Debilitating Anxiety

Nurses Stress 101

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Hi everyone,

I am in desperate need of help. Please bear with me. This is a little lengthy. Without going into specifics and telling the whole story (simply because it would be an even longer post,) I'll give the essentials. I have debilitating anxiety when it comes to jobs. I graduated a year ago, so I'm a new nurse who feels trapped, hopeless and helpless. I am currently not working because I, yet again, quit my last job after just 3 days. I'm 31 and have had this problem my entire adult life. When I start a job, any job, I have extreme anxiety because I'm new and feel like I won't catch on and be good enough. I know anxiety is common, but mine is so intense, I become irrational and impulsive and do anything I can to get myself out of that feeling of anxiety, meaning I quit. I can think logically and tell myself it just takes time and all that good stuff, but when I'm in that state of panic, there is no talking sense into me.

It is ruining my life. I do see a psychiatrist. I am on medications. However it takes large doses of benzos to reduce that anxiety. NOT good. I do NOT want that for myself.

So my question? I have two. 1. Has anybody else ever experienced this? I'm asking to know whether or not as a nurse, if I'm alone in this. 2. I'm researching self help books on the topic, reading reviews of books on amazon. Can anybody recommend a self help book that relates to my situation? My psychiatrist calls it "performance anxiety" which perfectly describes what I feel.

I love nursing very much and want to really begin my career. I did work as a patient care tech for a hospital for 3 years, and I worked for 2 months at a SNF right after I got my license. I loved working with the residents. I got through it with Lexapro and Xanax, but need to work on the anxiety myself with techniques. (After I get used to a situation, I no longer need the xanax, hence lasting 3 years at the hospital and a previous job for 6 years) I quit my first nursing job because I was overcome with panic before a shift and did not have any more xanax. I absolutely could not bring myself to go in, so I quit right then and there.

I moved up my next psychiatry appointment to discuss this more with my doctor. He knows I have built up quite a tolerance to xanax. ( I've been on it 7 years.) I am very honest with him. Please don't turn this into judging me about meds :/

So any books anyone is aware of? I'm only finding stuff of mild to moderate anxiety, and mine is debilitating to the point where I can't hold down a job. And anyone else that can relate?

Thanks for taking the time to read this. I'd appreciate any responses.

P.S. I actually know the source of my anxiety, when and where it stems from, and that it has to do with low self esteem. But now I think, "ok, that's the first hurdle. I have insight. Now what?"

I also don't think a book will be of help. You don't say or I missed it, if you are on anything other than the Benzo. If not, you may want to consider something like an SSRI or SNRI - Lexapro can be stimulating. I also wonder if your anxiety isn't masking something else - maybe a type of bipolar..have you been tested? Abilify is a mood stabilizer there is also Lithium.

I can tell you I identify very much with what you have posted and it's only been recently that I have faced certain things in my own life about my struggles w/depression and anxiety, have made some changes and also began an SNRI - which, to this point, has helped.

My advice would be to find a job out of the hospital setting - at least until you are a little more stable..maybe nights at a LTC if you can handle nights and research more about meds other than Benzos..am not sure those alone are doing you any good...take care and hope all goes well at the doctor

Specializes in Rehab, Med-surg, Neuroscience.

I also quit a job due to anxiety and panic attacks. It was a very bad job situation (neuroscience/neurospine/trauma) and I was already prone to have anxiety and I have been since I was a kid. My anxiety is now under control with medication and working in a wonderful job environment (med-surg rehab). My husband is also very helpful too. Just yesterday he drove 20 mins at 7am to bring me my Lexapro at work when I had forgotten to take it before I left. I'm very lucky and blessed to have found a job I love and to have a great support system.

I have found that reading contunially about anxiety tends to make me even more anxious. I also think in you're going to need more help than just books. I have found one book that is about anxiety but it uses language and wording that doesn't trigger my anxiety. Don't laugh... its the Overcoming Anxiety for Dummies book. Its actually very interesting.

