee Says:


  13. nursesaregreat Says:

    A confident nurse is different than a stupid nurse. I would put myself in a different category. I triple check and will not practice out of my scope bc if something goes bad the shit falls on the nurse. I also will not do a procedure that i’m not confident the reason is not bc im scared but bc its for the safety of my patients. They are not guinea pigs. Nurses are the backbone of the hospital and what i cant stand more than anything is a nurse that will turn another nurse in for a honest mistake that caused no harm. But that pt. with a dislocated shoulder has the right to know that its a nurse without experience in that feild is performing the procedure. It goes back to what really matters is the patients rights.

  14. nursesaregreat Says:

    I Love working with older nurses they are smart and I can really learn from them.

  15. nursesaregreat Says:

    To swatnurse…. I know what your talking about… but your arrogant and i bet you dont believe in teamwork and i bet your a male nurse

  16. nursesaregreat Says:

    Look what nurses put up with. One time I had 9 patients no tech to help, I felt like I was drowning and I had to go ask nurses to help me turn and do breif changes. I help them too. There are days where i feel like i’m drowning. I’m changing my degree to teaching. Not that i cant do it. Nursing is just getting dangerous. There needs to be state laws on the conditions that hospital can put on nurses.

  17. nursesaregreat Says:

    Oh yeah one more thing I seen a RN with an associates degree delivery a baby and the doctor was sitting in the nurses desk and knew about it. Shocked! Was that out of the scope of practice. I said this hospital is not for me. and left. Now if the Doctor was not there and the nurse had too. thats understandable, and that was a hell of a nurse very smart. But the doctor was drinking coffee and came to get the placenta. But if something went wrong that dr. would have not backed up the nurse. Maybe the nurse x didnt have a choice bc noone was there.

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