Doubting my competency

[Serotonin2]

Hello all, 

I apologize in advance for the long post. I am trying to process some feedback and determine what is valid and what should be let go. I am currently starting a new position as a mental health nurse in drug and alcohol rehab.  I'm thankful as this has been my goal since I started nursing school.  Previously, I was a pediatric neuroscience nurse for two years, and before that, I worked as a CNA on a Neuro/Trauma ICU floor for 4 years.  As a bit of background about myself,  my whole life I have been told by those around me and by my supervisors that I am considered to be very caring and compassionate, but also perfectionistic. I also have OCD and anxiety. However, the feedback I received from my last supervisor was quite different.  First it was feedback that she heard from the other supervisor who heard from other nurses that some nurses were afraid to give me report.  I asked if she could get clarification on what this meant and she didn't.  I tried to see if I had offended any of the nurses I typically get report from and none of them had an issue. I relayed this info back to my supervisor who responded, "well they might not be telling the truth". Then I was talked to about a pts mom who was livid because she felt I was cold towards her, "gave her false information" ( which I definitely did not), and didn't answer the call light after three tries. (I was very busy in two other pts rooms. I do feel responsible though because this pt was a new admit in the middle of my shift, but in the craziness I forgot that our new phones require us to assign the room number to our phones so that we get the call bells). I tried to apologize,  but the mom was too busy swearing on the phone. As a new grad, I was placed on an improvement plan for incidents regarding a ventricular  drain that I wrote myself up for. Some were valid, others, I was told by other nurses were not worthy of being written up and that I was being overly scrupulous. I successfully passed that plan and haven't had any errors since. However,  ever since the plan, my anxiety and OCD skyrocketed.  I felt as if I were having a mental breakdown. I ended up taking out some time for mental health help. When I came back,  everything seemed to decompensate.  The week I returned,  a family asked that I not be the nurse  because they were uncomfortable with how much I rechecked things. (I'm still working on that OCD). Then a week after that,  I was fired by another mom (historically known to be dreaded by every nurse and doctor because of how difficult she and the pt are to work with and how manipulative the mom is.  For example,  the pt took her meds mixed in apple juice. I mix up the meds, but she complains the juice is too cold.  Then I warm it up but she complains it is too warm. I cool it off but it is still the wrong temp.  This was a 20 min process.  Meanwhile I have other pts I need to attend to). Despite trying to advocate for her, clarify questions and concerns,  get the pt laughing when she was otherwise sad, this mom fired me for " being cold towards her daughter,  leaving a side rail down (even though I fixed it when she asked and the pt was not in danger of falling out of bed), and recommending that the pt pick a less saltier dinner option due to her sodium being high. So again,  I was called into the office and talked to about their concerns  for "inconsistencies in my practice" due to these complaints and the fact that I get out 30 min late half the time. I guess I'm flabbergasted because never in my life until this position have I been told that I act "cold towards people". I also don't understand how these two complaints point to practice inconsistencies.  I admitted that my anxiety and OCD had affected my practice and that I was getting help for this but they did not speak to this. All I received were vague responses and the above examples.  I explained that putting me on a PIP would only increase the anxiety and essentially paralyze my performance. They gave me time to decide if I wanted to stay and be placed on the PIP or leave in good standing 

so I began looking for other jobs. Then a very traumatic incident occurred.  The physicians say I saved the child's life and that I did nothing wrong,  but I still feel so shooken up by what happened. I was given time off to basically work through what occurred,  during that time I received an offer for another job so I resigned.  But now I am really bugged by the feedback that I am "cold, intense, and unapproachable ". This is the last thing I want to be especially because I will be working in mental health.  I've also never been told this until now so I'm confused. Also, my first 2 years as a nurse in this position were hell. I feel I have lost all confidence in my nursing and people skills and I'm feeling afraid that I'll fail in this new position. I start my job in a week am getting married in 3 weeks and am battling other life stressors.  I'm feeling numb, overwhelmed and a bit depressed.  Any advice?

[JKL33]

Sorry to hear of your troubles.

I don't have much experience with your exact concerns, but want to offer encouragement. Things are going to be okay.

Work with your own healthcare providers to make sure that your mental health regimen is optimized. Counseling can be very helpful in addition to whatever medical regimen your providers might suggest.

Next I think you should explore the idea of keeping your internal self separate from patients. Meaning, their problems are not your personal problems. Their problems are not a result of you or your nursing practice--their problems are THEIRS. I am emphasizing this because some of what you have conveyed in your post are criticisms you experienced solely because of other people's problems, such as the lady with the juice that wasn't the right temperature. Or the mom who didn't see anything positive in your efforts with her child. When you begin to see yourself separate from your patient's problems, you will grow stronger. You will realize, for example, that if 3 different juice temperatures are not right for someone, then **THEY** will have to make a choice and it is no longer up to you to try to satisfy them at the expense of other patients' care. Or that sometimes people have their own damn problems and instead of doing the hard work of dealing with them (or maybe they actually aren't capable of dealing with them), they just lash out at others.

Remember this: If you weren't there (as the nurse) these patients would simply be criticizing someone else (whichever nurse was there instead of you)!

Re-develop your confidence. Start afresh. Carry yourself with purpose, which helps patients have confidence in your care and be less likely to nitpick you or be suspicious of your competence.

I know this post is getting long, but one more thing: You need to be careful how you receive critiques from others such as management. You don't need to ask a lot of questions or waste your time telling them how you feel about it all. The more you talk, the more there is for them to pick apart and criticize. Again, while carrying yourself with purpose, simply say "thanks for letting me know" or as little as possible according to the circumstances.

I think you are kind of in a cycle where you hear a critique, you over-analyze it and take it personally, your anxiety and OCD tendencies increase further and then you are more likely to receive further complaints and criticisms and the cycle repeats. You've gotta break the cycle. Do that by making sure your own mental health is optimized and then developing an air of pleasant confidence which, while pleasant, also has the effect of decreasing people's opportunities to mess with you.

Anyway, hope you can somehow use some of these thoughts to your advantage.

Take good care of yourself and good luck to you ~

[Peachpit]

Some patients/family members are never going to happy no matter what you offer or do (or don't offer or don't do). In time you will learn, I hope, to not let that bother you. If YOU know you did a good job/all you could, then that is enough - even if it's not enough for someone else.

As far as coworkers, I have never been one to consider my coworkers friends. I am friendly to them of course and help them if they need help, but whether they like me or not, at the end of the day, I honestly don't care. It's a professional relationship and that's all. That is not to sound cold but like the previous poster stated, you need to, for your own sake, learn to separate yourself from patients, their families, coworkers in that you approach and respond as a professional and nothing more. You are not a caregiver/maid/personal assistant to them, you are a nurse.

As far as your anxiety/OCD, it sounds like you definitely need to get some professional help with it if possible. As the other posters said, you need to take care of yourself first and everything else will fall into place.

As far as your supervisors, they are poor managers if  they are calling you into the office to discuss issues they have no basis for other than something someone said versus facts. It sounds like part of the problem where you work is the management.

Please do not let a handful of patients, families or managers keep you for moving forward (even if that means moving onto another position). Some people are only happy when they are making others miserable and not everyone in a leadership position is a leader.

You sound like a very caring, dedicated nurse. Keep that part of yourself but set some boundaries, never be afraid to stick up for yourself and you will do just fine.