Debilitating Anxiety

Long Term Care Columnist / Guide · Aug 9, 2013

I'm so sorry. Nursing is hard enough without suffering severe anxiety on top of it. I can relate to your situation because I've been through a few jobs for similar reasons, although I usually stay a year or two. Part of my own problem is that I have bipolar disorder, and the anxiety is a component of that. I get the initial nervousness, then settle in for a while; unfortunately, something always comes up and people expect too much from me. That's when the anxiety attacks begin, and I have to quit or I wind up being fired.

You mentioned that you have developed a high tolerance for Xanax. You may want to ask your doctor if a different benzo might be right for you. (I've had to go to Klonopin myself because Ativan wasn't doing the trick anymore; it's a little stronger and lasts longer than the others.) There are also antidepressants that work better than Lexapro for anxiety, but again, you need to talk to your p-doc and see what he thinks.

It's pretty obvious that your current med regimen isn't adequately addressing your issues, but even with proper medications, psychotherapy is almost always necessary. If you're not in therapy right now, please ask your p-doc to recommend someone (unless he is also your therapist, as mine is). Personally, I've found cognitive-behavioral therapy to be invaluable, as it helps the patient replace negative thought patterns with healthier ones.

If all else fails, you may have to consider a less-stressful occupation, or something within nursing that doesn't carry the burden of holding peoples' lives in your hands. I've learned that if I don't have my mental health, I've got nothing, and I recently made the reluctant decision to semi-retire from nursing because I can't take the stress anymore. Now I only work weekends doing admissions at my LTC, and that I can handle.

Wishing you the best. This is a tough profession to be in when one has mental health issues. Please keep us posted.

allnurses Guide · Aug 9, 2013

I second the suggestion of cognitive behavioral therapy. It's worked wonders for many people. There are other meds out there which can help with anxiety, such as beta blockers and other SSRIs/SNRIs.

I'm so sorry you're going through this. Please talk to your p-doc and let us know how you're doing.

Alphabits · Aug 9, 2013

Did you have this problem with non-nursing jobs? Is it the feeling that you are the one responsible for the patient's well-being and you're simply not up to the task yet? You might want to consider a less stressful nursing job--or one with more safety nets, where you're not the ultimate repsonsible person (for instance, a doctor's office).

I had a simliar experience to you, wound up working in the pharmaceutical industry (on a call-in informational line) where I could use my nursing/medical knowledge but not have the fear of harming anybody.

chrisrn24 · Aug 9, 2013

Did you have this problem with non-nursing jobs? Is it the feeling that you are the one responsible for the patient's well-being and you're simply not up to the task yet? You might want to consider a less stressful nursing job--or one with more safety nets, where you're not the ultimate repsonsible person (for instance, a doctor's office).
I had a simliar experience to you, wound up working in the pharmaceutical industry (on a call-in informational line) where I could use my nursing/medical knowledge but not have the fear of harming anybody.

Possibly that until you learn to manage your anxiety.

Also just saying this but your reactions seem quite extreme. I understand that is the basis of anxiety but it seems even more heightened. When you ran out of Xanax and quit your job, why didn't you just call into work sick and call your psychiatrist?

That is great you are already seeking help but to be frank I think you need even more help. Nobody should need to take anti-anxiety meds every day to go to the same job...and quit a job with no notice. Perhaps it is time to switch therapists or seek in-patient therapy? Anxiety is anxiety but yours is debilitating.

SleeepyRN · Aug 10, 2013

Did you have this problem with non-nursing jobs? Is it the feeling that you are the one responsible for the patient's well-being and you're simply not up to the task yet? You might want to consider a less stressful nursing job--or one with more safety nets, where you're not the ultimate repsonsible person (for instance, a doctor's office).
I had a simliar experience to you, wound up working in the pharmaceutical industry (on a call-in informational line) where I could use my nursing/medical knowledge but not have the fear of harming anybody.

Thank you everyone for your replies. Yes, I do have the anxiety in jobs outside of healthcare. For example, in my early 20's I was trained 1 day to be a cashier at Sam's Club, and my anxiety caused me to quit that job as well. When I was 18, I worked for 3 days at a movie theater, and quit due to anxiety as well.