Quitting all those jobs isn't going to look very good on job applications unfortunately. I hope you can find a place that is willing to work with you and your unique situation. Theres lots of jobs that are outside the hospital setting that are less intense. Remember that you're not alone, there's lots of us out there. May you find peace!

Specializes in Oncology; medical specialty website.

I worked in psych for several years and often used this book in working with patients who had severe anxiety:

"Feeling Good: The New Mood Therapy Book"--David D. Burns

It's basically cognitive therapy, written in an easy to understand format. IIRC (it's been almost 25 years since I worked in psych.), it gave you exercises you could do. The author is a psychiatrist.

Honestly, I think you need more than what a self-help book can do, but it probably won't hurt. IMO, you may need a different psych. as well as a change in med regimens. When something isn't working after a while, you need to look at making a change.

I'm sorry you are dealing with such severe anxiety. Have you considered looking into Social Security Disability? It could give you the time to get yourself stabilized on a new med regimen and work with a therapist who can be more helpful.

I don't quite know what to advise. I think you're on track to make great progress, however slowly and painfully. I guess the best things to do are to continue therapy and meds, perhaps turn to God as you understand Him to be, and maybe listen to shows like "Hope For The Heart" by June Hunt. I wish you all the best.

I also don't think a book will be of help. You don't say or I missed it, if you are on anything other than the Benzo. If not, you may want to consider something like an SSRI or SNRI - Lexapro can be stimulating. I also wonder if your anxiety isn't masking something else - maybe a type of bipolar..have you been tested? Abilify is a mood stabilizer there is also Lithium.

I can tell you I identify very much with what you have posted and it's only been recently that I have faced certain things in my own life about my struggles w/depression and anxiety, have made some changes and also began an SNRI - which, to this point, has helped.

My advice would be to find a job out of the hospital setting - at least until you are a little more stable..maybe nights at a LTC if you can handle nights and research more about meds other than Benzos..am not sure those alone are doing you any good...take care and hope all goes well at the doctor

Hi Marshall,

Just a couple responses. I do take Lexapro for depression. It does wonders for me. There have been times where I forgot to take it and would end up going over a month without it. I wouldn't even get out of bed those days. Im not making that mistake again. I feel "normal" on my lexapro. It just does nothing for my anxiety, which I want to stress, only occurs right before going in to work.

It all started when I was 16 (Im 31) and helped my mom out in her Dr's office doing some billing work, and I just didnt understand what I was supposed to do. I didnt feel my mom explained it right. She got very frustrated with me, and ever since then I have felt stupid (except for being book smart; Im very book smart.)

I also want to make it clear I do not think anything, especially a book, will cure me. I do want a book to gather more insight and utilize tools. I HAVE stated I pushed up my next psychiatry appointment to discuss my medications, and that I need to start therapy again.

As for working in a less stressful environment, the work environment doesn't matter. I would quit a job that was mopping floors just the same as I would quit a job working in any nursing environment. Thank you to everyone who offered suggestions and helped me know I'm not completely alone.

I definitely don't want to get off lexapro. It helps tremendously with my depression. I ran out and told myself "oh, ill just fill it tomorrow. The next day I told myself the same thing, and so on. It's inconvenient to pick up. The pharmacies around me charge an obnoxious amount when I can get it at Walmart for 4 dollars, but that's a half hour trip. I'm never making that mistake again as I never want to experience that again. I fill my script a week in advance. I had to laugh a little when I told my psychiatrist about it. He was like "would you ever just not give your patients their medication? Of course not, so start treating yourself as well as you treat your patients." That was a big wake up call.

The main way I worked through my other issues in the past was through exposure and desensitization. Im thinking of applying to a non nurse job and viewing the job as a tool of sorts to expose myself to the anxiety, and this time be more aware of my feelings and that it is just anxiety. So when I say im looking for books, I mean Im looking for books that suggest things like this and ways to make the most of it.

