Feeling overwhelmed at work, need help managing it.

[Catch22Personified]

A friend and myself moved to a new hospital in the emergency dept. He came from a large university hospital ER and I came from a very small community hospital ER both of us had less than a year of ER experience before moving to this hospital. This hospital is the only level 1 trauma center in like a 50 mile radius so it gets really busy.

My friend has been doing well and basically thriving, but I'm doing terrible. In less critical areas I was doing fine since it's like my old job dealing with abdominal pains/flank pains with the occasional nursing home patient that had something wrong with them. But as soon as they put me in their critical care area hit I felt completely useless.

They start me out with a chest pain which is fine then the charge nurse goes take this MVA coming up. So in the trauma bay I completely choke and fail to get the IV (the vein was so huge too you could probably put a 14 in it!). Patient is stabilized and then I gotta chart. I go to lunch so my preceptor is covering for me, when I come back a patient that was assigned to me was showing stroke like symptoms, CT scan him and he resolves so its probably a TIA. During most of this time I keep just freezing up/spinning my wheels not getting anything done.

More happened that day but getting new patients while monitoring these critical ones basically killed me. When I had a TPA patient, I was basically 2 hours behind since I can't leave the patient for the first hour. And when I get so overwhelmed my nursing judgement just disappears, BP on one of my patient's is 80/42 and I'm about to hang fluids and call the doc. Little did I know the patient is being admitted for this problem, the patient is asymptomatic, and the patient's pressure has been trending like this.

I rarely felt like this at my old job. But at this new one I feel like I know nothing and all I do is get nervous/freeze up. Any tips to suppress the freezing up/getting overwhelmed part? On the floor when I had so much crap to do, I knew I could prioritize it a lot easier because I knew my patients were stable, but here all my patients are sick so prioritizing is even harder to me now.

[JWG223]

I've had these feelings twice in my life. The first time I was 16, and my grandpa was working under a car. It came down on him as he was negligent in using blocks and just used a hydraulic jack, which bled down rapidly. I screamed. My dad solved the problem and jacked it back up. I felt rather worthless, and it's one of my more shameful moments.

The second time the wheels came off of my bus, I was doing room clearing drills at night using simunitions (real weapons just firing paint filled plastic markers. They hurt a little worse than paintball). There were "non combatants" and one armed combatant. The other guy was hunting me and I was hunting him. He engaged me as soon as I entered the dark building. I just saw muzzle flashes and bang bang bang and ran immediately to a large room and took the hard corner (corner near the wall on the side of the entrance. The most defensible point in a room). He refused to enter the room. I refused to leave. I would pie off the door and then move back to the hard corner. Over and over and over. The instructor came in and no began challenging me "wasting time. Vapor lock. You're not getting it done. You're shifting momentum to the other guy..." And my heart rate and breathing got even faster. I began pacing faster and faster and I remembered my failure as an did young boy with that car and jack.

I took action. Pied off the door and exited the room. Cleared the hall. Progressed down it. Exchanged a few shots with my opponent who was taking cover in a utility closet. I pied that off. Too space away from him one foot at a time until he was hunkered in the corner, came around and used my handheld light to disoriented him and scored a solid hit.

Why the long story? Because I can relate to vapor lock. I can relate to the wheels coming off the bus. And I found the solution!

You do what comes next. One. Step. At. A. Time. Any trained monkey can do most things. Just break your task down into manageable chunks. I stopped thinking "this guy is trying to shoot me...I'm trying to shoot him!" And just started thinking "okay...properly clear the room you're in. Now the hall yiu can see. Now into the hall. Now. .."

It carries over into every single facet of work, family, finance. Everything. You handle the immediate issue first. Don't think about the whole process except as a blurry abstract. Handle that issue. Then the next. Then the next.

Don't see: "messed up mva that I have to fix." See: "iv I need to start". Then the next task. Then the next. Soon you will have your patient stable and squared away...or they will code. But you know what to do then, too. Do your part in the code the same way. In this manner you will serve and save every patient that it is possible to, one step at a time, and without overwhelming yourself or stressing over things before their time. ("Who cares about CT? I haven't started the iv yet....involved care about CT afterwards...")

Just my .02 and what helped me to arrive at it.

[SubSippi]

The advice you received from the above poster is great. That's exactly what you need to do.

You're feeling this way because you're letting yourself get overwhelmed, but you can minimize this feeling by concentrating on one thing at a time. Because, since I'm assuming you're a human, you can only do one thing at a time.

And since you can only do one thing at a time, another important skill to focus on is the ability to prioritize.

I have a feeling that your friend who is thriving does these things, but it came a little bit more naturally. There's nothing wrong with having to work at it, most people do. And quit comparing yourself to other people, that's a sure-fire way to feel inadequate. Think about the progress you've made, I'm sure you're better than you were on day one.

Another bit of advice, is that is everyone is stable, get the quick tasks out of the way first. Don't try and get the most difficult or time consuming thing first, to get it out of the way. These things often take more time than your bargained for, and then you're behind on a million things. If you get all the little stuff done, then maybe you're behind, but it's just on the one thing. And it's much easier to catch up that way.

[jadelpn, LPN, EMT-B]

Breathe. Just Breathe. You can only be one place at a time, and do one thing at a time. Watch your monitors, get to know your trends. Check you orders. Otherwise, if you need help from your preceptor, ask for it.

Remain focused. You will get this, just a matter of being able to prioritize. If you are 1:1 with TPN, then you need to report off to your preceptor on any other patient that is left undone. Sound like your low B/P person was taken care of in that they were written up for admission.

Do you have computers at bedside? Laptops? You could (and should) chart as you go if feasible. If there is a way to be able to look at the monitor of your patients on the computer, learn how to do that. Then you have a thought about what is happening to your other patients while you are 1:1.

This is still a learning curve for you. At the end of the day if you could I would have a few minutes with your preceptor to say "I am feeling as if I am not prioritizing as well as I know I can. Could you help me with this?" Or, "when I need to monitor the first hour of TPN, what happens with my other patients?" Then you can have concrete answers you can deal with in your practice going forward.

Best wishes!