I agree to what everyone has said. To another poster, yes, you are correct. It is debilitating. Hence the title of my post. This is why I am seeking help. I KNOW how severe this is. Again, it is why I am seeking help.

With my first nursing job, I used my xanax for the first week, then no longer used it anymore because I felt comfortable enough without it. I took care of a few emergency situations, sending the resident to the ER, and felt good about myself because I handled the situation well. Then a trigger occurred (extreme bullying which I did address to the Don and ADON, which only made the situation worse.) I managed a week of this, crying while at work. Then, one day I I got up for work, put my scrubs on, and then had a panic attack and contacted my nurse manager to quit. I did actually have xanax that I just hadnt filled yet. By that time, it was too late. I KNOW it is unprofessional. I do not want to be this unprofessional person. I have been a reliable, long term (6 yrs) employee in the past, so I know I have it in me. As I said, while I am in that state of mind, there is no talking sense into me. I think illogically during those times, so calling in didn't occur to me. I also could have called to fill my script, and called work to say I would be an hour late. Then I could have sought a counselor's help to help me with coping strategies for the extreme bullying. (Nurses were refusing to give me a real report, and also not accepting report from me, pretty much ignoring me. All over a complete misunderstanding that led to false rumors that reached EVERYONE in the facility. Nobody listened to my side of it. I had never had an issue with not working well with others in my entire life, so this came as a shock, and it was very very hurtful. )

Cognitive Behavioral Therapy is along the lines of what I am looking for. I want to find a good, reputable book to get me started. I saw a therapist for about 4 years, ending just over a year ago. My therapist thought I was ready to cope with things on my own. I had made tremendous strides in issues we worked on. I am very proud of that. But now I know I need to go back again.

I just need suggestions for resources, like books. Again, thank you all for taking the time to read my post and to reply. It's very appreciated.

soulshine101 · Aug 10, 2013

Hello,

I am a survivor of diagnosed panic disorder and anxiety! I know exactly how you feel and it takes a very strong soul to openly admit your weakness and seek help, I applaud you! It took years of self-healing to get to a positive place in my life with anxiety, its never actually cured in my opinion just manageable. Its a chronic "disease" but all the things above such as cognitive behavioral therapy can be beneficial as well as yoga or acupuncture. For me, it took finally realizing that I have felt the worst of the worst with anxiety/panic and I survived, just acknowledging that it is anxiety in the moment is the first step to climbing over the hurdle. I tried all the SSRI's and clonazapem but it finally took getting a beta-blocker to really feel relaxed enough in situations that challenge my "disease." I am in my first semester of nursing school and was terrified about stress triggering panic/anxiety and it has in tenfolds, however, I find a support system with my family. I was told once that if you tell one person that you work with that you suffer from anxiety that it can be very therapeutic and take the edge off. I did this starting the nursing program and when I feel anxious I turn to her and just tell her I feel anxious. I'm not asking for the person to counsel but just letting someone know your feeling that way can instantly reverse the negative notion that you feel alone in the situation. I assume you probably never uttered the words "I have anxiety" to the jobs you left quickly b/c of anxiety? I suggest trying it and finding someone you feel an instant connection with at the next job and letting them know. YOu will be surprised how many people are suffering with you and have dealt with the same anxiety situations as you that are co-workers. Don't give up on nursing because of anxiety, YOU CAN BEAT THIS!~!

neversaynotopanda · Aug 10, 2013

Well done to you for seeking help and advice: you are already on the road to overcoming this anxiety by being so open and self-aware. I have also suffered debilitating anxiety my entire life and will till the day I die: it never disappears but you can learn how to control it very effectively. You obviously have the ability to overcome this; you have after all studied for and earned your nursing degree and I bet there were a few stressful days associated with that!

What worked for me was admitting my feelings to just one friend who put me in touch with a wonderful doctor who prescribed SSRIs and referred me to a psychologist for cognitive behavioural therapy (CBT). I would never rely on just meds alone or therapy alone but both of them together was the turning point for me. I finished 12 sessions of CBT and took baby steps to getting better: each achievement was a huge confidence boost to go a further step; then the next step and the next. I will be on SSRIs (100mg Zoloft) every day for the rest of my life I think as they give me that objectiveness I need to realize I'm becoming stressed and am able to step back and put into action techniques that work to pull me back to normality.

