experienced nurse with anxiety on the job

Nurses General Nursing

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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.

Specializes in Med/Surg, OT, Mgt.

first of all thank you sfdrn for bringing this issue to light and beginning a discussion in the nursing community. you said that you're an academically-minded person (working on your second master's) and you're certified in your specialty. you also have preceptored several new grads and you're known for cultivating good critical thinking skills in the new grads on your floor. wow. this is amazing! ok so you're armed now and ready for the battle and nothing can bare your existence including those 2 damn clinical skills :). i'm always telling my students clinical skills are just one part of nursing profession.

dear sfdrn from the comments i think you realized that you're not alone . you said during emergency you usually end up having to ask for help and this was the right decision. you knew your limitation and you acted as an assertive nurse. :up:. i suggest you talk to the staff development unit in your hospital to arrange some refreshing clinical courses including starting ivs and inserting foley catheters. remember never too late. finally, don't be so hard on yourself and remember the following:

"confidence comes not from always being right but from not fearing to be wrong". ~peter t. mcintyre

if you hear a voice within you say "you cannot paint," then by all means paint, and that voice will be silenced. ~vincent van gogh

"always act like you're wearing an invisible crown"

nobody can make you feel inferior without your consent. ~eleanor roosevelt

Great response Alot... and you must be in a different time zone than a lot of us here in U.S. I do not know of any places here that offer clinical skills due to the economy (the economy of the hospital) so on the job is how it is done most places here. Most nurses would love for others to do their tasks and to help teach so putting the word out "please let me put your IV in, etc" will work wonders. Oops, my computer time is off so you look like you are in my time zone.

I am so glad we can be honest and say, "hey...I freak out about some clinical nursing skills." I am a new grad and will begin working at a step down unit in the Ocotber, but I can't stop thinking about how I don't feel I am ready clinically. I am great academically and with my critical thinking, but I feel I lack with my clinical skills simply due to lack of practice and repetition. I am so so worried to start the step down unit and seem so dumb. What freaks me out are all the lines (knowing what can and cant be run on each), medicine calculations, and IV's. So, I am thinking about maybe taking a clinical refresher class to simply ease my fears and maybe get more practice. Has anyone reading this done any clinical refresher class in souther california where we can practice with IV's, lines, etc... Any suggestions? How do I overcome my fears. I am beginning to feel that maybe I am just not fit for this job? :crying2:

Sounds like you are one of those people who strive to excel in all that you do which is good, however; that can lay a large of amount of self imposed stress on you. Nursing is a second career for me as well, and I always excelled in the military even under high stress situations, but find it a little more difficult to push through that as I get older. Failure anxiety is a crusher at times, and can be pushed through, but really saps the fun out of the job. Most often we think everyone will think poorly of us if we don't do everything perfect. They actually might be relieved that you are not a machine, and struggle with some things like everybody. FYI...Some folks (nurses included) can have a General Anxiety Disorder and find a lot of relief from the stress by taking a med to help, like Lexapro.

Also, Extra IV starts may be something you could do at same day surgery, they do umpteen million before the sun comes up for sure. Maybe they would let you shadow and spend the whole morning doing all the sticks for a couple days. Just a thought. That is where I got the best understanding of doing IV starts. Had the best RN, actually the Manager walk and talk me through about 16-20 of them and it has stuck with me.

Remember to enjoy everyday! Take care.

Specializes in M/S, ICU, ICP.

i have so "been there done that." my thing was having to put down ng tubes on patients that were alert and oriented. i would rather be run over by a mack truck than do that. i guess what i mean is that we all have skills or tasks that we are less comfortable with than others, or even do poorly compared to others.

as long as you are trying, experience will help a lot of that discomfort decrease. but 20 years down the road there will still be things you are less proficient at performing. there are some tasks that i do well but lets say i am just "average" at starting iv's and a patient comes in with few to no veins to be found and needing iv therapy stat. i will likely ask someone that i know is extremly good at hitting a vein with their eyes closed at 50 feet. no sense putting the patient through it and wasting time or veins.

i am comfortable with foleys, iv's, (i am one of those 50 feet away with eyes closed types) and dressing/ostomy changes, etc. but to this day if i have a patient that needs an ng tube i will look for my buddy-nurse to do it for me and then i will go do iv hard sticks for her.

it gets better. 2.5 years is still very early in a lifetime career. experience and time are the best teachers of all but don't beat yourself over the head if you have a skill you are not "the best" at. tell your anxiety level "this too shall pass". good luck.

Doing IV's on the elderly can be tough with their tiny veins and no muscle or fat to hold them still. I too have that "OH NO" feeling and I'm an endoscopy nurse. You have to just grit your teeth and try it ONCE. Then ask someone else to try. You can't blow too many veins or they won't have any place to be stuck.

As far as foleys, my daughter in-law is an LVN at a nursing home and it is her job to change the foleys every month. She said to aim up. I've tried it and it works. Just tilt the tip up and it seems to go right in in elderly women. My instructor used to say look for the wink but you have to have good lighting down there to see that. Maybe try a flashlight down there for better vision.

I'm a second career nurse too and it takes a while to feel confident in your skills because everyone is different. No one is built the same. The one thing I do is listen to the client. If they say they are a hard stick, I don't even try, I get help because I don't want to hurt them by sticking them unnecessarily.

