still overwhelmed

  1. Hi, I am new to the board but have been a nurse for a year and a half. i work as an RN for inpatient gyne onc. Looking for some answers to the questions that always burn in my mind!

    the first is this...why after a year and a half do i still have major anxiety going into work? i still don't feel completely comfortable at my job and once i get there, the first few hours are crazy...i work the night shift and i feel very overwhelmed for a couple of hours. i am running around while everyone else is calm...and i even have good time management! Is it because i care too much? I feel like I need to see my patients all within the first hour. is that even possible?

    the second is this...i want to help my patients, i want them to be comfortable, i want to give them the best care possible. but i am too hard on myself and i put too much pressure on myself. are my feelings normal? i mean this far into the game, were all of you still feeling this way? seems like the people that i work with are very laid back. will i ever feel that way? or will i always be so high strung?

    finally, this one is simple and probably been asked on here a thousand times. what is the typical nurse to patient ratio on nights for oncology patients?

    thank you all for your time. its nice to have nursing professionals to lean on. i have no nurses in my family that can talk with me about all of my fears. have a great day!
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  2. 14 Comments

  3. by   AfloydRN
    Maybe you should try a different specialty? Onc is not for everyone- I don't know if I could do it everyday. My father is an ONC patient and it kills me to go to the floor and see so many people suffering. That alone would cause me great anxiety. Maybe it's just your personality- high strung. I know noc shift typically has alot ore patients than days- is there a day spot open?
  4. by   vampireslayer
    Wow, I'm surprised you haven't gotten more replies by now. Makes me feel like maybe it's just you & me! Because, yeah, I'm right there with you! Well, not all the time, but it's been a year and a half for me too, and I also feel nervous and edgy on my way to work, I think about work all the time at home, after coming home from work I have a hard time sleeping because I'm always running through various scenarios in my mind, what would I do if....xyz happened....what would I do first, then next, etc etc etc. I work in an ER so mostly traumas and CPRs are what I think about, MIs and strokes, anaphylaxis, stuff like that. I find that when I make a mistake, or even when I almost make a mistake then catch it, I agonize over it for weeks, thinking about how I should have known better.

    But the good news is that it's getting better all the time, I'm getting more comfortable as I become more knowledgeable. And I read read read. I have just gotten my ER textbook out again and am reading it cover to cover. I read here on allnurses, I read nursing magazines, I have a Critical Care handbook that's really good. So I figure that at some point I will have seen and dealt with just about every major medical emergency or trauma that I can, and will be more and more comfortable as I gain that experience. One thing I did decide though, recently, is that because I've been having trouble sleeping, that I need to stop reading textbooks and nursing educational stuff at bedtime. I think it makes me think about it too much so that I can't get to sleep. I am going to start reserving my educational reading for day/early evening, but not right before bed.

    Since I'm not in oncology I don't know about ratios.

    I have made a conscious effort lately to change my attitude at work. I am usually very hard on myself, trying to get everything done right away. I see myself racing up & down hallways, for example. So last shift I decided "I can only do what I can do", if you get my meaning. I mean, no one can do everything at once, you can only do one thing at a time, and a nice brisk pace is fast enough, I don't have to race around all shift.

    Anyway, my point is you are not the only one who still feels the anxiety even after all this time, but I really feel that it's a combination of continuous education and attitude that will help.

    Good luck!

    VS
  5. by   anne74
    I feel your pain. In my first nursing job, the stress was unrelenting. I lost 17 lbs in the first 6 months due to stress and never having time to eat. I had trouble sleeping, and woke up in the middle of the night thinking "Oh my God - did I tell them this in report? Did I remember to do that?" etc. And when I made a mistake, I thought about it for days, weeks.

    I think some stress is normal for new nurses. But, I think the unit I was working on fostered an environment of stress and anxiety. My preceptors were NOT nurturing in the least - when I made a mistake, they would tell other nurses, they'd roll their eyes, etc. The only focus was all on my mistakes, and never positive things like when I caught a doctor's error, or noticed a problem with a patient that other experienced nurses had missed. I was constantly on egg shells.

