need advice-student nurse with anxiety disorder

Genista, BSN, RN · Apr 17, 2006

Hi Sasha. I'm an RN who has struggled with anxiety issues for as long as I can remember. I'm an extrememly organized person at work, and can appear very calm and decisive, but I have to admit that multiple sensory overload that occurs on med/surg floors can kick in the internal anxiety at times. First of all, the more experience you gain, then later on hopefully, the less nervous you will be. I was personally a wreck my 1st year as a new nurse, with having to do all these new procedures and caring for 6-8 patients. While I've been a nurse for nearly 8 years now, I still sometimes feel the anxiety kick in when it gets super busy and the demands are high, or when stressful situations unfold.

I will tell you what has worked for me. For one, I am seeing a therapist/counselor to help me deal with personal issues that contribute to anxiety, such as perfectionism and self criticism. I also was upfront with my doctor about my anxiety, though I don't take any meds for it.Sounds like you are already getting treatment, which is fantastic. Good for you! I do exercise at least 3 times a week. This helps a lot. I find that if I don't get enough sleep I feel spacey and it exacerbates my anxiety. Also- don't skip meal breaks at work. I find that even if the shift is really busy, I always try to eat,even if it's a dine and dash, because I get crabby and forgetful on a low blood sugar.;-)

As far as work/clinicals go, make sure you have a game plan at start of shift. Things will crop up, and you will have to be flexible, but I find it helps to plan out my night first thing. After report, I have a time line for every hour of my shift. I write in times that each patient needs meds, so I can cross them off my list hour by hour as I go. If I have a block of time with few or no meds do, that is when I try and squeeze in treatments, and charting (if not done after 1st assessment) and chart review, etc. I find that there is so much activity and things pop up, so having a time line and tasks written in (shorthand of course) helps me so I can get stuff done and not forget anything. I try to chart after my initial assessments, whenever possible. But to be honest, often I am on the run and don't get to it until a few hours later.

Of course, I still have moments where I get nervous too. These are the times where you take a deep breath, and prioritize! Ask yourself, "What is the most important thing to do right now?" Utilize your resources if you need help in figuring situations out...peers, instructor, other nurses, pharmacy, whatever.

Try to have a sense of humor about it! You will soon learn there are plenty of other nurses just like you, who care, are smart, but perhaps get a little flustered at times.

Oh- and another tip. I used to get sooo nervous calling docs when I was a new nurse. When you call doctors, have the chart and MAR right beside you in case there are any questions. I often will go so far as to write down the items I want to discuss with them before I call, so that when they call me back, if I am busy or forgetful, I can touch base on all the topics and not forget.

Good luck! Hope some of what I said was helpful to you.:balloons:

sasha2006 · Apr 19, 2006

Hi Sasha. I'm an RN who has struggled with anxiety issues for as long as I can remember. I'm an extrememly organized person at work, and can appear very calm and decisive, but I have to admit that multiple sensory overload that occurs on med/surg floors can kick in the internal anxiety at times. First of all, the more experience you gain, then later on hopefully, the less nervous you will be. I was personally a wreck my 1st year as a new nurse, with having to do all these new procedures and caring for 6-8 patients. While I've been a nurse for nearly 8 years now, I still sometimes feel the anxiety kick in when it gets super busy and the demands are high, or when stressful situations unfold.
I will tell you what has worked for me. For one, I am seeing a therapist/counselor to help me deal with personal issues that contribute to anxiety, such as perfectionism and self criticism. I also was upfront with my doctor about my anxiety, though I don't take any meds for it.Sounds like you are already getting treatment, which is fantastic. Good for you! I do exercise at least 3 times a week. This helps a lot. I find that if I don't get enough sleep I feel spacey and it exacerbates my anxiety. Also- don't skip meal breaks at work. I find that even if the shift is really busy, I always try to eat,even if it's a dine and dash, because I get crabby and forgetful on a low blood sugar.;-)
As far as work/clinicals go, make sure you have a game plan at start of shift. Things will crop up, and you will have to be flexible, but I find it helps to plan out my night first thing. After report, I have a time line for every hour of my shift. I write in times that each patient needs meds, so I can cross them off my list hour by hour as I go. If I have a block of time with few or no meds do, that is when I try and squeeze in treatments, and charting (if not done after 1st assessment) and chart review, etc. I find that there is so much activity and things pop up, so having a time line and tasks written in (shorthand of course) helps me so I can get stuff done and not forget anything. I try to chart after my initial assessments, whenever possible. But to be honest, often I am on the run and don't get to it until a few hours later.
Of course, I still have moments where I get nervous too. These are the times where you take a deep breath, and prioritize! Ask yourself, "What is the most important thing to do right now?" Utilize your resources if you need help in figuring situations out...peers, instructor, other nurses, pharmacy, whatever.
Try to have a sense of humor about it! You will soon learn there are plenty of other nurses just like you, who care, are smart, but perhaps get a little flustered at times.
Oh- and another tip. I used to get sooo nervous calling docs when I was a new nurse. When you call doctors, have the chart and MAR right beside you in case there are any questions. I often will go so far as to write down the items I want to discuss with them before I call, so that when they call me back, if I am busy or forgetful, I can touch base on all the topics and not forget.
Good luck! Hope some of what I said was helpful to you.:balloons:

thanks, your advice was great!

sasha

Kitty-MayRN, BSN, RN · Apr 21, 2006

Hi,

I have anxiety/panic disorders too. I've been a Med-Surg nurse for 4 months. It is a challenge. I have to block each hour and ask myself what do I have to do just this hour? I try to take it in small steps, but when a monkey wrench gets thrown into my day, I freak. I haven't figured out how to keep calm and focused yet in these situations.

