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.
practice is the best way to learn... I have had days where I couldn't hit one vein, and other days where I hit even the hardest veins. You just have to keep trying! Also, if you can't get a line, know who on your unit you can ask for help. People don't mind, if you're willing to help them do other things!
I am only a third semester student, but I know the feeling. It's especially hard for me when I seem to be acing everything I try, then miserably fail in front of the instructor. I'm glad to hear that even experienced nurses have problems with foley and IV insertion, although we usually end up getting the "you should have been able to do that" lecture when a foley insert or IV attempt fails.
This is an interesting topic of discussion because I too faced similar challenges while I was practicing in the clinical setting. I've been an RN for over 20 yrs & decided that although I was good at my job, I had skills that reached well beyong the clinical setting.
My point is that sometimes, limiting oneself prevents you from exploring other ways to practice nursing. My advice to you is to keep your mind open & think well outside the proverbial box. You may be surprised that you can perform very well as an RN in a different setting, such as Community Health, Education, Case Management, Public Health, School-based nursing...and the list goes on. Try it, you might be surprised at what you discover! Good luck!
Bless you- I remember feeling that way during clinicals in nursing school. The more I would think about it-the more nervous I would get. I'm just better to just grab what I need n do it. Get the foley kit, tell pt what I'm going to do, be on right side of bed bc I'm right handed- with a female pt- if you get them to cough it will help you to find meatus. When I'm nervous I talk to distract. Once you do a task a thousand tends, it's second nature.
No one gets good without practice. 3 years in LTC and I am really pretty dang good at Foleys, IVs I have had less practice on, but am getting better. The more you try, the more you get. Get out there and Stick every chance you get. Remember when you were in school and as a student in clinical were always asking the nurses to let you know if they had any skills that needed completing? Well consider yourself back in school so to speak and like another poster suggested put it out there you want the first attempt on every IV and Foley on your shift. Before long you will be the IV and Foley Queen.:):redbeathe:nurse:
Placing a foley in the older female- meatus is usually closer to the lady parts or "down around the corner" one of my nursing instructor would say. Also older pts w bad hips or the demented ones, u want them to lie on their side- it's easier to access from behind
I'm a new grad and needed more practice at IV's. So, I spread the word and told my CNS. She had me go down to the ED where I got to practice and they gave me some good tips. Use the manual BP cuff (100mm/hg) as your tourniquet. Pops them puppies out real nice! lol You just have to let it down to about 40 or so before you can advance the catheter. Also, go in pretty much parallel to the skin. I f you go in at too much of an angle you'll go right through. Good luck!
You are totally normal. It takes time to get comfortable with this job and there are just some things that we excel at and some that we do not. Many gave the right advice: ask for someone to be there with you and help and take over if you have a problem. Then do it again next time. Eventually you will succeed. And remember a lot of us are anxious and put on "the face" to all. I remember going into the bathroom at work a few times a shift taking deep breaths and then going back to work. Don't be afraid to ask and all good nurses will be happy to help.
Specializes in Critical Care. CVICU. Adult and Peds PACU..
i work on a urology floor and whenever i have to cath a female patient, i always bring in a second set of hands. it's far too difficult to try to stay sterile, hold and insert the foley.
You brought up a good topic. Yes it is impossible (at least for me) to cath a female and be sterile. Need two sets of hands. And sorry big girls, but cathing a heavy patient can be a nightmare. Easier with guys except when you hit that prostate!
:)
:redbeathe:nurse:
NamasteNurse, BSN, RN
680 Posts
How about taking a certification class? The only way to get better at skills is to actually do them.