anxiety at clinicals: the kiss of death?

[amianurseyet?]

whoa! okay, i've always been inclined to anxiety. however, i maintain a decent sense of humor about it most of the time. i laugh is off as "neurosis" ala woody allen, and most of my friends, girlfriends, etc. have generally considered it an even endearing aspect of my character. perhaps because i'm open about being afraid about certain aspects of life, and am willing to talk about it with people?it's a good ice breaker, generally. but.....the level of PHYSIOLOGICAL anxiety that i'm experiencing in nursing school (in labs, and now in clinicals) is ,at times, totally humiliating. i mean, the other day at clinical, my hands were actually shaking as i typed my patient info into the system. this would not normally have been the case, of course; however, my clinical instructor was observing me while i did it, and i've got a thing about that. basically, when i've got anxiety, you would never really know it, EXCEPT for if i had to do anything fine-motor related (like, say, typing) in front of you. i can't exactly tell my sympathetic nervous system not to be my sympathetic nervous system at will. it was embarrassing. she's really cool, but she noticed enough to tell me to take a deep breath and chill. see, that just kinda sucks that my anxiety is that visible and there's nothing i can do about it. my brain is there, i've got it more or less together, etc. but, i'm not acclimated to the clinical setting yet, and, until i am, these physiological manifestations of anxiety are going to persist. i know myself well enough to know that, with time and repeated exposure to the environment, all that will dissipate and i'll be completely fine. my fear, though, is that, due to the constant scrutiny of observation i'm under, my instructor might consider anxiety an actual "problem," a sign of weakness, etc. there is no jedi mind trick for me. i've tried them all. all i can do is persist and wait for my brain to turn the anxiety thermostat down. i just hope that this instructor (and future instructors) are cool enough to understand that. anyone else experience fairly persistent physiological manifestations of anxiety while under the supervision of clinical instructors? i'd be really interested to learn how it's been for you. and, i'd be particularly interested to learn whether or not your anxiety issues have ever come up in your evaluations. thanks.

[dudette10, MSN, RN]

Are you early on in your clinical experience? Some anxiety is normal, and it does get better with time. However, it should never completely go away, as some anxiety is important to performance.

It sounds more like you have the jitters with something new or with being observed, rather than all-out, debilitating anxiety. Give yourself time.

As for evaluations, I think a lot goes into it, not just if your hands were shaking. If your brain is working, you're good to go.

[amianurseyet?]

yeah, just started this weekend. my instructor seems, thus far, impressed by my academic stuff (e.g., care plans, chart reviews, ability to answer science/health related questions, etc.) but, she's indicated that she can see my anxiety. i just wish i could hide it better. my return-demos in lab, for instance, though i passed all of them, were an absolute disaster (imo). very jittery/sloppy indeed. i just don't do well at performing fine motor tasks on a tight rope over a snake pit with no practice. but, maybe that's just me. my real concern, is that i'll eventually get one of these instructors who, rather than focusing on teaching me to be a nurse, will instead take it upon herself to make comments about my personage (i.e., a tremor in my hands, things i generally have no control over at all, etc.) and somehow equate those things with not having what it takes to be a nurse. because, i can say with certainty, that being personally attacked does not generally motivate me to perform exceptionally well.

[nursel56]

I could have written that amianurseyet. When you are observed and you need to do something involving fine motor skills the anxiety can get so bad people start to ask you if you are alright and is there anyone you would like for them to call for you. There are a lot of threads in the (now don't freak out) Disability Forum, and the Stress Management Forum.

One of the doctors I worked with a long time ago had me cutting sutures while he sewed up lacerations and minor surgeries, and for some reason the more I thought about those that had to be cut really close to the knot made me freak out about my hand shaking and of course the extra adrenaline meant my hand would shake even more. Same thing for when you learn venipuncture. I found out that it helped to tell people I had the issue ahead of time, which removes the "what if they see my hands shaking?" element.

It's certainly nothing to be ashamed of and there are a lot of people who take meds that have a tremor as a side effect. It doesn't mean you can't be successful! It will probably help to practice all your motions that require fine motor skill over and over as repetition does help. Time under your belt will help. If it's so out of control it is intolerable you can see your doc who can prescribe something like a beta blocker but that advice is way out of our pay grade here on allnurses.

I'll see if I can find some of the threads that suggest books and other strategies people have used to manage anxiety that has started to dominate their thoughts to a distressing level.