Specializes in adult psych, LTC/SNF, child psych.
I definitely don't want to get off it. It helps tremendously with my depression. I ran out and told myself "oh, ill just fill it tomorrow. The next day I told myself the same thing, and so on. It's inconvenient to pick up. The pharmacies around me charge an obnoxious amount when I can get it at Walmart for 4 dollars, but that's a half hour trip. I'm never making that mistake again as I never want to experience that again. I fill my script a week in advance.

Wal-Mart does mail order medications - would that be helpful? Also, there is a website called GoodRx that shows prices around your local pharmacies and offers coupons. My insurance company originally wanted to charge me over $80 for my Lexapro but the coupon brought it down to $20. What dose of Lexapro are you taking? I'm taking 20 mg and I have anxiety in addition to my depression, but I think it helps me with both at my current dose. I'm also taking Wellbutrin SR and Lamictal (a mood stabilizer), which are both helpful. You might want to consider adding a complimentary antidepressant (Wellbutrin is an SNRI which works in conjunction with the Lexapro) or a mood stabilizer.

I used to take Klonopin in addition to my meds but it was just too much and if I started to feel the slightest bit anxious, I was like, "omg time to take my Klonopin" rather than taking a step back to see if there was anything else I could do to work towards a solution.

The main way I worked through my other issues in the past was through exposure and desensitization. Im thinking of applying to a non nurse job and viewing the job as a tool of sorts to expose myself to the anxiety, and this time be more aware of my feelings and that it is just anxiety. So when I say im looking for books, I mean Im looking for books that suggest things like this and ways to make the most of it.

Exposure and desensitization are both great ideas, but I also suggest seriously working on your coping skills. What do you like doing in your free time? IMHO yoga is really beneficial for stress relief.

Working as a nurse is stressful and I'd be lying if I didn't admit to some moments of anxiety at work. I do my best to work through it and there are techniques I use to keep things in check. I constantly make lists and am super organized with my shift brains. I sometimes think that maybe it would be less stressful to be in a position that didn't have so much responsibility but this is a career that I truly love doing. I use my history of mental illness to be sensitive to patients with mood or anxiety issues or even who just have pain.

As far as books go, I recommend looking into DBT (dialectical behavioral therapy). It's similar to CBT, but it focuses on absolutes, like black and white thinking and helps to find balance. The 4 principles are mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. There are therapy/education groups for DBT as well. I think you might benefit from being able to meet other people who have issues with anxiety and stress, and be able to share stories and solutions. There are also tons of worksheets and other free information online. Feel free to PM me if you'd like! I'd love to share my support and experiences with you.

You can succeed. You just need the tools. Once you have the tools, the bad things won't look so bad, because you'll know how to better handle them!

Specializes in Neuro, Med-surg..

I've had terrible anxiety most of my life (I'm 32 now). I've also battled depression and am currently diagnosed with type two bipolar disorder. I take a few meds including lithium, Celexa and Wellbutrin ER, but nothing specifically for anxiety. I was on clonazepam daily but it seemed to adversely affect my short term memory.

As a new nurse, anxiety is tough. A few hours before I start a night shift, I'm a wreck. I have gotten behind on my work because I've been too nervous to go into a new patient's room (I always felt like they could tell I didn't feel confident in there). In my personal life, I've declined invites to hang out with friends. And dating? Forget it!

I did like a book by Edmund Bourne. It was a workbook, but I don't recall the title. But I will say this:

You owe it to yourself and your personal and career goals to try everything. Pushing yourself in inherently uncomfortable situations is anxiety producing. Anxiety sucks so we avoid it. But that actually makes our anxiety stronger. The relief we feel is a temporary illusion. One of the hardest things to do I'd soldier on with terrible anxiety in crappy situations. But exposure helps.

Get a second opinion. Try a different med if these aren't helping you. What good is paying money for meds if they aren't helping?

I'm preaching to the choir here, but trust me. I've been there. My anxiety was debilitating. And in some ways it's still very limiting. But I'm ten times better off than I was ten years ago. It took awhile, multiple meds, docs, trial and error. And even failure.

But it's worth it.

Sent from my iPhone using allnurses.com

Specializes in Critical Care.