Specializes in M/S, ICU, ICP.
shared this on the allnurses.com fb page for more input. if you have not liked our fb page, please do so :)

http://www.facebook.com/allnursescom

just a thought here brian but i love this place so much at alnurses and the format that i prefer it over fb. there is no telling who reads fb, and i know this is not "private" so to speak, but it feels more nursey. is nursey a word?lol.

of course i am older and not too thrilled with change and progress...they didn't have computers smaller than one that was 3 stories high and several city blocks wide when i started nursing. (at least we didn't have to write on stone tablets tho)

Specializes in ED, Informatics, Clinical Analyst.

This is a great thread! I have foley anxiety big time and it's good to know I'm not alone. I've been a medic for 7 years so IVs are no biggie. A few things I've learned: most people with bad veins know it and don't expect you to get it on the first try or sometimes at all. Sometimes no matter how good you are you get patient after patient with horrible veins and every once in a while people get in an IV starting funk and can't get their sticks but it passes. There's nothing wrong with using smaller gauge needles in people that don't need a large bore IV, 22s and 24s are just fine for giving meds and they are easier to thread because the catheter is shorter. Sometimes in darker skinned people or people who have been stuck a billion times using a larger gauge is helpful because they has thick skin or scar tissue. There are some people that will scream like you're killing them no matter what so don't take it personally.

Also, it never hurts to ask where they usually get an IV or if one arm is better than the other.

Specializes in CVICU.

The OP doesn't indicate whether he/she is male or female. I'm guessing if the OP has trouble inserting foley's into women that there is a good chance the OP is a guy. If I'm wrong I applogize.

But here is my 2 cents when it comes to men inserting foleys into women. Simply DON"T DO IT. There are plenty of women on your unit to do it for you. This is not meant to sound sexist but men should avoid that area like the plague and if it is absolutely necessary have a female in the room and even better have the female do what ever is necessary there.

Take some of the pressure off of yourself. Whenever you have an IV or foley to start, just tell yourself that you are gonna give yourself 2 shots at it. Best case senario - you get it! yaaayyy!! Worst case - you grab someone else to give it a shot. Yeah, the pt will endure another minute of discomfort but it is a necessary evil when you are admitted. Oh, and if the person is a screamer/super anxious/etc, don't feel bad about getting someone else to help (even to just help distract them). This one hysterical lady is one of the few IV sticks I have been unable to get... their anxiety will just pile on yours and kill your confidence. Another thing - I consider myself pretty darn good at IVs but every now and then I will still find my hands starting to shake once it's done! Don't focus on that anxiety. It will get the best of you. And just keep practicing! Good luck! :)

Wow, you guys are fantastic! Thank you for all your helpful and supportive comments!

It is so reassuring to hear people say that they still struggle with skills 15-20 years out of school. Hearing that has made me feel that perhaps I have unrealistic expectations for myself to do everything well with only 2+ years on the job. I think my other problem is that I put pressure on myself to get things right the first time and within 5 minutes or so! Maybe I just need to slow down and take some deep breaths, as a few of you have suggested.

Yes, I could probably get my CNS to let me have a day in pre-op surgery for IV sticks and possibly Foleys as well. Great suggestion!

Also, I definitely do attempt all IV sticks myself the first time when a pt needs a new line (I try 2x and then ask someone else) ... Foleys--same thing--I usually bring someone else in, but I'm the one doing the first pass at insertion, then I hand things off if I get too unsterile/frustrated. We don't have an IV team or a catheter team, so my backups are resource RN and charge RN. If need be, we can also ask our UD, who's an amazing stick, but we try to save her for super hard situations.

And, yes, I'm actually pretty good at NGT insertion and don't have a lot of anxiety about that skill--no idea why! Thanks for reminding me that there are SOME skills I'm actually quite good at :)

Oh, and FYI, I'm female ... that doesn't necessarily help you Foley other women, though, as many other female RNs have testified here :-) I think it does help female patients feel more comfortable, though, to have a female RN insert a Foley.

Anyway, I just want to say THANK YOU AGAIN for all your reassuring, helpful, and confidence-boosting comments. I feel energized by the pep talk! I'll save this thread to my hard drive and look at it when I get down on myself again in the future. Now I'm actually looking forward to going back to work next week.

Specializes in M/S, ICU, ICP.

oh, and fyi, i'm female ... that doesn't necessarily help you foley other women, though, as many other female rns have testified here :-) i think it does help female patients feel more comfortable, though, to have a female rn insert a foley.

i am so with you on the foley and genders. being the same sex does not give you extra help on meatus finding from the catheter gods.

i think that there is nothing more elusive than an elderly woman's urethral meatus! i do not care what the textbook says or what the diagrams show....those things recede, hide, run away, tighten up into less than a dimple, and move up into nether regions! (i have seen them up inside lady partss by several cm!) there must be a childbirth-to-moving-meatus ratio somewhere. ever tried to find one when the little lady is a grand multipara with 12 children "living". get me a guide dog for hide-and-go seek!

i would rather do a foley on a rock. lol

and yes, give yourself a break. you do lots of things well, even some things great. but as ong as we are human there are always going to be those tasks we are not good at.

i used to have what i called iv pms. you could almost bet good money that if i could not start an iv that day without several sticks..... then i was more than likely fixing to start. those days a vein could be half an inch wide and standing up on the arm with a sign saying "stick me right here" and i would miss it. i knew menopause had some good qualities! lol.

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