New Grad...Anxiety over losing my job

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I am a new graduate nurse and I am on my 3rd week of orientation. I am terrified of losing my job or license or even putting my patient in harm. Is this normal to have anxiety like this? For instance, on my last shift I was documenting my head to toe assessment, but I forgot to assess his bottom for breakdown. However, he was eating when I was going to assess it again, so I came back later in the afternoon. I did not notice any breakdown or blanchable redness on his bottom but the night nurse before me documented that he had some. However, in my opinion i did not notice any redness, so I documented intact without redness. But now I'm paranoid that maybe my assessment is wrong. And I'm scared that I am going to get in trouble for not documenting correctly. Another thing is my patient's IV site had some dry blood around the site and when I was assessing it was currently infusing. I asked if it was hurting or felt tender he said no. I did not change the IV dressing, but now I am thinking I should have changed the dressing. Now I am jumping to conclusions like what happens if he develops a peripheral IV infection. And i probably should have mentioned the small amount of dry blood in my documentation but I did not. If something happens to this patient could I lose my job or license. Honestly, I am just scared that any small mistake I make can create a bigger mistake and that I could lose my license. Did anyone have the same anxiety when starting out.

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When you start to obsess like your post suggests, turn your anxiety into positive action to affirm what you will do to insure that none of your feared catastrophes come about. But if this happens when you are at home, at the beach, or in the grocery store, engage in another activity. You will make yourself sick if you don't learn how to handle this anxiety now. Fully engage while you are at work and can do something about it. Otherwise tend to the other necessities of life in their due time.

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Specializes in ER OR LTC Code Blue Trauma Dog.
1 hour ago, DH1234 said:

I did not notice any breakdown or blanchable redness on his bottom but the night nurse before me documented that he had some. However, in my opinion i did not notice any redness, so I documented intact without redness. But now I'm paranoid that maybe my assessment is wrong.

Have you considered the pt. may not have been repositioned in the bed at regular intervals on another shift, and this explains the cause of the redness as previously documented on the other nurses shift?

Perhaps in your case, they are being regularly repositioned on your shift or even up and out of bed walking around for that matter? Therefore this perfectly explains why there was no observable redness present during your examination.

See... the situation is always subject to change and it's not anything you did wrong after all. ?

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1 hour ago, DH1234 said:

I did not notice any breakdown or blanchable redness on his bottom but the night nurse before me documented that he had some. However, in my opinion i did not notice any redness, so I documented intact without redness. But now I'm paranoid that maybe my assessment is wrong.

1 hour ago, DH1234 said:

Another thing is my patient's IV site had some dry blood around the site and when I was assessing it was currently infusing. I asked if it was hurting or felt tender he said no. I did not change the IV dressing, but now I am thinking I should have changed the dressing. Now I am jumping to conclusions like what happens if he develops a peripheral IV infection. And i probably should have mentioned the small amount of dry blood in my documentation but I did not. If something happens to this patient could I lose my job or license.

If your worries are missing an element of reason (are somewhat irrational) then no that is not normal or healthy. Remember that when you are new or encountering new situations, part of your learning curve involves gaining understanding of which adverse potentials are more likely and which are way less likely. Lack of experience can contribute to irrational fear.

Your best bet is to focus on doing what you know is a prudent assessment, seeking to learn which actions your assessment suggests are necessary, and then taking appropriate action as warranted.

If you actually assessed your patient's skin and accurately documented your assessment, it doesn't matter what the person before you documented aside from being aware of it for comparison or trending. With the IV site, you should follow policy in assessing and caring for them, but overall it is not likely that something is going to happen to this patient based on your particular action and then you are going to lose your license. It just isn't.

Try to keep the big picture in mind, don't miss the forest for the trees, etc., etc. Right now it's most important that you learn to handle your assignment enough to properly contribute to and follow the plan of care and recognize changes in condition and other more important matters.

It'll be okay. ?

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Anxiety is totally normal when you're first starting out. Yours might be at a little higher level than most ? Sounds like you're doing fine!

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Specializes in ER OR LTC Code Blue Trauma Dog.

Nurses are their own worst enemy at times. We are constantly assessing and overthinking every little detail to death.

Just chill okay?... No one is going to die if you write something different in the patient chart than another shift does, and everything will be alright.

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Specializes in Critical Care.

I agree that this is normal.

It is good to be attentive, aware, and question "should I have done that instead?" - that is how you develop critical thinking and practice safely.

These things are what your preceptor is there for. If I was your preceptor I probably would have said "yes, you should absolutely change that dressing," but this would be meant to be encouraging, not demeaning. I would be glad for your awareness and attention to detail, and I would train you to continue practicing in that way. It would not be on the top of my list of things to get done though - no one is perfect, and we can only get so much done in a day. If it's a crazy busy day the next shift can take care of it. I just wouldn't want to see you ignoring it entirely or not telling me about it out of fear.

Your preceptor is your resource, there to help you, answer questions, etc. You are learning, you are going to make mistakes and miss little things and that is ok. Since your preceptor is your oversight they would likely get into trouble if you got into trouble, so they have a motive to not let you mess up too badly (I would not lean on this as an excuse to not do something or expect that your preceptor is going to catch every little thing, but I always kept this in mind and it helped lower my anxiety when I was a new grad).

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Specializes in Cardiothoracic ICU.

I agree that anxiety is normal. Starting out in the ICU, a year ago I recall questioning myself OFTEN. However, I limited my worrying to work, when I could actually do something about it. One way I accomplished this is by asking other nurses during handoff to let me know if I forgot anything or how I could improve/what I could do differently. This allowed me to leave my worries behind knowing that my co-workers would inform if I made any "mistakes". This also created many learning opportunities for me, which only added to my knowledge base.

I vividly recall one of my biggest worries being if my assessment findings were incorrect because the prior shift or my preceptor documented something differently. This is all a part of developing your own intuition and critical thinking skills. You will get there. Just confirm your findings if you are unsure. If you haven't had experience with something but suspect something is wrong use your resources....Charge nurses, NP's, colleagues are good resources.

A

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Document. Document. Document. It does not matter what the nurse before you did or did not see (well kind of). Things can change for the worse or better and you should chart what is right in front of you and how you perceive it using your best judgement. I've seen nurses simply chart what the nurse before them charted without even assessing the patient. Other nurses make mistakes, we are all human. But it is best to not second guess ourselves just because we see or don't see something different. That alone could save a person's life.

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Specializes in ER OR LTC Code Blue Trauma Dog.
On 7/21/2019 at 1:35 PM, AquaFina88 said:

I vividly recall one of my biggest worries being if my assessment findings were incorrect because the prior shift or my preceptor documented something differently.

I am always amazed why other nurses think they are somehow required to document things exactly the same way as previous shifts.

That's just not true, nor should it true for that matter. If your observations are different, that means you're out on the floor doing your job.

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