How to control nerves

[unicoRNurse]

I had my first return demo tonight, on vital signs. I practiced a lot and was comfortable with the skills going into it, and I have done well on all my tests and quizzes thus far (knock wood). Anyway, I tend to be on the anxious side, so I was pleased with myself for being able to get through a day at the office, followed by lecture and lab, maintaining focus and without chest pain -- a major improvement over how I handled the days leading up to the start of school, by the way -- and without worrying obsessively about my impending competency evaluation, which was scheduled for 8 PM.

Well, class ended at 8, and I was fine. At 8:02 I sat down in the testing room, and immediately my hands went ice cold, I started to sweat, and I began uncontrollably shaking like a leaf. So I try to calm down and start with temp (fumbled getting the cover on the probe because my hands were shaking so much, but I managed). Then I looked at the pulse oximeter, picked it up, pressed the button several times, hard, and couldn't figure out why it wasn't turning on (hint: I was pressing the off button). Then I looked at the finger clip and couldn't figure out why it wouldn't open when I squeezed it (uuuh, that would be because I was holding it backwards, despite the picture of the finger on the sensor clip -- which looked like hieroglyphics to me at that point).

Okay, I PRACTICED these things -- never mind that a 2 year old could properly operate this pulse oximeter. I kept myself calm all day and all evening, then as the test began I became stupid with fear! My HR was 95 (a poor classmate had to take my apical pulse as part of her exam), and that was after I had calmed down some from the humiliation of handling the pulse oximeter like it came straight from Mars. I passed, thank heaven, because I truly do know what I'm doing, but talk about a hot mess!

So. If you've successfully completed a few return demonstrations, and especially if you tend to be a little on the anxious side, like me, please share your techniques for keeping your nerves under control. (This was just vitals -- I need to nip this in the bud before we get into things involving needles!)

Thanks!

[BostonFNP, APRN]

I know it doesn't help but it honestly does pass with time. Most people have moments when they do there first demos or give their first shots or give report for the first time or do their first scope. The more you do the easier it is the next time.

[CheesePotato, BSN, RN]

There there, Jill. Deep breath.

I promise you it will get better and easier as time goes along and you become more comfortable in your newly acquired nursing skin. Keep in mind that we have all flubbed things at some point or other and return demonstrations are particularly nerve racking. To the point of flubbing things, some of us still do on a routine basis (ever notice how tech support's first question is always, "Is the device plugged in and turned on?"....yeah...there's a reason for that). Let's face it,@#%# happens.

Personally, I did my fair share of damage during my first return demonstration taking vitals on a mannequin. Tore the arm straight off. Laughed so hard I swear I nearly peed the floor. Still nailed it.

As time goes along, I can promise you that these crazy moments will turn into amazing stories--as many crazy moments do. My days of nursing school as well as my nursing career are chock full of just such moments and I wouldn't trade them for the world.

For those of us that tend to border more towards the anxious side of things, proper preparation and rehearsal seem to be the key ingredient to maintaining calm in the face of pressure. That being said, allow for plenty of time in the practice labs and be sure to have a strong practice partner who will be supportive and act as a cheering section for you. With practice, such things as deep breathing, meditation, and, my personal standby, the art of personal forgiveness (which is the awareness and acceptance that one has done the best they can in the situation they are in) will also serve you well and aide in allaying some of your anxieties.

Keep in mind that as you go along, should you feel yourself becoming flustered, you are empowered the ability and the right to pause. I don't care if you are taking a test or performing a return demonstration. If you feel that spike in anxiety, just take a second to have a breath and gather your thoughts. Many instructors will not tell you that such a thing is perfectly acceptable (thought why the neglect to talk about it remains a mystery) and even the most seasoned of us need a moment, every now and again, to reign everything back in. As you go along, you will find your own way to sneak a paused moment so its not quite so obvious--I, for one, wash my hands. Started doing so during one of my return demos in nursing school and continue to do so to this day. In fact, some of my best thoughts have been had over a scrub sink.

Let's face it, the unpredictable happens. Many times the instructors are just as interested in seeing how you will handle yourself in these circumstances as they are in seeing whether or not you can correctly complete the skill. You did good when you kept working at the pulse ox (trust me, they know you don't walk around with one in your pocket being used on a day to day basis. The instructor was really just glad you didn't have a hissy fit and wrap the chord around the patient's neck.) and there are going to be tons of firsts in your world.

Chin up. You did just fine. If nothing else....it made for a great story. :)

[unicoRNurse]

Thank you very much for your kind and thoughtful responses. CheesePotato, I sincerely appreciate the time you took to offer me such good and detailed advice, and I will definitely implement several of your suggestions.

[S.RN]

I hear you about the nerves! These days I don't even know what a good nights rest is. I'm on "10" all day at school that when I get home by body is exhausted but when I lay down my brain will not shut off!

[Despareux]

I remember my very first check-off; it was vitals and I was a mess. I was shaking the whole time and even cried afterward because I was so anxious. The anxiety was so torturous for me during my first semester, I even considered seeing my doctor for something temporary to quell the anxiety. But I never had to go that far because I had a great lab instructor who helped me. She told me to associate a bright electrical ball with my anxiety and visualize a place in my body to always store this ball. Every time I felt my anxiety I was to locate where I stored my ball and to visualize the ball's brightness as it relates to my anxiety. For example, if I was anxious enough to be shaking, my ball would be as bright as a spot light, but if my anxiety was nearly manageable, my ball would have the glow of a 150 watt light. To quell my anxiety, I would visualize my hands around this ball, squeezing the brightness (anxiety) out of my ball, all the while controlling my breathing and slowing my heart rate, also using visualization.

I practiced this method a lot during nursing school. Now that I am an RN, I still use this method and it is still very effective. It certainly doesn't hurt to try something like this.

[DawnJ]

I can't tell you how many students in my class either have crushing anxiety or are medicated for it. Zoloft can be your friend!

[JessL85]

Too funny I came across this thread tonight because I was going here to post something similar, asking for help!! I had my third checkoff this afternoon. I didn't feel nervous at all before going in. I knew what I was doing, and the other two had gone fairly well, so what was there to be nervous about?? But just like previously, I started shaking. We were doing NG medications and my hand was VISIBLY shaking as I picked up the container of water to put some in the tube (it's a wonder I didn't spill any). I also was visibly shaking during our first checkoff too (second one I felt better about, for some reason), and my teacher actually commented on it. Today she just said that I did well, but I really need to work on my nervousness...I'm quite worried that when we start clinicals, that I'll be just as nervous, if not more so, and the patients will not want me anywhere near them. I almost never get nervous taking written exams, but anything that involves someone watching and critiquing me - nerveracking!

So anyway, I have no advice, except to say I relate AND I appreciate you starting this thread so hopefully I can read some comforting words of experience and wisdom as well.

[JessL85]

I can't tell you how many students in my class either have crushing anxiety or are medicated for it. Zoloft can be your friend!

Haha, I seriously started contemplating today if maybe I should get medicated and see if that helps!! Just seems like I should try to deal with it in different ways first...

[unicoRNurse]

Thanks, everyone, for your suggestions and/or commiseration. I feel like I've gotten several good ideas from this post, and while I wouldn't wish this anxiety on anyone, I am also oddly comforted to know that I am not alone.

As for my first experience with real live patients (next week), I am hoping that by using some of the techniques described above, and by really focusing on my patients -- and not the fact that I am being watched and judged -- I will be better able to let go of (or at least better mask) my anxiety. Then, hopefully, having managed not to freak out in the hospital will help me get through my next return demo. :)