Getting older and learning not to care so much about others and their opinion of you also helps! I'm 48 now and have only really got this under control about 6 years ago so have a lifetime of missed opportunities because of crippling anxiety. I absolutely adore where I am now even though it has taken this long and believe me, if I can do it, you can to. One book I bought which really helped me was called "Fearless - Your Guide to Overcoming Anxiety' by Wayne Froggatt : check out his site Rational New Zealand - it's a fantastic resource.

I can only urge you to keep trying to find something that works for you and never take it for granted you will be 'healed' or the anxiety will suddenly magically stop one day - it won't! But you will be all the stronger for dealing with it and living a better life. Your brain can't wait to sabotage you and CBT really helps you to show it who's boss! Best of luck to you - you can do it.

sistasoul · Aug 10, 2013

Hi SleepyRN,

First off I want to offer my congratulations on finishing nursing school when you suffer from anxiety. I also have really bad anxiety and barely made it through NS so I know the challenges you faced. People who don't have anxiety have failed out so give yourself a huge pat on the back.

I have also quit jobs without a notice due to anxiety. I have also wanted to quit my med-surge job many times in the last 4.5 years due to anxiety. I have even been written up for anxiety. I really do feel for you. I don't know how old you are but I am 47 years old and have missed many opportunities due to stress/anxiety. Please get help now before any more time goes by because you will look back with regrets. I know I do. I have recently accepted a position in a Dr's office and I know this will be less responsibility for me and a better fit.

People who are anxious are usually sensitive and the patient's can benefit from this. I bet you have a lot of gifts you are not even aware of. Think of all the good you can bring to the patients and you will be able to do this.

Take care and please don't let any more time go by...

LadyFree28, BSN, LPN, RN · Aug 10, 2013

Thank you everyone for your replies. Yes, I do have the anxiety in jobs outside of healthcare. For example, in my early 20's I was trained 1 day to be a cashier at Sam's Club, and my anxiety caused me to quit that job as well. When I was 18, I worked for 3 days at a movie theater, and quit due to anxiety as well.
I agree to what everyone has said. To another poster, yes, you are correct. It is debilitating. Hence the title of my post. This is why I am seeking help. I KNOW how severe this is. Again, it is why I am seeking help.
With my first nursing job, I used my xanax for the first week, then no longer used it anymore because I felt comfortable enough without it. I took care of a few emergency situations, sending the resident to the ER, and felt good about myself because I handled the situation well. Then a trigger occurred (extreme bullying which I did address to the Don and ADON, which only made the situation worse.) I managed a week of this, crying while at work. Then, one day I I got up for work, put my scrubs on, and then had a panic attack and contacted my nurse manager to quit. I did actually have xanax that I just hadnt filled yet. By that time, it was too late. I KNOW it is unprofessional. I do not want to be this unprofessional person. I have been a reliable, long term (6 yrs) employee in the past, so I know I have it in me. As I said, while I am in that state of mind, there is no talking sense into me. I think illogically during those times, so calling in didn't occur to me. I also could have called to fill my script, and called work to say I would be an hour late. Then I could have sought a counselor's help to help me with coping strategies for the extreme bullying. (Nurses were refusing to give me a real report, and also not accepting report from me, pretty much ignoring me. All over a complete misunderstanding that led to false rumors that reached EVERYONE in the facility. Nobody listened to my side of it. I had never had an issue with not working well with others in my entire life, so this came as a shock, and it was very very hurtful. )
Cognitive Behavioral Therapy is along the lines of what I am looking for. I want to find a good, reputable book to get me started. I saw a therapist for about 4 years, ending just over a year ago. My therapist thought I was ready to cope with things on my own. I had made tremendous strides in issues we worked on. I am very proud of that. But now I know I need to go back again.
I just need suggestions for resources, like books. Again, thank you all for taking the time to read my post and to reply. It's very appreciated.

I understand your post; however, I agree with the poster that you posted this response to, in some form.

