Sense of Dread....When Will It End?

tokmom, BSN, RN · Jan 7, 2012

Personally, I don't think it's limited to ICU. Every nurse, either new, or as old as dirt as me, goes over the day, hour by hour and wonder if we missed anything or did the right thing.

Does it ever go away? Yeah, I think it gets to the point you realize you did the best you can and thankfully your patients survived through the shift.

tokmom, BSN, RN · Jan 7, 2012

As for getting sleep? Try some melatonin. Works like a charm for me. The only downside is you can get some pretty vivid dreams. :lol2:

AICU RN · Jan 7, 2012

Thanks, tokmom. It's crazy. I worked at another hospital for ten years as a desk clerk/aide and I thought having that experience would help and it has. It's just the incredible amount of responsibility that is inherent with all nursing piled on top of the fact that my patients are intubated, have a-lines, trachs, triple lumens, ventriculostomies and what not.

Some days I feel so unintelligent. I make silly mistakes and get overwhelmed. I don't like my preceptor having to tell me something more than once and they tell me I'm very good at not making the same mistake twice. Nevertheless, I feel like everyone in that unit is just so overwhelmingly smart. They tell me it comes with experience, sometimes I just feel like I'll never get there.

Then there are days like today when I feel that I've done everything right. My patients were happy and my charting was timely and thorough. Yet, I still can't shake that feeling that I've missed something. I get that if I did forget something, chances are night shift will catch it and fix it. I don't know. I know it will take time, I just worry a lot.

Thanks for the melatonin tip, I am going to try it for sure. Also, thanks for listening and letting me know I'm not alone. That's always nice to know .

Home Health Columnist / Guide · Jan 7, 2012

moved your thread to our first year after nursing licensure forum. if you take a look around you will see many similar laments... 3,6, 9 and 12 months all have different levels of dread/concern. i can remember being on vacation at disney world in year 2 and having to call unit as i had concerns about a patient that i left out detail from report.

a great read is sticky found at bottom of forum:

hang in there new grads and new nurses it does get better..i promise

NCRNMDM, ASN, RN · Jan 7, 2012

I hope to be a new grad ICU nurse after I graduate from school. Even though my clinical instructors tell me I do a great job, and have given me nothing but positive reviews, I still have days when I feel like I'm doing absolutely everything wrong. There are days when I go home from my twelve hour clinical wondering what I missed, if that breath sound was really significant, if I should have reported that drainage from the JP, if I made some mistake that I'm too stupid to even realize, etc. I know that my patient care has to be good, or I would be in conference with my clinical instructor as others in my group have been. I think that being self-conscious is natural for those of us who really want to be good nurses and provide the best patient care we can. I know a few people in my nursing program that aren't really in nursing for the patient care, and they don't seem to have these concerns. While all the rest of us are rehashing the clinical day with each other to ensure that we didn't miss anything, they are looking up football scores on their phones, calling their friends, planning trips to the bar, or talking about something totally unrelated to nursing. The panic usually doesn't really hit me until long after clinical is over. I get home, take a shower, eat, and get in bed. Then, in the middle of the day/night (depending on what shift clinical was) my mind begins to race. The panic rises in my mind, and I realize that it's too late to correct any mistakes I may have made. Did I do that dressing change right? Did I record all my I&O? Was my change of shift report acceptable? Was my head to toe assessment good enough? Did I miss something? Was that drainage normal, or should I have said something about it? It happens almost every night. I'm not sure when it will stop, but I don't think it will be anytime soon.

AICU RN · Jan 7, 2012

Matt,

Here is an example of an actual conversation I had with my preceptor. To put things in perspective, we had a patient who coded at 6:30pm on a 7am to 7pm shift. Our other patient was sweet LOL who was on a vent.

Me: I think I forgot to do 6pm mouth care on our LOL in bed 40 last night.

Preceptor: You were in a code.

Me: Yes, but her mouth care was due at 6pm. What if she gets vent assisted pneumonia because I didn't do it?

Preceptor: Did you do mouth care on her the rest of the day?

Me: Yea, of course.

Preceptor: Relax. She's still here, see. It was a crazy night. She doesn't have pneumonia and the world is still turning.

So yea, I worry a little. And honest, I know the importance of mouth care in preventing VAP. I was just illustrating my point.

Good luck in your nursing career. I'm sure you'll be fine.

Nurse Karen,

Thanks for getting my thread to the right forum. I already read the post you linked me to but thank you, it's a good one. I guess I just needed to hear it again.

