Feedback frustration of anxious over-analyzer

[jjjoy, LPN]

When I'm a newbie and I get feedback "Do it this way/Don't do it that way" I get anxious and want more reassurance and clarification. Does this mean it's a life or death matter and there's no room for error at all? Does this mean that in some cases, to some degree, it can be dangerous, thus it's best to avoid it if possible but it's not totally unavoidable? Does this mean there are various ways to deal with it but this is hospital policy or one's preferred method? And there's always the possibility that the person giving the feedback is wrong. Often, there's not time for clarification or the person giving the feedback doesn't see how their comment leaves anything open for interpretation. They get all huffy and say something like "I told you how to do it, what part of that don't you understand?"

For example, in school, we were taught NO AIR IN LINES... and that meant absolutely no air. We'd spend ridiculous amounts of time trying to get that last little bubble out. Then we saw a nurse running an IV with a few teeny-tiny bubbles - what the &%#$? When we asked our instructor if that's correct. She just told us that we were responsible for our own practice and shouldn't just do whatever we saw someone else was doing.

And it's difficult to interpret to what degree to interpret advice and corrections. Clearly, if I'm new, I'm going to be slow and not get everything done, so what exactly do one mean when they say I should've been faster with the meds?

In some cases it might be that the person is letting me know that I should be getting faster over time but isn't expecting me to be there yet. In other cases, it might mean that I should be faster by this time and I'm risking endangerment and termination if I don't improve. In some cases, it might be that my perceived slowness wasn't any different than what might slow down an experienced nurse and the person criticizing doesn't realize that or is very nit-picky.

If it's not obvious, I'm the type who over-analyzes things. I'm trying to learn how to tune out the innuendos and intonations and emotions and to evaluate if the feedback is a simple reminder (eg, I need to be faster but I'm doing okay overall) or if it's something I really need to focus on (if I don't improve, I'll be endangering people and need to find other work).

Any thoughts on this from folks who understand what I'm saying?

[Julie_Bean]

ask for feedback, if you are doing ok overall etc.

and the bubble thing.... we were taught that too but before getting out of clinicals nurses were teaching me ways to trouble shoot air in the IV line. I don't know for myself but apparently tiny bubbles are ok in peripheral lines as long as they aren't large bubbles and/or = more than 3ml. This is what I was told. But its not a good idea to disconnect it and let it run till all the bubbles are out, especially if its an expensive antibiotic. you'd be out money and the right dose.

[AfloydRN, BSN, RN]

Basically, when you are a nursing student you are being taught the " correct and approved " way of doing things. The basic textbook version. Then, there's reality. You will eventually find your own way of doing things. I have found over the years every RN does something different than I do. Different schools teach different things. Hospitals vary and so do their policies. Just politely listen to your clinical instructors and preceptors and find your own way.

[nurse4theplanet, RN]

I understand that you feel as if your are being held to standards, yet the standards vary from instructor to instructor, preceptor to preceptor, hospital to hospital, etc. It can become frustrating especially for students who tend to be perfectionists, high achievers or overachievers, and intensely self critical. If you are the type that seeks out approval and needs reassurance that your performance is up to par, it can be especially painful to be pulled in so many directions.

You have to be flexible. Learn the textbook way of nursing and master it. Be confident in your practice and able to quote the literature. Almost all nursing concepts come from evidence-based practice meaning there is extensive research and literature that proves the rationale behind why something is done a certain way. Then, when you perform a task "by the book" as is expected of a student and new nurse, and an experienced nurse shows you the real world way....accept it. (as long as its safe and you will know the difference)

Until you are on your own, you have to play by the rules, so to speak. To get satsifactory clinical reviews and preceptor evaluations, you have to be willing to bend to their style to an extent. You will be compared to your peers...students and new nurses with your similar amount of training and experience. As long as you are on par with your peers, then you have substantial grounds to insist that you are performing adequately.

Don't sweat the small stuff. You will never get the recognition you deserve for all the successes in your career. Don't look for a pat on the back or constant reassurance that you are performing well. In fact, it's better to hear nothing than to hear negative comments. It's better to hear there is a better way of doing something, than to hear that you are absolutely doing it the wrong way.

