Advice for working floor with "attacks" (anxiety?)

[Aliens05]

I am a new nurse, graduated in May and got my license in July. I have been working at a small group home since I began and I am wanting to transition to a hospital floor job such as med/surg to get some acute care experience, skills, etc.

I have been putting it off due to these attacks I suffer from and not knowing how I will be able to handle it when I am on the floor working with patients in stressful situations.

I will describe the attacks as beginning with a thud in my heart, and immediately feeling like my heart is racing super fast, but at the same time like I cannot catch my breath, and it feels to me like my heart beats quick little fast beats, almost like it is not beating adequately. Accompanied by this is usually dizziness, anxiety after attack begins, sweaty palms and feet, and sometimes my feet and palms go numb and tingling. The first several times it occurred I thought it was a heart attack, and even to this day even though I know what to expect it feels like I am about to die every time this occurs. These attacks last anywhere from 2-20 minutes before my heart will randomly just go completely back to normal and I am out of the attack.

I have and do see a cardiologist for this, also been to the ER about 10 times for this with absolutely no answers, no diagnosis. The ER says they are guessing its anxiety attacks as my EKG are always normal. I have worn halter monitors and currently have implanted bluetooth heart monitor that I press when feeling symptoms, still they say nothing ever shows up as abnormal at all. The cardiologist does say I have PVCs and PACs. These began randomly when I was 27 . I am currently 32. These begin typically when I am working out especially running or doing squats. They also will occur if I drink any caffiene. They have happened a few time in stressful situations or when I realized I made a mistake.

I am worried that this issue will affect my ability to provide care on the floor as a nurse, especially when doing anything physical or when in life/death sitautions such as performing CPR etc. I am not looking for any medical advice, but looking for advice on if people do/have work on the floor with similar issues and are ok to do so. Any feedback is welcome, please and thank you in advance.

[guest1054874]

Thanks for sharing your experience. I also struggle with anxiety and panic attacks. I take a beta blocker before work because my HR is through the roof whether or not I am having anxiety, I also have dysautonomia/ POTS. I am also a new grad and honestly I am so busy at work that I am distracted from the sensations in my body that might cause me to panic. Staying busy helps at least for me, anything that can help distract yourself. I also work night shift so there is less people around and the floor is pretty calm which helps a ton. Low levels of anxiety can be a good motivator but high levels of anxiety can cloud your judgement. Being a new grad is anxiety inducing enough even for someone without an anxiety disorder. It took me awhile, several ER visits, cardiologists and second opinions to trust that what is happening in my body is a normal response to stress. I may feel dizzy and shaky and those are all normal reactions to anxiety and will not cause me harm. Good luck on your journey!

[guest940422]

I've had panic attacks since high school, they've become more managed now and have almost disappeared. I worked in ICU most of my career, the weird thing was I never had anxiety or a panic attack once in 10+ years working PICU (beyond typical what did I get myself into new grad anxiety). I think it was because I was always so focused on my patients and not on myself... but that is just speculating.

See a psychiatrist, they can decrease or even completely prevent attacks with SSRIs or other depression meds, and drugs like propranolol and neurontin are also used off label for different kinds of attacks. I have to take a Benzo if my anxiety gets too severe, but that is rare.

If you had Diabetes would you let that stop you from advancing your career?

[Aliens05, ASN]

Thank you everyone for your feedback, i appreciate it a lot.

[amzyRN]

I work in the ER with anxiety, but I don't get panic or anything but have had anxiety. I find that putting myself into critical situations helps because then I've done it before and learn to deal with it. I've never performed badly, but I do get nervous but the more and more I stretch myself and force myself to do what is necessary, I become more comfortable. I trust in my abilities. Whatever gets you to trust yourself is what you must do. Life is in the moment, anxiety is an obstacle that people can chose to overcome or allow to block them from their goals. You are capable of overcoming it.

[hppygr8ful, ASN, RN, EMT-I]

This may sound a bit nutty but since you have tried all traditional medical treatments and evals you might try attacking your anxiety with alternative practices (with your cardiologist input). I'm not talking about anything controversial but Maybe something like Yoga or Tai chi. That will teach you focused breathing to address anxiety. I learned these techniques from my son's martial arts coach and it really helps.