    So, I finally asked to be transferred to a new unit and my life is so much better now! My preceptors are very supportive and if I make a mistake, they explain where I went wrong, etc. but don't "punish" me or make me feel like a total idiot. And when I do something correctly, they praise me. I feel like they've got my back - not like they're just waiting to jump on a mistake I make. So for me, just changing units relieved my stress.

    What's your unit like? Is it that same time of environment? Do your coworkers include you and make you feel like they're on your side?

    And I'm often perplexed at how other more experienced nurses leisurely go through their shift. I think they're just more efficient - they can memorize things easier, they can anticipate things and plan ahead, all to save time. I also think they do a lot of shortcuts, and are able to zero-in on the important issues, and let other lower priority things slide. To be like that just takes time and experience. And, even experienced nurses miss things and make mistakes - you just don't hear about it as much because they're not under the microscope like newers nurses are.

    At my hospital, I think our onc unit ratio is 4:1 days, 5:1 nights.

    If you think the anxiety is getting to be too much, consider moving to another unit. I'm now in the PACU, which is much less stress than being on the floor. I could never be on the floor again.
    Last edit by anne74 on Feb 5, '07
  6. by   wowie51
    This is my first time on. Hi. Ive been a RN for one yr. Just now the ball in my stomach is begining to shrink. I know where your comming from. My worst time is in giving report. Ive been pouring my life into my pts and at report time I sound like I dont really know any of them.
    Im at this sight to learn, read and become more educated on becomming the best I can at what I am doing. Watch, listen, learn and when in doubt, ask questions!
    God bless and keep you in your quest to become a good RN
  7. by   jjjoy
    Quote from anne74
    And, even experienced nurses miss things and make mistakes - you just don't hear about it as much because they're not under the microscope like newers nurses are.
    I think this is a valid point. The experienced nurses may be making similar mistakes, and I mean non-priority, non-life-threatening mistakes, that tend to be overlooked because 1) the managers are confident that the experienced nurses know what the ideal practice is even if they are cutting corners at times and with the newbies they aren't sure, so they tell you every time you do something that potentially could be wrong or 2) they assume the experienced nurses are doing everything more or less correctly and don't look over their shoulder they way they do for the newbies - though if they did look over their shoulders, they might find more mistakes/short cuts than they liked to know.
  8. by   Franksters
    Welcome to nursing. I have been a nurse for 17 years. I worked night shift x 15 years. It was at least 1.5 years before I stopped praying from the time I awoke to the time I went to bed. "Please don't let me kill someone"!! It took 2.5 years before I stopped calling the nurse I reported off to as soon as I got home. I just knew I had screwed something up. All total, it took 5 years before I believed I could take care of anything that came through the door.

    What nursing instructors do not tell you, at least they didn't me, is you learn to become a nurse AFTER you graduate. It's not until you have worked as a nurse that you learn true nursing.

    You are having normal feelings. As a veteran nurse, if new nurses do not feel this way, if they do not ask questions, I become VERY WORRIED about their patients' safety. Not to say they aren't doing a great job but I have been a nurse for 17 years, I still ask questions. I ask docs, more experienced nurses, younger nurses and brand new nurses.

    As a new nurse you bring the latest evidenced based knowledge to our field! You learned the new innovations, new meds, new labs, etc.

    Hang in there! Ask questions! Be proactive in learning your trade! Be proud of your choice! It takes a certain kind of person to be a nurse.
  9. by   Franksters
    Quote from jjjoy
    I think this is a valid point. The experienced nurses may be making similar mistakes, and I mean non-priority, non-life-threatening mistakes, that tend to be overlooked because 1) the managers are confident that the experienced nurses know what the ideal practice is even if they are cutting corners at times and with the newbies they aren't sure, so they tell you every time you do something that potentially could be wrong or 2) they assume the experienced nurses are doing everything more or less correctly and don't look over their shoulder they way they do for the newbies - though if they did look over their shoulders, they might find more mistakes/short cuts than they liked to know.
    Hi. I have been a nurse for 17 years. Believe me, we do make mistakes. Some of those mistakes are the same ones newbies make. If management is not looking at them maybe it is because no one alerts them to this fact. I belive that the majority of managers are fighting the good fight. They want to improve patient care and working conditions. Call me niave, but I believe in pointing out mistakes/things overlooked so we can all improve.
  10. by   allantiques4me
    Quote from sunneeRN
    Hi, I am new to the board but have been a nurse for a year and a half. i work as an RN for inpatient gyne onc. Looking for some answers to the questions that always burn in my mind!

