experienced nurse with anxiety on the job

[SFDRN]

Dear colleagues,

I was searching for pre-existing threads that I could contribute to, but only found ones written by nursing students. I, too, have performance anxiety at work, especially starting IVs and inserting Foleys (on women). Those two skills are the bane of my existence!

A little background: I work on a med-surg/tele floor that mostly takes care of >65 y.o. pts. I've been a nurse for 2.5 years, have worked on this unit the entire time, started there as a new grad. I spent a year on nights, learned a lot, then last year switched to days. I've been on days for a year. I'm an academically-minded person (working on my second master's) and am certified in my specialty. I've preceptored several new grads and am known for cultivating good critical thinking skills in the new grads on our floor.

It's those damn clinical skills that get me! Most of the time, our patients come up from the ER with Foleys inserted and IVs in place and our pts are in and out in usually less than 4 days, so often I don't get a chance to practice my skills. But when urgent things come up and I need a new line quickly or I need to insert a Foley quickly, I freak out, get all of those bad physiological anxiety symptoms (shaky hands, sweaty palms, racing heart, racing thoughts, crazed/distracted look) and usually end up having to ask for help.

I know part of the problem is that I'm rushing myself (going too fast), putting super high expectations on myself (additional pressure than just the situation), and thereby creating more anxiety for myself. AND, I have a history of depression/anxiety, which I mainly have managed (in the past) via therapy, exercise, stress-reduction. I'm not opposed to medication, just don't think I need it that badly.

However, all that said--I still want to be able to do these skills MYSELF without asking our resource or charge RN for help! What makes my anxiety worse is that I worry that I'm going to lose credibility in the eyes of my colleagues. I'm scared that they'll think I'm a total fraud who can't do her job. In every other job I've had (I'm a second career RN), I have been a leader and one of the most competent people on the job. It really bothers me that I'm not there yet in nursing--at least skills wise.

I see other nurses--totally relaxed (or at least able to hide it well), great at their skills, seemingly no problems with anxiety--and what kills me is that they have the same exact experience level as me (2 years or so) and have spent their entire careers on the same unit! Where the heck did they get so good at their skills?

Please share your thoughts with me about how I can get over this low self-efficacy/self-esteem and face my fears! Sorry for the rambling. Thank you in advance.

[Mrs. SnowStormRN, RN]

Hello, I can relate. So if you don't mind I'm following this thread for advice as well. I get anxious when starting IVs too. GOod Luck to you!

[Orange Tree]

Attack it, headfirst. Spread the word that you are horrible at foleys/IVs, and ask everyone to let you start theirs. I also like to bring along a resource person to critique my failures (and to take over and get the job done when it's not working out for me!) I just make sure to let them know how appreciated they are and to help them out in any way I can when they need it.

[NAURN]

I have been a nurse for 5 years and still suck at IVs! I work in an ICU too! It is just not a skill that I am very good at. But I am surrounded by nurses who are excellent sticks and I either have them stick after I have tried, or if we have the time, ask them to coach me... I have them watch my technique and ask them what I am doing wrong (usually nothing, just luck I guess). But I can stick an NGT or Foley is anyone, anytime... so we all have things that we are excellent at, and things that we are not so good at. Being aware of those weaknesses is the important thing, and then you know what you need to improve on. But always try.... I never ask for someone to do something for me if I haven't at least tried first.

[FancypantsRN]

Ok, just my experience. I was pretty awful and both IV's and foley's on women (esp older women). I now work in the ER where I have to constantly do both. I get about 9/10 IV's now and 7/10 foley on the females. It is only because of constant practice (not bc I am that great or anything). I never had to do either before on cardiac units (they came from CVICU or ER with lines in place). I can relate to what you are experiencing.

Is there anyway you could try to shadow for a day in your pre-op or ER to sharpen your skills? You would get loads of practice there.

[tokmom, BSN, RN]

Well, I have been a nurse for a lonnng time and I still pray before starting an IV and inserting a foley! Even foleys on men make my blood run cold when they don't thread. As a charge nurse, *I* feel as though I'm in the spotlight when it comes to insertions because of my years as a nurse and should be able to do it without problems.

