Debilitating anxiety and fear of harm

[Curious1alwys, BSN, RN]

Hi,

I need help. 6 months ago I secured my dream job after a little over two years in nursing. It's cardiac rehab. When I was hired there was an RN manager that was present in the outpatient (offsite) facility. Right after I was hired all kinds of changes were made and now I have a different manager, NOT an RN. So basically, now, when I work outpatient, I am the only RN in the facility with a couple other exercise physiologists. We have a "code drawer" and no mock codes currently.

This is making me very uncomfortable. I mean, can't sleep uncomfortable. This is not new to me. Since I began as a nurse I have had overwhelming anxiety that I am going to hurt someone from panicking. Yes, I have a history of poorly controlled anxiety. I did a year on Tele but amazingly never had my own code. So I've never been a participant and never have ran the code on my own. In this outpt facility we call 911 but the first 5 or so minutes of the code is all us....er, me. I run the show. I do have ACLS but apparently this is of little comfort to me. Cardiac rhythms look different on our monitors due to so much artifact that I am uncomfortable on the monitor too. This is all contributing to some real trepidation that if I can't get over this feeling than maybe no area of nursing is right for me.

When I started it was so perfect. They started me in Phase I where I got to go all over hospital and educate patients. I am so good with people and it was literally a DREAM job since I don't care much for skills (performance anxiety) and am better at the "people" aspect of nursing. But now changes are being made that are pulling me into the outpatient area where there is no code blue or rapid response button. What do you think I should do? I mean I know I can "brush up" on all this stuff but I feel like I am going to panic no matter what plus I've never even been in a code. Hard to go to my manager and be honest without sounding like I am totally inept. But I am very good at the other aspects of job. So should I tell him I am uncomfortable and the reasons or what? I was honest in the job interview that I had never had a real code, so......

How does anyone with an anxiety disorder work in nursing? This would be all different if I had worked many codes or had worked ICU I think. I'd still be nervous, but......

Honestly, I feel dangerous and that scares me.

Help!

[Alex Egan, LPN, EMT-B]

Ok. So let me provide you with an EMS prospective.

For out pt medical facilities, I expect high quality BLS. This means high quality CPR with rapid defibrillation, and adequate airway control using a BVM or pocket mask.

Thats whats important. Your anxious that you cannot provide a level of care that you are not equipped or staffed to provide. even if you have an advanced monitor and cardiac drugs, you should not delay compressions to establish IV access, or place an airway (if able to ventilate with basic adjuncts).

do the basics. Study up on that quick and try to remember that you are not expected to provide hospital level care in an outpatient setting.

[Curious1alwys, BSN, RN]

Thank you so much Alex for taking the time to reply.

I think we are staffed though. Usually there are at least 3 of us but my job is defib/ALCS protocol and starting the line, pushing drugs. So, with other to help with the other components, I WILL be running the code. Anxiety comes in if I will remember ACLS protocol, recognize the rhythm, be successful with the IV, etc.

I guess I will brush up and see how it unfolds. If it feels really unsafe though I will talk with my manager. I'd be gone if I didn't love the other part of the job so much.

Thanks again, I appreciate it.

[Double-Helix, BSN, RN]

I agree with Alex. Learn the algorithms for the times when the patient is dead (V-fib, pulseless V-tach, and PEA). And in those cases, high quality CPR and defibrillation are going to be your priority interventions- that's BLS, not ACLS. The exception is PEA (push epi always), which doesn't require too much knowledge to manage. In the great majority of other instances, if you've got perfusion, you can keep the patient stable until EMS arrives with out major intervention. Outside of that, it may be helpful to know the acute coronary syndrome algorithm, so you can at least get the aspirin, nitro and O2 in the patient before EMS arrives.

[WinterLilac]

I like Alex's response. When in an emergency situation and you feel like panicking, just remember First Aid. In Australia it is DRSABCD: Danger (remove) Response (prompt responses from casualties) Send for help (000 / 911) THEN Airway: maintain or obtain an airway, head back or on the side - get air. Breathing: maintain the airway. CPR (cardio pulmonary resuscitation): get a pulse by mouth to mouth and chest compressions. Defibrillation: unconscious and not breathing, use an automated external defibrillator which will shock an irregular heartbeat into beating normally.

Dont panic. If anything just do basic first aid.

[meanmaryjean, DNP, RN]

OP: You don't have to 'remember' anything. It's written down in the ACLS book. Copy, laminate and have accessible.

So many times we think we have to memorize all this infrequently used stuff. You don't - the only thing you have to memorize is WHERE THE RESOURCES ARE.

[Horseshoe, BSN, RN]

Quality CPR is your priority, not establishing IV access or pushing drugs, especially if you are not out in the middle of nowhere. Getting in an IV is useless if you are getting poor circulation, i.e. compressions. You don't have to be the hero, just do BLS until the pros get there. If you have someone doing good CPR and can start the IV, fine, but that does not come before quality CPR. Remember that CPR is exhausting, and ideally there will be a team approach to do it so that the quality of compressions does not deteriorate.