    the first is this...why after a year and a half do i still have major anxiety going into work? i still don't feel completely comfortable at my job and once i get there, the first few hours are crazy...i work the night shift and i feel very overwhelmed for a couple of hours. i am running around while everyone else is calm...and i even have good time management! Is it because i care too much? I feel like I need to see my patients all within the first hour. is that even possible?

    the second is this...i want to help my patients, i want them to be comfortable, i want to give them the best care possible. but i am too hard on myself and i put too much pressure on myself. are my feelings normal? i mean this far into the game, were all of you still feeling this way? seems like the people that i work with are very laid back. will i ever feel that way? or will i always be so high strung?

    finally, this one is simple and probably been asked on here a thousand times. what is the typical nurse to patient ratio on nights for oncology patients?

    thank you all for your time. its nice to have nursing professionals to lean on. i have no nurses in my family that can talk with me about all of my fears. have a great day!
    You might need to find another speciality. I have been in the same situation.Everyone told me I m a great nurse.But I started having panic attacks,calling the place at 3 in the morning,thinking I might have forgotten something,ect.I felt I was the only nurse running to get many extras done while the other nurses were all calm.I was working on a brain injury/vent unit /tcu /at the time.There was always things to do and families to deal with.I do take pride that I am so concsiencious Many persons tell me Im a great nurse Ive been in the medical field since I was 16 y/o. A lifetime.You might just need to shop around for a minute to find your niche.Good luck and God bless ,I believe you are a good nurse.You seem very compassionate n awsome asset to the nursing community .
  11. by   blueiwahine
    It depends on the census...but I've seen our Oncology nurses on nights have 7 pts if the floor is full...which is way to many for Oncology...if a couple of the pts are really needy...it will make for a long night on your feet...and they will definitely be charting passed time to go home.
  12. by   oldiebutgoodie
    I've been a nurse for 1 and a half years, too, and I still feel inadequate. I did ICU for about a year, and got tired of the nastiness of the unit, so I switched to a Medical unit. The people are nice, but getting the hang of 5-6 patients on days has been a challenge.

    I also wake up at night and review the mistakes I made during the day, and get frustrated that I am not better at IVs. (All our patients seem to be elderly with NO VEINS!)

    Last week I had a crappy day, and swore that when I hit 2 years of experience, I am outta hospital nursing. But who knows, I may have a good day this week and change my mind.

    So, maybe what we are feeling is normal. I hope. Probably because we have passed the "baby" stage, we feel that we should be running, when we are still learning how to walk. Maybe we have too high of expectations. I dunno. But I'm right there with ya!

    Oldiebutgoodie
  13. by   RNSacht
    "I have made a conscious effort lately to change my attitude at work. I am usually very hard on myself, trying to get everything done right away. I see myself racing up & down hallways, for example. So last shift I decided "I can only do what I can do", if you get my meaning. I mean, no one can do everything at once, you can only do one thing at a time, and a nice brisk pace is fast enough, I don't have to race around all shift.

    "Anyway, my point is you are not the only one who still feels the anxiety even after all this time, but I really feel that it's a combination of continuous education and attitude that will help.
    "
    This is the BEST advice I have read so far!!!!!!!!!!:angel2: I have also taken this attitude and you know what!!????? My work seems to be better,or should I say my attitude is better, We cant all be supernurse even if we really want to. We will all burn out before you know it. Try this advice it truly will help.:lol_hitti
  14. by   nursemike
    Here, here! I sometimes feel like I'm running my butt off to do things that a year ago I didn't even know I needed to do. I'm not making myself sick with anxiety, so much, but I'm still nervous on my way to work. I try to remind myself that it's usually better, once I'm there, but there are still those moments when I want to lock myself in the med room and let the grown-ups handle it.
    I'm also getting the impression that I've been getting tougher assignments than I used to. I like to believe that means my CNs are getting more confident about me. I guess that's good. Sort of. But I do relish the nights when there are no surprises, everything goes smooth, and I finish on time.
    Next time I feel like I need some new challenges in my life, I'm going to try to pick some easy ones.

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