I'm Freaking Out and Frantic! Please, Help Me!
So many nurses talk about feeling scared, guilty and worried a good part of the time. A little bit of heightened awareness can keep us on our toes, but marinating in adrenalin isn't healthy. What are all these stressed-out folks to do?"I gave the wrong med, and I'm just sick about it."
"Today at work I dropped a full specimen container. My co-workers think I'm a total idiot."
"I make all kinds of little mistakes. Now I feel so guilty I can't even sleep."
"I feel sick to my stomach before every shift."
"The only thing I've ever wanted to be is a nurse, but I wonder if I should just quit."
Does any of this sound familiar? If so, you're part of a surprisingly large group called The Freaking Out and Frantic Club. Anyone can gain admission, but the most likely candidates are nursing students, newer nurses, or experienced nurses who are switching jobs, changing specialty areas, or coming back after a long absence. It helps if you're lacking in confidence or don't have a strong sense of yourself as a person. You get double membership points if you're a people pleaser. If you also admit to an inability to set healthy boundaries or rein in hysterical thinking you will probably be nominated as a club officer before too long.
Let's take a look at the common denominators.
The first is panic. Then self-absorption, followed by deflated confidence, lack of perspective, desperation, and, finally, over-reaction. This kind of thinking is a cocktail of torture and self-defeat. You can drink the poison, or you can pour it down the drain and replace it with a powerade smoothie.
The first common denominator--panic--is nature's way of kicking you into high gear to save your life. But fight or flight was never intended to be a long-term strategy. Nor was it meant to be free-floating and vague. If you can't pinpoint a specific and immediate danger and you find yourself in a state of high anxiety most of the time, that's your clue that this internal intensity has taken on a life of its own and it's far more threatening to your well being than any outside pressures. Why? Because the human body shouldn't run on adrenalin for more than a few minutes at a time. Longer than that and you will pay a price, both physically and emotionally.
Self-absorption is next. The list at the beginning of this article is made up entirely of "I" statements. But, don't confuse this with being conceited or selfish. Folks who are living in survival mode narrow their focus to the essentials. They just do. But that can look to classmates or co-workers like you're a cold fish or a stick in the mud who isn't willing to join in the normal break room give-and-take. They don't understand that in your mind you're just hunkered down, hoping to make it through the day without falling apart.
Your aloof demeanor can provoke a chilly, snippy or indifferent response from others and suck the remaining air from your already limp balloon of confidence. It can also prevent you from seeing anyone who is trying to reach out to help you.
Such utter deflation can totally rob you of perspective. In this mindset, every oops becomes not only a fire-worthy offense, but one that should get you reported to the BON who will make sure you never work again. That's appropriate if you saw your ex-mother-in-law in a room and pumped her IV tubing full of potassium chloride. But not so much if you mixed up labs in report or forgot to call a doc or gave a wrong med that caused no serious harm to the patient. Yes, there may be consequences, but execution at dawn should not be among them.
Which brings us to desperation. Who can stand living under such a black cloud for very long? Suspense in the movies is fun, but in real life, feeling like your body is made out of stomach acid and piano wire is torture. Even if you manage to have a good day now and then, all it takes is a minor mistake and--Whump!--you plummet down to the bottom of the coal chute again.
If you can't find a way out of this bleak and terrible dungeon, you might give in to the temptation to drop out of school, tender your resignation, or quit nursing entirely. But are these over-reactions the only options?
Fortunately, they are not. There is help, but you have to stop letting your imagination slap you around the room like it's a hockey stick and you're the puck. And you have to train yourself to remember that most of this fight is taking place in your head. Once you realize that, you're on the road to recovery.
The biggest weapon in your arsenal is telling yourself the truth. You may think you're already doing that, but chances are you're only coming up with the negative half of the story. You forgot to give a med. That's bad. But you called the doc, followed her instructions, called pharmacy, corrected the MAR, wrote out an incident report and took responsibility for your omission. That's all good.
Everyone makes mistakes, especially those who are starting a job. Anyone who says otherwise is forgetful or lying. When it's your turn, you do have to own your actions (or lack thereof), but you don't have to fall on your sword and agree to be horsewhipped, banished from the castle or exiled to Alcatraz.
If you insist on thinking that you're lousy as a nurse and unworthy as a human being, you won't be able to hear anything except the critical voices in your brain. This will color absolutely everything you think about and everything you do until you stop yourself and consciously decide to change your mind.
Here is the recipe for saving your sanity and maybe your career:
Refuse to panic. You can perk up some when the pressure is on, but panic tosses reason out the window. Tell yourself that you can do this. Take a deep breath. And then do it.