NCRNMDM, ASN, RN · Jan 7, 2012

I understand exactly how you feel. The first time I give meds they were thirty minutes late because every student in my group was giving meds, and I was second to last. I freaked out and told my instructor that I was really uncomfortable being even the slightest bit late with my medications. Our facility gives you an hour before, and an hour after to administer meds, so it wasn't a big deal. For example, the med was due at 11, but under our policy it could be given between 10 and 12. I give it at 11:30. To me, this was a major issue, but in reality it wasn't a big deal. The med was on time, the patient didn't suffer any harm, and everything was fine. I know that these things won't get better overnight, and I'm working on stressing less over these issues. However, I still find myself wondering if my actions harmed my patient (or if I forgot to do something important). Also, thank you for your kind words.

AICU RN · Jan 7, 2012

Oh, our charting is completely electronic and it's a really good system. We, too, have that our window and if something is overdue a little red overdue button will pop up on your MAR. I hate that button being there. Usually, it means one of two things for me. It is either a respiratory treatment that the RT gave but just hasn't had a chance to sign of yet or my patient has limited access and its an IV antibiotic that has to wait until one of my other piggybacks are done for me to hang it. Little by little, I am coming to the realization that this button is not going to make my patient spontaneously implode and on some shifts there's nothing you can do to stop it from being there.

On the bright side, I have met lots of ICU nurses, and let me tell you most of their personalities are just like ours. Almost every preceptor I've had says things like, "Don't mind my OCD, but these tangled lines are driving me crazy." In the meantime, I'm already halfway across the room because they are driving me crazy too. I hate tangled IV lines. Anyway, yes we stress. Yes, I have terrible days. I even had one last week where I kept telling my friend I was going to quit and walk away from nursing forever. It turns out we make pretty good nurses in the end. Just keep breathing (and preferably keep your patient breathing, too).

P.S. I just remembered that I forgot to tell night shift about my totally stable patient's leg twitches. Apparently, it happens when he's nervous or over tired. Happens all the time, but I kept asking him if he's okay. Forgot to pass that along, but look, I'm coping with that, okay? :thankya:

suanna · Jan 7, 2012

I've been working the same critical care unit for over 25 years and so far it hasn't completely for me. If you get a definitive target date let me know so I can have something to look forward to. The good news is it is less and less disruptive to your piece of mind at home as the years pass by. The most important thing you can learn is to leave work at work. When you punch that clock- refocus on what is MOST IMPORTANT- your home, your family, yourself. It's always OK for the shift that follows me to call if I forgot to do or give something that they cannot figure out from my charting or report- but Heaven help anyone that calls and asks me "why I didn't change my patients linen...." The job is important, but if you let it take over your life it will.

I have told my boss, and my co-workers- "I'm home and off the clock, this isn't something that is going to greatly impact the patients care today I'll be happy to discuss it when I come in next time. " You need to do the same with yourself- there is plenty of time for nit-picking when you are on the clock. I doubt there is ANYTHING you did or didn't do that is going to seriously impair the patients care in the course of one shift. Worry all you want when you clock back in the next day.

AICU RN · Jan 7, 2012

Suanna,

I just typed up a response that I was really happy with and it disappeared into cyberspace. So, round 2 lol.

I really appreciated your kind words. I have always been a worrier and now I'm worried that it's wearing off on my seven year old (sheesh). I hear from her teacher that she is a model student and incredibly bright but worries about everything. Because of that, I have made a concious effort to cut down on my worrying and obviously it is a work in progress. The profession we chose just makes it so much harder.

I like your policy on home phone calls. My problem is I am still on orientation and therefore still have a preceptor who is responsible for me. I don't want them to get the silly phone calls for a mistake that I made and I certainly don't want them to get in trouble for some crazy stupid big mistake I made. Of course I worry that I made some colossal error that is going to cause my patient major harm more but I also worry that my preceptors are going to lose faith in me or someone's going to tell my preceptor about something I did or didn't do that I didn't even realize. In other words, I don't want to cause grief for these awesome people who take the time to teach me so much.

I left the clamp on a piggy back once and didn't realize it for a whole 20 minutes. I was devastated. Until my preceptor told me it happens sometimes. Then I could breathe again.

And just now, I realize there is a nifty auto-save feature. :cool: Yea, I totalllly knew that.

CrufflerJJ, BSN, RN, EMT-P · Jan 7, 2012

I think that some degree of worrying/OCD is a good thing in the ICU. Especially as somebody with a couple months under your belt, double-checking is good. Being complacent or over-confident is not good.

It will be even more exciting when YOU start precepting newbies in your ICU. If you think you were paranoid about your own work, just wait until you're working to get somebody else up to speed. Fun times!