All I have to say is good luck and I can empathize with your situation. :monkeydance:

johnson0424 · Apr 21, 2006

I am in the same situation. I was dx with anxiety disorder and placed on Zoloft and dont take it anymore(I know nurses make the worst patients) but I was new in medsurg and a new nurse too..since then i have been in management and have calmed down alot but am going back to medsurg 5 yrs late and am nervous i am going to be the anxious person I was back then...we shall see..good luck

MimismomRN · Apr 22, 2006

Thank you guys for sharing. I am a new LVN, 48, who has had anxiety all of my life and struggle with my nerves. I don't like medication, have tried it in the past and only felt worse in other ways. I am working in med/surg at my local hospital trying to gain experience while I finish my RN prereqs. It is the hardest thing I have ever done. I am supposed to have 9 preceptorship days but from day one I was just thrown in to take half of the 10-15 patient load. I do not know how I will handle all those patients when I am on m own. Right now I can ask my preceptor for help and advice. I get such anxiety, my brain will not work and I freeze, but I have found I am so busy I just keep going. I recheck myself on meds and things probably 5 times. But I find meds is mostly all I can focus on and sometimes realize later I have not recorded an output of a drain or something. Wish I could get more training on how to do chest tubes, procedures, etc. but there just isn't time I guess as my preceptor is busy with half of our patient load. I'm trying to put together some kind of form to keep my meds straight as sometimes I will have one patient with 20 meds due by 0800 and we are usually 1 1/2 to 2 hrs late sometimes. I'm right there with you guys. I guess all we can do is hang in there. I worry about the judgment calls that I have to make with no experience though (i.e. hold med, insulin, etc.)

Anxious and Nervous New LVN in California

Genista, BSN, RN · Apr 22, 2006

Hi. I was just checking in on this post & wanted to comment to the new nurses who are nervous about "flying solo" on med/surg. I had four weeks of orientation (pretty good huh?) as a new grad, but I was still nervous to fly on my own. An experienced coworker helped me out by reminding me that I wouldn't really be alone anyway, even after orientation. You can always ask for help from a coworker. If you are not sure what to do in a situation, you can ask another nurse, the charge nurse, even the nursing supervisor to help you in making a decision. To this day there are times that I call pharmacy, or another unit to talk to their nurses for advice (like the time we had a traction patient and I needed advice from the ortho floor).

Don't let the crabby "know it all" nurses get you down. There are always a few grumps out there eager to take you down a few pegs. I had one after me when I was new, and it was a real bummer having her follow my assignment. But I lived through it. LOL! Try and figure out who the friendly nurses are. Help your peers out too, when you can. Even the experienced ones need help! It's a busy job. I'm lucky to work with some wonderful peers, and I learn from them all the time. There's nothing wrong with asking for help when you aren't sure what to do. I have grown so much in this area in past years- where I can now be honest without embarassment with a doctor before procedural assistance and say,"You know, I haven't done this in over a year, so please talk me through it and let me know how I can help you." I think there is NO shame in inexperience, as long as you are learning & trying to be safe for the patient. To this day, if I have to do a procedure I have never done, I will grab another nurse who can help me or has experience...and we do it together! Good luck new nurses!:balloons:

MimismomRN · Apr 23, 2006

Thank you Kona for your thoughts and advice. I needed to hear this as I am so scared to be on my own after only nine days of orientation (which hasn't been an orientation) it has been a go do it situation. I just don't feel confident at all about being on my own and handling 13 patients or more.

Shell5 · Sep 28, 2006

Sasha, I know this is late, but i do want to respond and let you know I have struggled since I was 17 with anxiety, depression. I was raised with family who was critical and negative. When I went to nursing school my perfectionism and self critisicm only worsened. I was a perfectionist in many areas of my life. I was anxious because I wanted to succeed and I was afraid if I didn't that I would be a failure at life. I did not want to be life my family as I thought my family was not successful people. I felt my only way out was to make it through school. I turned to drugs/alcohol. I eventually got off of them. You don't want to do that. I did have therapy to find the root of my anxiety (fears). I found that being afraid is okay. The most important thing it to find a person, persons, and a Higher Power you can trust and believe in to turn your fears over to. You have already made a start by admitted you have these anxieties. I would have never admitted mine openly back then. You, alone, cannot handle all your problems. I am 37 years old now. I take Zoloft and Topamax. I have been sober for 5 1/2 years now and I help other women recover from drugs and alcohol. I am a RN and a good one. I still get anxious, especially when there is a bunch of work that starts to pile up on me and I feel I'm getting swamped (feel I'm not going to do it all perfect). I eventually make it through each day.....Sober. If I can make it you can too. Good Luck.