Stay connected to healthy co-workers. Ask for help when you need it. Build others up and hope some of that goodness comes back to you when you need it. Reach out to someone else who's having a bad day. It's amazing how that can arrest a downward spiral, in them and in you.
Keep the big picture in mind. Take a step back to ask yourself what's most important at that moment. Prioritize. Reassess now and then. But whatever you do, keep on keeping on.
Just say no to shutting down. Don't fall apart. Don't drop out. Don't give up. Don't quit.
Even if you have to regroup later, don't do make any major decision in the midst of an emotional meltdown. Just a few minutes (or hours or days) can make a world of difference.
Borrow someone else's perspective (make sure they're trustworthy and in your corner) when yours is shot. Take time to process your emotions. Learn to set aside worries (write them down, talk to a trusted confidant, pray about them), and turn off the "endless loop"--that litany of all your faults and errors--that prevents you from sleeping or enjoying your time away from the job.
Jettison the tendency to beat yourself up--that helps no one! Determine that you will treat yourself well, no matter what. Make a nice meal. Take cookies to a neighbor. Cuddle with someone you love. Substitute a calming mantra for the barbed wired accusations of self-condemnation.
Make an action plan for yourself that will improve both your skills and your disposition. Learn the difference between who you are and what you do. Cultivate and show gratitude.
Look at each shift, not as another loop around the noose, but as a fresh start.
Try to connect in healthy ways with your co-workers and give them a chance to draw closer to you. Be aware that while each of your flaws shows up as a permanent aircraft carrier on your radar, other people are most concerned with their own lives and they see your errors as little blips that fall off their screens pretty quickly.
Do not embrace intentional hurt. Hold any criticism at arm's length. Examine the thoughts and extract anything helpful. Give the rest a vigorous toss the way you would a live hand grenade. Thank those who care about you for their concern and input. Thank even your foes for the truth tucked into their harsh words. It confuses them greatly.
At the same time, don't look to your job to validate your existence. Get your strength and personal affirmation from those you love.
This battle takes place in your head and in your heart. But the good news is that you are in charge of deciding who wins. Please, please, please, pick you!Last edit by rn/writer on Mar 29, '12
From 'In the heart of the heartland'; Joined Dec '04; Posts: 11,700; Likes: 14,808.2Dec 11, '11 by cyb3rRNWow! This has been such a blessing today! Thank you SO, SO much for sharing this! I made my first med error yesterday and I have been "just sick" (No pun intended) about it! I have been trying to talk myself out of all the thoughts of quiting and quiting nursing all together! I'm already feeling a teeny bit better having read this! I think I need to use someone Else's perspective until mine come back around! Thank you again for sharing!1Dec 11, '11 by Good Morning, GilWell-written, and very true! I guess that's why you're rn/writer haha. I'm a new ICU nurse, and I'm guilty of the "Will I ever be good at this?" thoughts every now and then, but then I remind myself: one does not become the most able nurse in the unit after only a few months lol, how far my skills/thinking have progressed, and the GOOD things I have accomplished for my patient during the shift. I have told other new nurses to try to do the same thing. Although I must say, focusing on my negatives has helped me in that I work to improve what my weaknesses are. Nursing's tough, and I think we just put a lot of weight on our shoulders because of the huge responsibility that it is, but all we can do is our best each shift and work to improve our weaker areas. And, most importantly, leave work at work and not play the "oh no, did I remember to do x? Did I tell her x?" When I'm really not sure if I told them something important, I just call when I get home, but that's rare that I have to do that. I make a point now to make sure I mention the really important thing first in my report so I don't forget it once I get to the end lol.
Thank you!6Dec 11, '11 by nursel56 GuideThank you!!! There are so many people who struggle with this - as one who is "wired" to be an anxiety prone perfectionist (and lived to tell the tale ) I want to help but it is difficult to give as comprehensive a response as you have with this blog/article.5Dec 11, '11 by Always_LearningWhat an absolutely wonderful article. I am a new nurse in a stressful specialty area, and I haven't read anything that pinpoints the thoughts in my head so closely as this. I am still in the process of learning the fine line between helpful reflection ("What could I have done better?") and self-defeating inner commentary ("I am clueless; I should have done X, Y, and Z"). When I get home from a shift, I give myself a few minutes to go over what I could have done better, but then I have to lay it down and move on, or else I do become a mass of "stomach acid and piano wire."
Thanks again for this; I think it should be a sticky on the "Nurses practicing for less than 1 yr." forum. :redpinkhe5Dec 12, '11 by Flo.Wow. That was me to a T my first year of nursing. It is slowly getting better but I remember wanting to quit so bad even if that meant I worked at Starbucks the rest of my life. Life is so much more enjoyable when you are not freaked out all the time. This is such a great article. Thanks