Hppy

[Kristy96]

I've had panic attacks since high school, they've become more managed now and have almost disappeared. I worked in ICU most of my career, the weird thing was I never had anxiety or a panic attack once in 10+ years working PICU (beyond typical what did I get myself into new grad anxiety). I think it was because I was always so focused on my patients and not on myself... but that is just speculating.

See a psychiatrist, they can decrease or even completely prevent attacks with SSRIs or other depression meds, and drugs like propranolol and neurontin are also used off label for different kinds of attacks. I have to take a Benzo if my anxiety gets too severe, but that is rare.

If you had Diabetes would you let that stop you from advancing your career?

I suffer from this as well. I was prescribed Propranolol and since then it's gotten better. I've been thinking about requesting an SSRI prescription just to have if i ever need it... would you mind saying which one in particular you were prescribed? I've heard Zoloft is great!

[twinsmom788]

This may sound a bit nutty but since you have tried all traditional medical treatments and evals you might try attacking your anxiety with alternative practices (with your cardiologist input). I'm not talking about anything controversial but Maybe something like Yoga or Tai chi. That will teach you focused breathing to address anxiety. I learned these techniques from my son's martial arts coach and it really helps.

Hppy

I highly recommend yoga and actually regular massages. They both worked for me when I was experiencing some stress/anxiety when my father was terminally ill and I was being asked to travel much more for my job.

Neither one will be a negative and I believe it really helped me with anxiety during that period of my life.

Best wishes with all sincerity.

[Chrispy11, ASN, RN]

I take propranolol as off label use for anxiety. You can ask your doctor about that.

This! I use a different medication. Whatever works for you.

[Jules A, MSN]

I suffer from this as well. I was prescribed Propranolol and since then it's gotten better. I've been thinking about requesting an SSRI prescription just to have if i ever need it... would you mind saying which one in particular you were prescribed? I've heard Zoloft is great!

SSRIs are standing order, check with your provider to see if this would be appropriate for you. I'm guessing most who posted here aren't being treated by an actual psychiatrist. I am surprised to read multiple posters have been prescribed off label meds without a trial of a medication with FDA indication such as SSRIs for anxiety/panic.

[Aliens05, ASN]

Yes, my cardiologist only prescribed propranolol, I don't know that he is convinced it is anxiety, but he ruled everything else out...so he basically just said you can either take propranolol, which doesn't help me in the least, or just deal with them and ignore them.

[Oldmahubbard]

After going through some very difficult situations, I developed anxiety. I saw a psychiatrist and tried a couple of different medicines before finding one that helped. It really saved my career.

I took it for about 10 years, and gradually realized it was no longer necessary.

I also used cognitive and behavioral strategies, but I do not think they would have been effective on their own.

[guest940422]

I suffer from this as well. I was prescribed Propranolol and since then it's gotten better. I've been thinking about requesting an SSRI prescription just to have if i ever need it... would you mind saying which one in particular you were prescribed? I've heard Zoloft is great!

Everyone is different, see a psychiatrist, don't try to be your own doctor (we are all guilty of this). They put me on Zoloft first but it gave me stomach issues, Prozac was doing a good job for many years until I had a near-death experience in a flood and they decided to change me to Wellbutrin to battle the PTSD along with the panic attacks.

It's not a PRN though, you have to take it every day and then you may have a prescription for a benzo if your anxiety is severe or you know you will be in a situation with triggers.

Think about it like Asthma, you may take Singulair daily to avoid symptoms but occasionally you need a rescue inhaler for wheezing.

You take the SSRI or other depression med to prevent anxiety symptoms not treat them after the fact. But you can't be managed by a PCP you need to see a Psychiatrist and you'll have to go every 3 weeks for a little while until you figure out what works for you. Problem with Propranolol is it treats the symptoms of anxiety and panic attacks but not the cause, a lot of doctors have started doing that because they don't want to prescribe Benzo's anymore, same with Neurotin.