Extreme Anxiety and Nursing

[Aliceozwalker]

Good afternoon everyone,

Sorry in advance for the long post. I am looking for support on what to do in this situation. For background information, I have been a nurse for exactly one year now. I am currently working as a nurse at two locations (a busy medical floor at the hospital and in the community). I have diagnosed generalized social anxiety, social anxiety disorder and a history of depression. I have had five suicidal people who I was close to in my life, one of which who did hang themselves while I was in university (this all becomes relevant to the post). 

2020 was a very challenging time as I feel it was for a lot of people. I started nursing by myself in February and felt extremely blue for a while and felt the patient loads at the hospital were very intense. In April, I had a panic attack while at work (hospital) and was sent home. My manager then called me and told me that I should go on short-term disability and seek some professional help. I did get a psychologist and saw them every week for 2 months, I currently see them once a month as therapy is expensive and not covered. 

However, recently another patient came forward and told me a similar "If I die it is all your fault" sort of statement and again I did get triggered and went into this almost panic state loop for a full 24 hours and called in sick. I have talked to my therapist about it and she states that it is a fear-based reaction surrounded in guilt for not being able to save or help the suicidal people in my life toppled with my already high level of anxiety. We are looking into trying to help me with this problem but she states I will likely always be an anxious person.

The issue is that even after a year at the job, I feel frustrated as I still have extremely bad anxiety when going into the hospital and a bit at the hospice. I have to practically drug myself (9mg of melatonin and 50mg of gravol) to fall asleep before day shifts as if I don't I will wake 5-6 times over the night or have a nightmare and wake up in a panicked state unable to get back to sleep. When I do go to work, I feel sick for the first few hours before and during my shift. It's not unusual for me to feel nauseous, lightheaded, dry heave, get a pounding headache, etc. I feel a sense of dread every time before I go to work and have gained 25 pounds since starting nursing. While on my shift, I can't relax and often spend my time charting during my breaks. I had hoped that my symptoms would get better as time went on as new grad nerves can be a thing. 

My psychologist states that I do have a pattern of avoidance and worries that if I leave the hospital job that it won't really help me overall since wherever I go my anxiety still follows. I'm just not really sure what to do at this point. I spent five years getting my degree in nursing and worry that even if I switch professions that the anxiety will still be there. On the flip side maybe there is an environment that isn't so fast-paced, with no knowledge of what you are walking into day by day. 

I'm curious as to what other people who struggled with anxiety or mental health do to keep going on. I'm starting to wish that I got sick or injured so that I wouldn't have to go in anymore. Any suggestions, insights or personal experienced would be much appreciated. 

[Been there,done that, ASN, RN]

Bedside nursing causes anxiety for many of us. There are many settings where you can use your degree. Search here on AN and the job boards. There is home care, insurance companies, and clinic nursing  .. just to name a few. Get searching, best wishes.

 

[speedynurse, ADN, BSN, RN, EMT-P]

Financially - are you able to go down to one job instead of two?

A change in jobs is sometimes needed. There are more routine jobs out there or non bedside jobs....

[TheMoonisMyLantern, ADN, LPN, RN]

I'm so sorry you're having a difficult time, but please know you're not alone. I realize that your psychologist says your anxiety will follow you, and I'm not going to contradict that because he/she knows you. However, I would encourage you to either try a different specialty within the hospital or consider moving to a non-hospital job in a different setting, not because it's easier but because each setting and specialty is a different kind of stress so depending on the setting/specialty perhaps your anxiety won't be as debilitating.

Several months ago, I had to make a similar decision, I liked the job and the specialty I was in, but the type of stressors on that job were breaking me even with intensive interventions. I made a change to a completely different setting, and of course I still have my issues, but they are no where near as severe as what they were.

There are many, many, nurses who struggle with some sort of mental health issue with varying severity, I hope you are able to find a position that will be more conducive to being able to cope with your anxiety.

Please be good to yourself.

[Davey Do]

17 hours ago, Aliceozwalker said:

even if I switch professions that the anxiety will still be there

I can identify and empathize with you, Aliceozwalker.

Know that you are on a pathway to improved mental health. From reading your post, I can see that you have great insight to your situation and you're working on improving that situation. Those are two key ingredients to recovery.

I copied this part of your post because I agree with it- no matter what situation we find ourselves, there will always be stress and we will react to that stress in the same way.

Case in point: I worked with a great Intake Worker who was a Vietnam vet and he would experience anxiety over a stressor in his job much like he did as a soldier. He told me this.

How do we get out of that place we're in when we experience stress?

By working a program. We live our program. We eat, drink, breathe, and sleep our program: 24/7 365.

You have already began developing your program, Alicozwalker, by seeking professional advice, taking some meds, expressing yourself, and reaching out  in order to gain understanding.

I will make suggestions on things that I have done that have helped me: In living my program, I start my day with positive reinforcement- a spiritual reading, I do art, I deep breathe, use visual imagery, and pray- especially when I'm stressed.

