Need some reassurance

[OrthoRN1979]

I've been a nurse for about 5 years now. I've got a pretty awesome job working for a surgeon in his office. I do mostly telephone triage and post-op office visits. My boss and I work well together and he always gives me positive feedback and so do the patients. I've been with him long enough that I can read his mind. He gives me A LOT of autonomy, so much that I have to reel him in sometimes (one time I asked him for a zofran order for a patient and he said "you know you don't need to ask me for that". Hah.....I had to break it to him that I do have to ask).

For some reason, more recently, I've been having almost paralyzing anxiety about making a mistake or missing something. I replay incidents in my head, and worry about missing something and having a patient report me to the board or sue me. Last night it was so bad that I cried and snapped at my poor husband. Nothing has happened recently, other than him being more busy than usual. Does this happen to anyone else? It's driving me nuts. Unfortunately, I'm the only nurse in the practice, so I have very few colleagues to talk to about this. Any tips on getting past it?

[amoLucia]

By any chance, have you started attending school again or started a new class? Something that has scared the bejeepers out of you?

Just a thought ...

[OrthoRN1979]

By any chance, have you started attending school again or started a new class? Something that has scared the bejeepers out of you?

Just a thought ...

Not really, the only other thing I can think of is that when I started at the job, I had only a year of experience. I settled in nicely, but I was the first nurse they hired so there were no policies or procedures in place. I combed through the nurse practice act and had to try to decipher what I could do and couldn't do. Some of the things the docs let the MAs do, I'm not allowed to do according to my state. So, I kind of had to create my own position write standing orders for myself that my boss signed off on, etc. That's tough as a new nurse, but I'm mature enough that I figured it out.

There also was an incident several months ago where I saw a patient in the office for a p/o visit. I check all patients for possible DVT, he had mild swelling in one leg but no calf pain and swelling was expected for his surgery. Next day he threw a PE and had bilateral DVTs. He was ok, and I discussed it with my boss later and he agreed with my assessment, but it freaked me out that it was missed. That's the kind of stuff I replay in my head.

[amoLucia]

I think it's terrific that your Doc has that much confidence in you. It bespeaks much of your competency and skills, not to mention your IPR relationship. That is high praise beyond just my compliment.

I can't determine what might have rattled your self-confidence (that's why I just guessed that maybe something in school may have distressed you). I'm assuuuuming that you discuss pt care issues with your Doc, maybe you might want to do so a bit more?

And this comment is NOT meant to scare you, but you do have malpractice insurance? I plug insurance for ALL nurses in ALL areas of practice. If you DON'T have your own policy, I believe one might ease SOME of your worries just to know that someone else 'has your back'.

I'm thinking there might be some organization of 'Office Nurses Association ' or some such group that you might network into for further information.

Good luck and wishing you well.

[OrthoRN1979]

Thank you for your kind words. I do know that he appreciates me. I'm lucky to have a boss that constantly tells me how much he appreciates me. In fact, it was a fight for the clinic to hire a nurse for him. They all felt nurses were too expensive. Well, now that I've been there for a few years, they want to hire more nurses to help the other physicians.....little bit of a culture change! Back to the original topic, I think you're right. It probably would behoove me to be more conscientious about discussing things with him, I might need to get out of my "routine" per se. I'm trying to look at this as improving my practice and learning, rather than "screwing up". I don't have Liability Insurance...I did have it for about a year, then let it lapse while I tried to decide if it was worth the expense. However, I've read that you would be more likely to be kept individually named in a lawsuit if you have insurance, so I'm torn.