Always feeling a bit anxious/stressful before each shift...need some tips/wanting to vent

sunnybabe · Dec 31, 2015

I had to comment on your post because it sounds exactly like my experience, except I am a new transfer to ICU. I have a year of nursing experience on a observational med surg/tele floor which is less acuity, but it's always stressful to be a new grad and I feel like new grad all over again. In my last job, I use to think what could go wrong in my shift, how I was perceived by my coworkers, calling doctors [i work night shift as well], and dealing with changes in patient condition. And here I am, on my second week of being off ICU orientation, and I have had the same feelings as well.

When you ask about how to not feel this way, it really struck me because I don't think we need for the feeling of anxiety to necessarily disappear. It may keep us on our toes, keep us from making mistakes, and create conscientious nurses out of us, because we care to be good nurses. However, I think we have to recognize the fear and then determine what is truly causing the anxiety about the job. For me personally, I placed a lot of emphasis on how my coworkers felt about me- if they thought I was a good nurse. Not to mention I had in the back of my mind, that I couldn't make mistakes or else I was stupid. I thought that I had to perfect or else I was not a good nurse. So, in general, its the thought behind the feeling of anxiety that matters. Here are some things I have used to cope with my current transition and also where I started as a nurse.

#1- Journaling: When I look back on my entries from my journal from when I started nursing a year ago, I realized that I am having the EXACT feelings as I had back then. I see how one entry talked about how nervous I was, how I didn't want to be a failure. But then, I would read entries from weeks later that said how I enjoyed my job, how confident I felt, all the good things that happened on my shift, and even the lessons I learned without the self-condemnation (like, calling myself an idiot). It was very encouraging and it's something I still do, especially with this new transition to the ICU. Usually when I get off work, on my way home, I'll just think about things that went really well (like maybe I finally got something for my patient who I thought really needed something) and things that could have been better (ex:next time, I'll remember never to ___________ because _____________ can happen). I try to avoid beating myself up and going around and around my weaknesses ( which includes talking to physicians and staying calm and being able to think in bedside emergencies). I'm aware of things that could get better, but we have time on our side! That's why they say its takes a year to feel comfortable in your unit ( they say two years in mine :eek: ). Be patient and kind to yourself. As long as you care to learn, you will be fine.

#2- Get a hobby!-I think every nurse (well, everyone) should have a healthy outlet. We are nurses but it doesn't have to consume our lives. You have to take care of yourself. I'll admit that I think about work a lot, more so a reflection of things that happened, but I have to aware of that and snap of it and remind that I need to take care of myself. I think working nights may make it a little harder because you spend time sleeping during the day, but find something you like to do during your night owl hours. Do something that you enjoy and helps you not think about work as that next shift will come when you finally do have to think about it.

When dealing with people, my best advice is to not take anything personal. I used to be the nurse who would send a physician who was sitting next to me a page to his cell phone to call back rather than just speak up. But since going to ICU, I realized that I cannot afford to speak up, or else the patient suffers. And I just think that it's wrong that my patient didn't get the care they needed because I was afraid of ______________. Most MD's/PA's/NP's are very reasonable to speak with, however, we also have to communicate well about the situation because sometimes they don't know anything about the patient ( in my experience). I noticed that I tend to rush my conversations with them and that's something I personally want to work on, so they have a better picture of what my patient is going through and may need. And if you encounter anyone who is rude to you, just remember who's its about- as someone once put it on AN: The dude in the bed (the patient). I'm learning that we have to check our egos out the door. And at the end of the day, everyone who works with you is just human with flaws and all.

As far as getting stressed out when your patient's condition changes, that has happened to me several times at work. You passed the NCLEX, you can do this. I am very used to task nursing from my old floor, so a lot of anxiety comes from a lack of critical thinking, which can only come with time, patience, and learning. Your orientation was only the beginning of how much you have to learn. When something is going on with your patient, pause and think back to what you have learned (I would encourage you refresh yourself on concepts you don't totally understand when you have downtime or for your leisure- sometimes we fear because of of our own ignorance, so if you educate yourself on the side, you will feel a little more prepared). And if you just don't know, then just ask someone whose opinion you respect. I usually ask the nurses who have been there forever about patient situations that is frustrating me or I'm scared about what to do. They have seen enough to think more outside the box than I am and my favorite thing is that they are calm. Sometimes, they just say call the MD, but at least that is better than nothing. It's even better if you find a nurse who you notice loves to teach, so you can be around them and soak up all that knowledge.

I know this is an extremely long post, but I really do hope you find more peace and contentment in this field. The point is, even if it feels uncomfortable, whatever it is, if you know it's the right thing to do, you have to do it. You know you have to do it. And when its done, anxiety has lost its battle with you because you still did the right thing. It's a long journey to feeling comfortable but once you feel totally comfortable, you may be ready to move on to the next challenge. Good luck :) You're going to make an awesome nurse.

juliah ngugi · Dec 31, 2015

Am following

barcode120x, RN, NP · Dec 31, 2015

@ sunnybabe, thank you so much for your opinion/post, read the whole thing! It is very encouraging to me to see that there is someone out there that have the same or very similar feelings as I do. You actually just answered part of my question in regards to the feelings of anxiety. I happened to speak to my former preceptor when I was getting off shift because she asked me how I was doing. I expressed to her the same concerns as I did in this topic and you and her said the exact same thing...that the anxiety should not disappear because it's actually there to help us critically think. She said that she gets it too and that's how it helps us to recognize a change in the patient condition and gives us the ability to think about the next step. I do have to say I am very fortunate to have an amazing nursing staff and they are always willing to give advice and help out especially my charge nurses.

