Anxiety Makes Me Want to Quit

Specializes in Geriatrics.
Anxiety Makes Me Want to Quit

I have been a nurse for about a year now. I work in a physical rehabilitation hospital where I work with mainly elderly. My work position is the kind where I am every day in a different floor depending on the hospital's needs, in exchange I don't do night shifts and usually have weekends off.

I have had anxiety since the beginning. I fear making mistakes. Quite often I am worried sick at home and I have spent whole weekends and holidays worrying about non existent mistakes such as "are you sure you doubled checked everyones names before giving the meds?" I used to think of everything I had done during a working day and if I didn't remember doing or checking something, the mental torture would start. "What if you gave the wrong medications to the wrong patient?""What if you didn't prime the IV line?", etc. Time and time again experience has proven that I don't make such mistakes and that I can't remember every single thing I do in a working day. Neither should I try and go through everything on my mind once I am home. Thanks to therapy and experience this situation has improved. I trust my skills more.

However, last week I had a 90yo patient who had a severe infection (CRP >300) and hypernatremia. He wasn't able to speak properly and his conciousness level was compromised, he also had a lot of secretions that made his breathing hard. He had a g tube. My other RN coworker administered the nutrition and I later administered the medications through the g tube. One hour after administering the medications the patient died. I asked time and time again to my coworkers if the procedure I had done to administer the drugs was wrong and all of them deny it. In our hospital patients like this are typically put to palliative care for a few days until they pass away. However this caught us by surprise. What else could I have done wrong? I don't think I could have had medication errors, I scanned all the meds and was careful. However I don't know anymore. I go through every fatal scenario in my brain in which did I not notice and instead of K oral suspension I gave risperidone (unlikely as I took care of them one by one and scanned them), did I administer too many liquids at once? (the patient did have a lot of medications at once going through the g tube). My head tells me that "I must have done something wrong because he died almost immediately after giving medications". Worst of all is that I even asked the doctors what they think the death cause was and they don't know but they don't think the patient needs to go to autopsy due to his condition and age (he also had cancer, coronary artery disease, etc.)

Fighting with this issue for a year I feel exhausted. I feel that I can't do this anymore. That when I finally think that I have things under control this happens and completely debastates me. Maybe I am not made for this type of job where you carry the responsibility of taking care of other people's health. I want to quit immediately. People keep telling me that I should give it a try for a year longer.  I don't know if my mental health can take it.

Can I get some advice from other people on the field? Did something similar ever happen to you? Do you ever wonder if you did something wrong after your patients suddenly dies?

11 Answers

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

90 year olds die.  Especially very sick 90 year olds.  I doubt very much it had anything to do with you administering meds through his G-tube.  (Even if they were the wrong meds, unless you made an egregious error. As for egregious errors -- you are unlikely to make one because you seem to be very vigilant.)

Confidence comes with experience -- I used to be hyper- vigilant just like you.  I remember once being so worried about whether or not I had actually changed the dose of the heparin drip as ordered that I drove back to the hospital at 1am, sneaked up to the unit the back way and peeked into the patient's room at the drip to make sure that I had.  I had.  Did that cure me of my anxiety?  Not immediately, but as I became more confident in my knowledge base and in my system of checking myself for errors, the anxiety and hyper-vigilance ebbed.  

Devise a system for yourself so that you can relax, knowing you've checked all the things you're supposed to check.  That still won't prevent you from EVER making an error.  We're human.  We all make errors.  There's even a thread or two about that here -- I encourage you to look for them.  But with a system, you minimize the chance of errors, maximize the chance that you will catch an error before it gets to the patient and it helps you to stop driving yourself crazy about potential errors.  Then you can concentrate on the big picture, which you may be missing now because you're so worried about making an error.  I missed a number of "big pictures" because I was so worried about the possibility of making errors.  A system for taking report, giving meds, assessing patients, etc. helped enormously.  

Good luck.  You seem like you'll be a great nurse one day.

18 hours ago, pucatalia said:

One hour after administering the medications the patient died. I asked time and time again to my coworkers if the procedure I had done to administer the drugs was wrong and all of them deny it. In our hospital patients like this are typically put to palliative care for a few days until they pass away. 

You said the patient was breathing hard and had a lot of secretions. That's a red flag especially administering G tube meds and feeding. They seem overloaded. What were the vital signs? Was the patient a DNR or full code? Whenever I get a patient like this especially at 90 y/o and has secretions and especially a respiratory infection, I call the family or responsible party. Just out of respect to say I believe he/she's gravely sick, we need to think about the next step or have someone make a phone call. 

With that much anxiety, the job isn't worth it. 

Specializes in CRNA.

From your post, I can tell that you are good at your job. You may lack confidence and you may second guess yourself. But the fact that you take steps with every patient to ensure you are not making mistakes tells me that you understand what can happen if you make the wrong call. The anxiety associated with the responsibility you have will get better, but it will never go away. Most nurses, APRNs, RTs, and MDs will second guess choices they’ve made on a daily basis. So no, your anxiety will not go away. But, as your experience and confidence grow, your anxiety over everyday decisions will improve. Stick with it because the amount of care and concern that you have for your patients is exactly what health care needs. 

I am sorry you are struggling with this.

You do sound like a very conscientious nurse and we always need more of those.