You mentioned that you "wake up in a panicked state unable to get back to sleep", for which I can truly identify. Even now, and my life is currently stress-free, being a retired nurse.

Here's what I do: I recite a mantra, the Lord's Prayer being my fav, over and over and over again. I deep breathe to a count of 8-12 seconds. And I focus on the phosphenes- the blurbs of light we see when we close our eyes.

If I use this technique, I have never not been able to fall back asleep. If I don't use this technique, I invariably suffer from insomnia.

A couple of other things I do is exercise every day, lifting weights and doing aerobics. I try to eat right.

One last suggestion I may make is to get involved with Emotions Anonymous. It's free support group that utilizes the 12 step program that gives us instructions for recovery.

I could go on and on until the cows come home, Alicozwalker, but that's the gist of my "suggestions, insights or personal experience".

Oh- BTW: I also use humor. See my signature line.

PM me if you like. The very best to you.

 

[Aliceozwalker]

Thank you so much for all of the replies! It really makes me feel appreciated and valued so honestly, thank you from the bottom of my heart. I will write a general response here, then respond to you one at a time.

Yesterday, I was moved to float in the ICU which really terrified me as I am a pretty new nurse. However, it was maybe a good thing as there I had some heart to heart with other nurses in the ICU and other nurses who were pulled from their units as well to float. The general consensus from all of us is that bedside nursing in the hospital is bad everywhere right now. A lot of nurses are telling me that as a new grad it would be hard to find a year that was worse to start in over the past 20 or so years. I think a lot of us are struggling, even those who don't have mental health issues, to begin with. 

I decided that even if I were to start a new job now, I would likely hit the ground running there too and may still feel anxious. Plus, I do want to eventually go and get either my master's or become a nurse practitioner so that I'm not necessarily tied to bedside quite as much and could instead do research/teaching/set patients. The only reason I have stayed with this job as long as I have is that most universities require a minimum of 2 years of bedside nursing. I felt it would look good to have hospital and community experience on the resume plus I honestly could never do hospital alone without having panic attacks and such. 

Partially from a sense of obligation and partially because of my future career goals I have decided to stick it out BUT with much stricter guidelines on myself or I will never make it without breaking down at some point. I used to work a lot of 48hour weeks between the two jobs but while the pandemic is on, I'm setting that to no more than 40hrs with no more than 24hrs being at the hospital. I may also ask for a low-level anti-anxiety medication for when I do need it. When the pandemic is over around March or April, I will look into solutions for switching units at the very least and ultimately as soon as I have my two years applying for a masters/nurse practitioner license asap. This way while I will still feel dread and get anxious before work, it is not a constant feeling due to so many shifts and I can also focus more on self-care with the extra eight hours or more in my week.  

[Aliceozwalker]

Responses:

beentheredonethat: Honestly, if it weren't for the pandemic and my future plans to get a master's degree, this would be my plan. But to my knowledge, if I am interested in any post-secondary I should stick to bedside as much as I can for another year. 

speedynurse- The community job I am at does pay less but I did get a dollar raise this year. The community job does also not have the ability for me to put money towards a pension, which the hospital offers and is considered essential to me from a future income/stability standpoint. Hence why I always stuck the two out. 

themoonismylantern- Thank you so much for your kind words. I am sorry to hear that you also struggled but am glad that you found a better workplace that fit for you. If it wasn't for the pandemic, moving units in the hospital would be easier. As it is, they have actually blocked some people from moving to certain units and such which is crazy to think about. (ICU nurse tried to move units and the hospital denied her applications citing that the unit absolutely needed her and she could be moved when the pandemic was over basically). They couldn't do this if I switched hospitals but the hospital is literally a 10 minutes drive to my house with the next closest being close to 30. I'm also not convinced that at this moment switching units would help anyways, every unit seems crazy busy right now and I would be with new staff/new setting. I think my best bet is to so some shifts at the hospital while starting to do more in the community which is actually a lot more chill at the moment. 

Davey Do- Thank you so much for sharing your story and strategies. I agree with you that this is something that should also be my focus. As it is hard for me to change my environment I need to get better at self-care and finding some semblance of structure in my life. 

[SmilingBluEyes]

Oh I feel you. Been there recently. For me the solution was as simple as moving to a less chaotic clinic with fewer patients and less stress.  It made ALL the difference.

You are certainly not alone. Try to work w/your psychologist to figure out a way for  you to reduce your stress and anxiety; maybe a new job, and as someone else pointed out, or,  if you can let go of one of your jobs, it may help.

Sometimes outpatient/clinic nursing helps some. There are work from home jobs like insurance, but they can be hard to get if you don't have the experience. I have personally had no luck, yet, getting anything--- and I have been a nurse in various settings for 25 years.  I may just not be putting the right things in my resume.

Anyhow, no solid solutions but I can empathize.  I hope you can find the answers to reduce your stress and feel better, soon.

[JKL33]

I will give my standard advice of making sure that your medical therapy is optimized.

Best wishes ~