[Nurse Kyles, BSN, RN]

I think the instructors are well aware that these new situations in clinical are NERVE racking!! I have crazy nerves with hands that tremor too. In a few weeks when you get more accustomed to the clinical site, instructor etc you will be fine, I'm sure. I always get super nervous, but after a while the nerves ease to a tolerable level. You will get better at adjusting to clinicals as time goes on.I don't think that you have to worry about personal attacks or them doubting your ability. All of the criticism I have received from instructors has been constructive. As nursing students, we need that constructive criticism to be better. My nervousness did come up on my eval, but wasn't a big deal. I was disappointed with my first clinical grade (B), but according to the rubric a B is consistently at the expected level. My next clinical my grade improved significantly, mostly because 1) nerves were less 2) I addressed every area that my first semester teacher indicated was a weakness.

So, don't sweat it. You seem to be just like many other first clinical students. As your comfort level increases, your anxiety will decrease. Good Luck to you!

[amianurseyet?]

thank you! yeah, i'm confident it will go away; because, as i've said, this is something that i've been dealing with on and off throughout my life. i know how it works. there's definitely a pattern and predictability to it. which is comforting in its own way. in other words, i know what situations are going to elicit the response, and i can generally predict how long it will take for it to dissipate. anyway, i've got 5 more days and then clinicals are over, which is hard to believe. so, not too many shots to prove my salt to this instructor. if i can't impress her with my typing, i'll do it with my care plans, i guess.

[jadedjane, ASN, RN]

I get it too! I'm nearing the end of my second semester now (doing IV starts and pushes scares the daylights out of me). I think the only way I can get over my anxiety is preparation. I have to get to clinicals at 5am and get all the information I can - look up all my medications (including compatibilities, dilutions and push rates). I still feel really nervous - and haven't had a ton of experience priming new bags and changing tubing. To make matters worse, I have to do it in front of my instructor (who is fabulous - but intimidating still) and tell her why the patient is getting the medication (including knowing levels for K, Cl, Ca, and NA for each patient - if there are additives) and what this medication will do to the patient - good and bad. If we choose a patient, they are OUR responsibility. All assessments, meds, procedures and charting from start to finish must be done, and on time. At any given moment our instructor will come along and ask "How's you patients?" and I'd better KNOW SOMETHING relevant and meaningful - or "tell me about your patient", "what do you anticipate" - holy cannoli!!! - lol

Preparation doesn't always ease the anxiety. I hope you have an instructor as fantastic as mine. I make it a point to discuss it with her after post-conference if I feel that it hinders my progress. We have been trying to isolate the actual source of my anxiety (other than scrutiny and the "newness" of the situation). It comes down to my need for more experience. I need more practice doing all the things that scare the willies out of me. I think I will always feel some anxiety (it's natural) and I never want to get to the point where I am completely comfortable and confident. That could lead to some dangerous mistakes.

I have to say....having patients has never been a source of anxiety. I love having the luxury of spending time with them (while in nsg. school). In many cases, it's the nurses that kinda scare me. Sometimes I feel like we impose on them. They are very busy and maybe don't have time (or the patience) to have a student nurse to worry about. I want to be that kind of student nurse that RN's want to work with, and no matter how hard I try or how much I know - it isn't always the case.

Sorry about hijacking your thread (and using as a outlet for my own anxiety). I just want you to know that you aren't alone, and I don't think it's the kiss of death (maybe the voice of reason instead)- unless you allow it to be.

If it makes you feel any better:

I dropped a saline lock on the floor after starting an IV (right in front of the charge nurse in the ED) I had to sit there and occlude the vein with one hand while getting a new one ready:eek:. I was so excited that I "got in" my brain went blank for a split second and it slipped right out of my fingers. Next time I'll have a kung fu death grip on that thing:D

[amianurseyet?]

not at all! i totally appreciate your input. that's exactly the sort of thing i came in here to hear!

[jabernathy]

I was terrified my first three clinicals (and I've only had three so far). My hands also shook and my mind seemed to go blank whenever my instructor came to observe me doing anything. I totally understand the desire to be able to NOT show how nervous you feel. I realized that I needed to NOT drink any coffee before my clinical because the extra caffeine was NOT helping my nerves. I thought I would need a little coffee to help me wake up (since we had to be there at the crack of dawn). Little did I realize that my nerves would keep me alert, no coffee needed. My third clinical, which was last week, I actually was so nervous that I forgot to drink my coffee that I had brought with me in the car. As the morning went on, I realized that although I felt nervous, my hands did not visibly shake and I felt that I was able to calm my racing mind. Perhaps it was just because this was my third clinical and I was getting more used to it. But I would still highly advise you to skip the coffee that day to try it out.

[dudette10, MSN, RN]

my real concern, is that i'll eventually get one of these instructors who, rather than focusing on teaching me to be a nurse, will instead take it upon herself to make comments about my personage (i.e., a tremor in my hands, things i generally have no control over at all, etc.) and somehow equate those things with not having what it takes to be a nurse. because, i can say with certainty, that being personally attacked does not generally motivate me to perform exceptionally well.

Cross that bridge if you come to it. If you keep thinking about it, your anxiety will only increase. Good luck!