Log in | Join


The number one reason that I see nurses get in trouble is due to lack of focus and follow through. There are many reasons why nurses can be unfocused and do not follow through. Our mind is designed to go on autopilot. If we were conscious and present 24 hours a day and had to make sure that everything in our body was working properly … making sure our heart pumped, making sure we breathe, that our cells got fed and had oxygen … it would be completely exhausting. So, when our mind goes on autopilot, we are not conscious in the moment.

There are 4 stages of competence:

►  “Unconscious – Incompetent.” This would be like a baby who is unable to do anything for himself.

►  “Conscious – Incompetent.” This is like when a child is first beginning to walk or, if you will, a nurse learning how to start an IV.

►  “Conscious – Competent.” This is the level where we want to be. This is the area where we start to get good at things and we’re paying close attention.

►  “Unconscious – Competent.” This is where you are so good at things that you can do things “in your sleep.”

It is important for us to stay at the “Conscious – Competent” stage. As nurses we do tend to go on autopilot, especially if we’ve had the same patients before.

As an example of being on autopilot — have you ever missed your exit or driven past your house? This is when we get thinking about something in the past or in the future and we’re not paying attention to our driving in the present. I don’t know about you, but I know that I cannot be the only one to which this happens!

As nurses, we are constantly being asked to do more with less. We are focusing on all the work that’s ahead of us rather than actually focusing on what is going on right now or what happened at home before we came to work. However, I can tell you that mistakes are made when your mind goes on autopilot and you’re thinking about the past or the future instead of the present. By being present in the moment and paying attention only to the task at hand, you will create a better relationship with your patient and be in tune with the subtle cues that your patient may be showing you.

Being present in the moment takes practice. Any time your mind wanders and you start thinking about the past or the future, just get yourself to shift back to the present and start paying attention to what is happening right now.

Something else that may help is Peterson’s Law which says that “things take only as much time as we give it.” Therefore, if you’re thinking about all the things that you have to do and how you are going to accomplish all of them, just give yourself a certain time frame to complete a task so that you can continue on. You will be surprised at how much can get done in a little time, if that’s all you give it.

Think about situations where time just seems to fly or time seems to slow down. They’re all perceptions in our mind. By setting a time limit on how long something is going to take, it will help you organize your day and be more efficient. Remember: any time that your thoughts are drifting to the future or past, bring them back to what is going on in the here and now. You will be a much more efficient, effective and fulfilled nurse.

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at FIVE PRACTICAL WAYS TO BRING MINDFULNESS TO THE BEDSIDE. Find out how to participate.



About Lorie A Brown, R.N., M.N., J.D.


  1. Thanks, Lorie, for your practical advice. I like those four stages, haven’t seen that presentation before, very effective way of putting it. We can’t help but spend some of our time on auto-pilot: from what I read that’s how our brains keep it together, by engaging unconscious habits much of the time. But we can carefully assess the results, and focus our attention in between. Great work!

  2. Staying in the present is critical. I recently ran a stop sign on a road close to my home. I was stopped by a policeman and had NO clue why he pulled me over. When he said I ran the stop sign I was shocked. I had been worrying about a personal problem and went on auto pilot. Luckily no one was hurt, but it is a busy four way stop and it could have been a bad situation. This was a huge reminder to myself to be present. Thank you for your post to reinforce my life lesson.


  1. […] Empowered Nursing blog suggests that focus and follow-through are key to competency in nursing. The blogger offers helpful strategies to make you a more efficient, effective and fulfilled nurse. […]

Speak Your Mind