Be confident in everything you do. Do not be overly self-critical. Be open to advice. Be competent in your knowledge.

[alwayslearnin]

Greetings,

Just a few suggestions-First of all Breath, breath, breath. Open up-it's ok to not know.You're new and this is your time to absorb everything you can but it's hard to do when your over-analyzing and anxious. When you feel that frustration and anxiety hit-pause and take a few deep breaths first-then if you need to, ask for clarification.

It is your responcibility (sp) to know your institutions Policies and Procedures. That is the standard to which you will be held to in a court of law. (That and what would a prudent nurse have done in the situation)

And, if your really interested in the airbubble question, there was a question posted about that here just a few weeks ago. go back in the archives and see if you can find it.

It gets to be quite fun when you can open up and enjoy the ride-and learning the answers or where to go (valid resources) is part of the learning.

Good luck to you!

alwayslearnin

[Julie_Bean]

found a good thread on the air thing

https://allnurses.com/forums/f27/help-iv-not-properly-flushed-69692.html?highlight=bubble

[UKRNinUSA, RN]

A word of well-meant advice, no criticsm intended. I think you need to relax just a little bit or you'll be on the high road to burnout real soon. Perhaps you need to find a preceptor that has the opposite kind of personality to you -someone a little more laid back than you. Or move to an area where your attention to detail will be useful and appreciated. Or maybe just take up yoga and as "alwayslearnin" suggested breathe, breathe, breathe.( I think the suggestion about following the P&P was an excellent one.) Best wishes.

[jjjoy, LPN]

Thanks for the feedback. I appreciate it. I do try to relax and take things one at time and all that. Repetitive affirmations actually work for me in this case ("good enough is good enough"). I appreciate reassurance that perfection won't be acheived even while we continue to strive for it (as opposed to the the attitude "failure is not an option").

Sometimes, though, if I'm particularly tired or have a series of frustrations or whatever, it's like my defenses come crumbling down and I feel overwhelmed, incompetent and unable to interpret the feedback I receive - instead taking it all deeply to heart. So I wanted to vent that feeling to get it off my chest, to see who might share such feelings at times, and to see what kind of advice people might have to deal with those feelings when they arise.

That's a big reason I prefer 8 hr shifts to 12 hours. By the end of twelve, I can get to a point where it feels like my brain is full and any new information just spills out and I can barely remember anything from that very morning. With 8 hours, I still have enough physical and emotional reserve to review the day and process what I learned as opposed to just functioning in survival mode.

Anyway, thanks again for the advice and feedback!

[Tweety, BSN, RN]

First of all, you sound very stressed and need to seriously chill out. I don't mean this casually or with malice. You need to learn how to "go with the flow", learning and observing but not getting too bent out of shape.

No matter what those others say, if you're not comfortable with something, if it's contrary to what you were taught, stop and get clarification. Many a nurse has gotten into trouble not listening to their inner voice but following some nurse on the floor. Whose butt is that nurse going to cover if do do hits the fan? Yours?

However, there's a little room for grey in the real world of nursing practice that doesn't kill the patients. Teeny-tiny bubbles is one of these areas. Things such as laying a sterile field when cathing someone or not laying that sterile drape, won't harm the patient one way or another. There's more than one way to skin a cat and this applies to nursing practice as well.

My advice is to learn good habits and stick to them. But also stay flexible so the "reality shock" doesn't hit you too hard.

Also, please don't judge the nurses you see. Take it in stride and know like your instructor says you are only responsible for yourself.

[RNperdiem, RN]

In nursing school you are trained for a profession that does not exist. Most of the learning you need as a nurse comes in the first couple of years of practice. The adjustment is stressful. We have all been there.

[jjjoy, LPN]

In nursing school you are trained for a profession that does not exist.

Interesting perspective! I can see your point. I'm very interested in nursing as a profession as it covers such a wide range of possible responsibilities. I tend to see hospital nursing as its own beast versus other avenues of nursing (school nursing, public health, some forms of advanced practice). And, yes, the way nursing is taught does seem to have some major inconsistencies with the way it is practiced.

Kinda ironic that I'm more interested in this topic than in practicing nursing itself!!!