It's pressure I put on myself all the time.

Do what another poster said. ASK to do others IV's and foleys. You will hone your skills quickly.

Remember you do have strengths in other areas. Everyone does. I might not be the best at IV (75% success rate), but I rock at NG's. :)

[brownbook]

I have felt the exact same thing. I've gotten over some of it. But getting over the psychological anxiety is a big start.

I really like orange trees advice. "Spread the work that your are horrible..." as orange tree said. Or if you don't have that much guts, (takes a lot of courage to admit to co-workers you are horrible at something) at least tell your self. Say to self, "Okay self, I need to start an IV and I am horrible at this, I KNOW I am going to blow it so let's not even get anxious or excited about it." Just a kind of jokey way to diminish the psychological pressure.

I really was bad at IV's, just practice, practice, practice, getting over the fear. Know you are going to blow it, try once and just get a go-worker if it didn't work. If I FINALLY got good at IV's anyone can!!!! There are numerous tricks and ideas about how to start IV's on other All Nurses sites.

Maybe You Tube has some educational videos about inserting foley catheters. They ARE hard of women!!!!!

[maryw1212]

if your hospital has an iv team ask to shadow them they would be the best at teaching you the secrets of venipuncture. even after 30 years i still suck at ivs and just came to realize its not my strong suit, but you are to young in nursing to give up. good kuck!!

[imintrouble, BSN, RN]

The nurses I work with trade off on procedures. That only works if everyone is willing. I stink at foleys. Actually the word stink is kind. But, I have a strong back. So the nurse who inserts my pt's foley gets her pts turned that night. We both consider it a fair deal.

[nicu4me]

inserting iv on neonates, as opposed to adults, very difficult. A few weeks ago, I just said to my self, "screw it" and just got my stuff all set up and didn't have anyone watch and got it in on the first try. It's very hard mentally to practice on 25 weeker as opposed to getting more practice on an adult with many veins to chose from. As far as confidence goes, I also finally decided as I walked through the doorway of a patient's room..... I'm going in there AS IF I had the confidence and see what happens. Sometimes with adults, they understand, just talk to them about their pets or whatever, they forget or don't watch you fumbling so much, or say I'm gonna stick you once and if I can't get it I have another coworker who will try. Getting used to neonates is very hard. Some people just have better fine motor skills, some people do great tape jobs and make great nests, I have some things that I am good at too, just not everything. Don't be so hard on yourself, and also I realized too that if I need a line in, that it's not JUST ME that has to get it. It has to be "gotten" somehow by someone so that eliminates some of the burden of responsibility. No one is gonna let your pt go without an IV just because YOU couldn't get it.

[Moogie]

I worked at a facility at which we had IV teams and catheter teams, so although I have been a nurse for many years, I haven't done too many IV starts or caths. My biggest concern is that I could be hurting the patient. Maybe that's what makes you nervous, too.

I think it's much better to say that you have problems with a skill or don't know something than it is to fake it.

[brandy1017, ASN, RN]

I'm sure practice helps, but some people are better at IV's than others. Some people are better at hands on, physical dexterity things like IV's. I've been a nurse for years, but consider myself only average at IV's. I make an attempt if I have the time, and know who the best IV inserters are. Usually somewill will volunteer, either a coworker or the stat team or ICU. Sometimes no one can get an IV in as so many's people's veins are picked over then we get a PICC line.

I think women are more tricky to put foley's in, its awkward and difficult to see. Men are a straight shoot, unless there's a prostate issue.

I too get anxious and frustrated when I can't get an IV in and wish I was better at it or at least that we had an IV team. Basically, lets face it we all have different strengths and weaknesses and if there is good teamwork and morale we all help each other and it works out in the end. But I understand that frustration that as smart, etc these little things can still trip a person up and be embarassing to someone who's used to being great at things. It is humbling. I still think nursing is the hardest job I've ever done and I've worked at alot of places from the time I was a teen till now and never struggled as much before in a job. Truthfully, it should be confidence building because my goodness if we as nurses can work under the stressful, short-staffed, overworked conditions one faces in hospitals and nursing homes, we should feel confident we can do just about anything else.