I will definitely look into journaling. I already journal my daily gym work outs and I do look at my previous weeks to see my progress and I think you'll be in that it will be encouraging to see how I progress as I move along in nursing. I do have quite a bit of hobbies (video gaming, occasional, quote "going out with friends" and I do hit the gym 6 days a week. It's just usually ON the night of when I work when I'm in a different mode, but once I get off shift, I'm kind of back to my usual self. Again, thank you very much for your input @ sunnybabe

RescueNinjaKy · Jan 1, 2016

You probably need some debriefing/validation. I'm basically at my 9 month mark and I haven't felt that anxiety in a while. I think it was somewhere along my 6th or 7th month that I started seeing all the patterns and routine that comes with my floor. When you feel more comfortable with everything the anxiety goes away. There are still some bad shifts but most of them are pretty okay.

What i suggest is that you talk to your unit educator about debrief and validation. After anything unexpected happens, there should be a moment in which some experienced nurses can debrief with you. It allows you to figure out what happened in a clear manner after the event, especially since it's usually so chaotic at the moment. Then you can identify what went well and what didn't go so well so that you can improve upon it next time. Validation always works well too. Sometimes I spot murmurs that others cannot readily hear or I notice a change in assessment that others didn't know about and when they validate you on it, you start to develop your confidence. I've had times when I was able to detect a slight change in status of a patient and we were able to correct it before it went out of control.

Had a patient who said he was breathing fine but seemed off to me. Sounded congested and was slightly restless. Paged the doc and got him transferred to icu where he went into respiratory distress while over there. Had another incident where I discovered my patient was having TIAs when I was doing my hourly rounding. They seemed slightly confused and off, even tho I had just woken them up for vitals. Decided to do a neuro check just to be safe and that's when I noted right sided weakness.

All these things that you will catch as you work more will build up your confidence. And as you know how to handle tough situations more, it gets less scary.

HouTx, BSN, MSN, EdD · Jan 4, 2016

Agree with PPs. Just wanted to add - SBAR is your friend. Adhere to this format when calling those grumpy docs in the middle of the night & you'll be much better prepared and more confident. Our job is not to make physicians happy.... it is to protect and advocate for our patients.

barcode120x, RN, NP · Jan 5, 2016

Thanks for the advice/encouragement! Still hanging in there. My most recent shift was crazy hectic, but I made it through the night with some great co-workers and other staff. Still trying to stay focused and be confident/prepared!

Zelda, RN · Jan 6, 2016

Don't worry about calling docs. It's their job and they make big bucks to do it. They'd be more than grumpy if you didn't call and your patient crashed.

nikki91 · Jan 8, 2016

I could have copied the OP from my own journal!

I'm also a new grad (almost 4 months)! I've found that blogging or journaling about my anxiety/feelings/experiences is kind of like debriefing myself.

Acknowledging how you feel is a huge step. Looking back on my orientation journal logs, I've already grown leaps and bounds as a person and as a nurse.

I'm not afraid to call doctors anymore, which is a tremendous growth for me. I work night shift and when I was in nursing school, I couldn't barely say hi to a passing Doctor.

Doctors are humans too. It's their job and when I express that I'm concerned about a patient, they usually listen and are thankful.

Fill your life outside of work with things and people you love. It has helped with my anxiety.

I don't think it'll ever go away until the day I retire from nursing. Keep your head up and keep going back for more.

You're much tougher than you realize.

barcode120x, RN, NP · Mar 19, 2016

So, I thought I'd bump up my old post and kinda update my status. As of next week, it will be 3 months since I've been on my own on night shift. I've gotten the hang of being a "nurse" in general and my anxiety has somewhat decreased as the shifts pass by. I still get anxious when calling the doctors at night, but I don't feel as bad as I used to now and I noticed calling the docs at night doesn't actually happen often and it actually isn't really that bad. When I did have to call, all the docs I've called so far have been pretty chill, or maybe too sleepy? Haha.

Aside from that, I am still dealing with some anxiety before work. I would always take a nap before work usually 3-4 hours prior; however, ever since I started on my own, I've been waking up from naps with some pretty bad anxiety. My heart would be jumping EVERY time, I would be sweating like crazy, and my mind would start racing the moment I wake up about work. This happens before almost every shift except for days I work back to back (as I am knocked out the whole day from the previous night). As of now, it has gotten better since January, but it's still there. It prevents me from getting a good rest before going to work as I can't get the full nap, I can't even get 20 mins of a nap without waking up. I don't eat super bad, I workout 3-4 days a week and my caffeine intake has been the same as it has ever been all these years. I've talked to a few friends about it and some new grad coworkers about it to get it off my chest. I have no problem sleeping during the day or at night or transitioning between (I was a 12hr night shift lift tech for 3 years prior to nursing so night shift is no problem for me). It's just these damn naps before work. My friend said to not take naps then. It's how I prep myself before work and kind of "rest" even though I don't get to rest because of the anxiety lol. Well, it helps me get through the night. I've tried to change my sleep so I wake up later that day, but I still get "tired" and have to lay down before work. On my days off of work, I am completely fine. I don't think about work at all.

Thoughts and ideas regarding my pre-work anxiety? I plan on talking to my director next week to kind of express my situation with her and get her thoughts on it. I also plan on seeing my PCP as well in the coming weeks.

ixchel · Mar 19, 2016

Barcode, fantastic update! The anxiety will fade more, but expect a small degree of it to linger awhile. You're getting it, though!

barcode120x, RN, NP · Mar 24, 2016

Thanks ixchel. The past few shifts since this post haven't been too bad. The naps I took prior to work were good and I actually didn't feel anxious. I had dinner with my older brother (nurse for almost 8 years now) last night and talked to him about it. He reassured me that it's completely normal and he felt exactly like I did when he first started and it would eventually go away. I just wish it went away faster and completely!