I do not think a book will help with your anxiety... :no: I know you are using it as an example, but I have to address this.

I say this because I tried to do all sorts of "alternative" treatments, with my anxiety issues with my PTSD...a huge part of having PTSD was interfering with my mood disorder trait of bipolar and that I had a history of test anxiety. I didn't have access to healthcare, and my health suffered.

My history of test anxiety was coupled with a few extraneous issues-low support at home for higher education...my father left my mother, and my mother was NOT the bet person to be around...they had a toxic relationship, which shaped me in not the best way. I almost felt at the mercy of my home environment. I sought out help and slowly got help from that. It reared up in nursing nursing school,unfortunately, and no one addressed the issue, it flew over their head...my not taking, engagement in class and clinical

and lab were excellent. They shrugged their shoulders and thought I would "get" it...I missed by one point to "get it". I eventually dusted myself off, and went back to nursing school for my PN...they identified and helped me with my test anxiety and used guided imagery as an example towards test taking success. I started taking up meditation, then yoga during nursing school, with much success.

When I suffered from PTSD, I was on mood stabilizers, and I had psychotherapy, which helped; but I knew when that ended I still needed help...especially when I entered into the BSN program I was accepted into. It took me some time to have access to healthcare, and to look for a therapist, with was anxiety driven itself. I found a good cognitive therapy and EDMR therapist and was able to take control of the issue, with success. I still have ways to go; I've been seeing my therapist for about 2 years...but I am better with the therapy than without it. :yes:

You may need to be on meds, and you may need an adjustment for a better med; at this time I think you should be committed to a medication regimen, CBT and go from there with your therapist.

The only resource I can suggest, which worked for me, is yoga. It helped me with clearing my mind, breathing during stressful situations, and positive focus. I also have an app on my iPhone that let's me "check in" on my stress levels, and has guided imagery that I use to help combat the stress. It has been helpful.

I send positive vibes in your journey.

coast2coast · Aug 10, 2013

http://http://www.amazon.com/Feeling-Good-The-Mood-Therapy/dp/0380810336

Feeling Good by David Brooks might be a good place for you to start. The original focuses a lot on depression, but there are some anxiety and self-esteem techniques in there that might help. He probably has other books specific to anxiety by now ... Just search on amazon.

Good luck.

swansonplace · Aug 10, 2013

Hello,

Below are a couple of tricks that I found that help:

1. Read as many books on a subject that I can on the subject. I would read from different professions point of view.

2. Handle the anxiety every day by: walking, yoga, exercising, writing, playing music

3. Taught myself how to break down an activity in small doable targets so I can learn skills that are needed:

1. For med surg floor nurse, break down into a skills class, a simulation class, clinicals with a professor to practice skills

4. Learned open eye yoga - way to relax self with eyes open. Can do this in public any time needed

5. Took a class on abnormal psych. My professor was exceptional and the knowledge from the class really helped.

6. Teach self how I could regulate or control anxiety by education, and physical stress handling concepts.

7. Learn to control the environment. For example, if a trigger is xyz, then try and control your exposure to xyz, at first to keep yourself safe, but build up tolerance over time, desensitize.

I found that doing cardio for a couple of hours on a low grade, relaxes me for 2 days. It relieves my anxiety very nicely, and I am calm and relaxed. This must be done consistently.

Also found that swimming for a bit, going into a hot tub, swimming, going into steam room, swimming, rinsing off, and then sitting in a dry hot sauna seems to relax every muscle in my body incredibly. This was just a treat.

A daily walking program really helps me. I walk and try to look around until I am extraverted or have figured how how to handle something.

If I want to do something, and I get nervous about it, I break the thing down in small doable segments, and practice each segment. When I go to do it with a team, it is much easier as I have practiced my basics already. This decreases the anxiety. For example, if I wanted to be a floor nurse, but am concerned about it. I would get the basic skills, and master those. A skills class could be taken, simulation class, and a class with a clinical professor. When I go to take my next step, it is just easier, as I broke it down into baby steps. Also, having a support system helps while doing the big step. This way I have broken things up into doable steps, and I have people to support me should I need it.

It's persistence and diligence that counts.