In general, do you tend to struggle with anxiety a little? It almost sounds as though you do; perhaps your new responsibilities this past year have kind of taken it over the top (not uncommon). It may be worth talking to your PCP about; there are things that can help, like counseling and sometimes medication may be really helpful. Both can help with your ability to keep things in perspective. Hate to have you living with near-constant worry. It affects lots of things--even one's ability to do things like enjoy basic pleasures or just rest.

All things considered, it is most likely that a very sick 90 year old died due to something other than your interaction with him.  I have had similar situations a couple of times, immediately double checked what I had done and found no error. It is at that point that you need the ability to just move forward. I do caution against making too much noise looking for reassurance from coworkers; that can backfire in the way of suggesting to people that there is a reason your actions can generally be questioned.

Please reach out for professional assistance. I say that not just for the benefit of your nursing career but for you as a person. You don't deserve to live like this! Things can be better than they are now.

? (hugs) to you.

From your writing it shows that you are very good at your job, very caring and very aware about consequences that might result from administration of wrong med or not administering it correctly.  With that said the constant worrying and doubting yourself can be exhausting and not good for your overall well-being. I went through some medical challenges that made me doubt everything I did, I would even make a list, cross it off as I completed a task but still wondered if I finished it or no as performance anxiety was so high that clouded my thought process. I saw therapist, saw my doctor and got on some meds.. first week or two were tough with starting new med but after it made so much difference in my confidence,  staying organized and following through even if the situation is critical without my anxiety taking over… So don’t give up on a profession  that you worked so hard to get into. Take some time off if you need to, to get proper help, or go part time or PRN if you have to, so you can take care of you first. All the best, you can do this and we need nurses like you❤️

Specializes in oncology.
On 12/9/2022 at 2:39 PM, pucatalia said:

My work position is the kind where I am every day in a different floor depending on the hospital's needs, in exchange I don't do night shifts and usually have weekends off.

This, in and of itself is exhausting. May be  getting acclimated to a usual (repeated)  population and medications,  normal and abnormal assessment signs etc. may help and be the trade-off.. BTW I was thinking today of my first year in nursing 1978 and I had all these  same thoughts! And then in your dreams you are still working. Trust in yourself. 

You sound very detail oriented and I’m sure you are not in any way responsible for that person’s passing. I work in a snf and there are patients who seem fairly stable one day and are dead the next. I used to think it was a weight off my shoulders when a patient dies because it would be less work for me, but then I had a patient die and get replaced with someone who is more of a handful and takes way more medications. Someone died while in your care and shortly after you worked with them, it can be shocking and depressing. It might be easier for you if you try to think of the positives. The patient is now at peace and you’re not responsible for that one anymore.  

Specializes in Geriatrics.

As a hospice RN I can tell you that there is often no smoking gun when it comes to why patients (especially elderly) pass away. It is a cascade of multiple issues like dominoes falling one by one. This particular patient was of advanced age with multiple comorbidities. Did you expect them to be cured? Hop off the hospital bed and get discharged home? Often times this scenario plays out over and over again because people do not understand end of life care or even plan for what their end of days should look like. Do not beat yourself up, you could have turned on the light switch or repositioned them in bed when the last breath was taken. This is not your fault. 

Specializes in Geriatrics.
On 12/11/2022 at 9:01 PM, JKL33 said:

I am sorry you are struggling with this.

You do sound like a very conscientious nurse and we always need more of those.

In general, do you tend to struggle with anxiety a little? It almost sounds as though you do; perhaps your new responsibilities this past year have kind of taken it over the top (not uncommon). It may be worth talking to your PCP about; there are things that can help, like counseling and sometimes medication may be really helpful. Both can help with your ability to keep things in perspective. Hate to have you living with near-constant worry. It affects lots of things--even one's ability to do things like enjoy basic pleasures or just rest.

All things considered, it is most likely that a very sick 90 year old died due to something other than your interaction with him.  I have had similar situations a couple of times, immediately double checked what I had done and found no error. It is at that point that you need the ability to just move forward. I do caution against making too much noise looking for reassurance from coworkers; that can backfire in the way of suggesting to people that there is a reason your actions can generally be questioned.

Please reach out for professional assistance. I say that not just for the benefit of your nursing career but for you as a person. You don't deserve to live like this! Things can be better than they are now.

? (hugs) to you.

Thank you so much for your comment. It really helped.

I do tend to struggle with anxiety, never as bad as this though. I have been seeing a psychologist for the last year, since my anxiety went worse. However, other than actually making a fatal mistake, losing a patient like this was my biggest fear. This caused the anxiety to peak even more to the point of seriously wondering about my career choices.

Specializes in Geriatrics.
3 hours ago, Ruby Vee said:

Confidence comes with experience -- I used to be hyper- vigilant just like you.  I remember once being so worried about whether or not I had actually changed the dose of the heparin drip as ordered that I drove back to the hospital at 1am, sneaked up to the unit the back way and peeked into the patient's room at the drip to make sure that I had.  I had.  Did that cure me of my anxiety?  Not immediately, but as I became more confident in my knowledge base and in my system of checking myself for errors, the anxiety and hyper-vigilance ebbed.  

I can totally relate to this type of experience. It's nice to hear that you went through something similar and still became a good experienced nurse. I have developed some systems at least for medications but I will think more about how to implement those in other areas as well. However, the problem with this particular patient wasn't a failure in my system. I was pretty confident that I had checked every drug carefully and administered it carefully. Still, when he surprisingly dies I immediately question what I did.

Specializes in LTC.

I feel your pain and can relate.

+ Join the Discussion