I experienced terrible performance anxiety as a new RN, crippling, but I suffered in silence. I never had this problem in any other job. I had several other jobs from secretarial to waitress and this is the only job this happened to me. The right therapist should help, and ideally meds are only meant to be short-term till the therapy kicks in. I made a self hypnosis tape to help me deal with a particularly stressful aspect of my job pulling sheaths on cath patients and the hypnosis tape really worked. I found a hypnosis script book and then wrote up something tailor made for my situation and used a recorder over relaxing music and then listened to it. I was surprised at how quick it worked. While I don't enjoy pulling sheaths, time consuming and aware of potential problems, bleeding, vasovagal; I no longer get anxious about it.

It sounds like you are psyching yourself out and focusing on the responsibilities of a nurse to the point of fear to do anything. I see this is a common thread people are afraid for their license or getting sued or making a mistake. I was always afraid if I would make a mistake especially in the early years and this dilemma came up when having to make judgement calls should I call the dr or not. I erred on the side of safety and was overzealous with calling dr's on things, but thankfully they were patient and appreciative. I transferred more patients to ICU than other RN's but I've never had a patient code with something I could have controlled. The only codes I've had were cardiac arrythmias that came out of the blue. I have caught some things early because of this tendency, such as a pt misdiagnosed with pneumonia who really had a PE and a patient who had a bleed while on heparin and it was caught early and corrected. So being overzealous is not necessarily a bad thing, but it can certainly add to the stress of the job.

My other ways of coping were to learn as much as I could, researching assessment, pathophys, seminars etc on my off time, and relying on trusted, experienced coworkers for their opinion. Thankfully we had a very helpful ICU staff that was happy to help with questions, concerns, chest-tubes, whatever. This was before emergency response teams existed. While the patients are sicker and the ratios may be higher today, depending on where you work; there are so many more resources available to the new RN from new grad residency programs, to the emergency response teams to other coworkers and lastly google and the internet for medical questions.

Lastly prayer and the grace of God took away the anxiety. I still have times of stress overload, but it is not the fearful anxiety I used to have. A beautiful prayer a loved one told me about is "Dear Sacred Heart of Jesus may I harm no one as I pass by". The prayer was said before driving and the person never had an accident, but to me that prayer embodies one's whole life. Asking Jesus that we do no harm, which embodies the doctors oath of first do no harm!

I'll return to let everyone know what my doctor says and how my next job goes! I received a lot of great info that I have already begun to look into. I was a productive member of society once, even with anxieties, and I can be that person again :-) Thanks so much to all!

SleeepyRN, I feel like I could've written this post. I too struggle with severe anxiety related to jobs; however, it had become significantly worse since becoming a nurse about a year ago. I have had several nursing jobs within the past year, all great opportunities, only to quit due to fears of being "inadequate" or a "failure". I told myself all the time "It's better to quit now out of fear of making a mistake than to be fired later because I actually messed up"...I now realize just how flawed and negative my thought processes were at that time.

Something that has worked wonders for me is a self-help program called "Attacking Anxiety and Depression" that was created by the Midwest Center. It is a series of recorded lessons and written work that really helped me get to the root of the problems I had with this. It addresses so many factors that play into anxiety such as negative thinking, high expectations, low self-esteem, guilt/worry, etc. Each lesson focuses on a different topic and the work book allows you to really delve into what, specifically, you are struggling with as an individual. Each recorded lesson contains a recorded "group session" with other people who have experienced this problem. It is truly amazing how many individuals are nurses or work in another health related profession! I still struggle with anxiety at times, but the difference is now I know exactly what it is that I am feeing and have the tools to handle it.

I am very sorry that you are struggling with this problem and I hope that you find a solution that works for you, whatever that may be. Best wishes!

Specializes in Nephrology, Cardiology, ER, ICU.

Very supportive thread. Thanks for all the suggestions forthis poster.

We do ask that you not give medical advice. It's ok to say "this helped me." However it crosses to medical advice when we suggest meds or dosages.

Thanks

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