New grad-Body/mind on high alert all the time due to anxiety

[Summers3]

Hi everyone,

I am a new grad that just started a new position right out of school. I am off training for about one week and currently doing okay but that's probably the majority of the patients are currently deemed pretty stable.

But I feel so mentally tired even when the shift is slow..... this is because my mind and body on high alert the entire shift because I am worried about making mistakes or missing something vital etc. I am, unfortunately, an anxious person and I worry about EVERYTHING.

And I worry about this on my days off too so I feel I am so high alert and mentally wearing out all the time and tired all the time.

But as a new grad, I can't do anything about my lack of inexperience and confidence. I of course ask questions when I am unsure or need help! But it's just the fear of messing up something big or missing a change in the pt etc etc that will lead to a bad outcome for the pt. I am afraid of that guilt.

Not to mention that I will be starting to float in a few months or so and i'm so afraid.

How did you survive your first year and.... the fear?

Thank you so much for your time!

[HouTx, BSN, MSN, EdD]

This is pretty normal. As a COB, I worry much more about new nurses who think that they don't need any help. You'll gain confidence with more experience. Be sure to take care of yourself. Try to eat healthy and get sufficient sleep & exercise. Rather than just hanging out and worrying, schedule some fun activities on your days off. Join a gym. Take Yoga lessons. Spend time with friends and family.

This too shall pass. In a year or so, you'll be the one providing reassurance to the newbies.

[NewMurse1014]

As a new grad with 1 year of experience, I'll be blunt with you: the unexpected can and will happen. You will experience your first med error, first patient fall, first RRT, etc. no matter how well you're prepared. What's important is what you do after the incident and what you take away from it. The appropriate actions you take and the lesson you learn from it will make you grow as a nurse. The only way to grow from a novice to expert nurse is to actually go through them. Your anxiety is a good thing; it's what keep us on our toes. But the overwhelming anxiety even on your days off is not good. Try to keep personal life and work life separate. Work is like Vegas, leave whatever happens there and don't take it home, and vice versa don't take the personal business to work. You will get there, embrace the journey, and one day you'll feel you "clicked", you'll be surprised how much you've grown.

[AceOfHearts<3]

You'll gradually gain more confidence. I have not quite 1.5 years experience and I've def. noticed a change in myself over the months.

I had a situation where I came in for my day shift and a patient had declined overnight. The patient was very medically complex and in my opinion should have been transferred immediately to a higher level of care with the change, but the on-call provider was either too lazy or incompetent (I'm leaning towards just lazy). I was able to confidently take charge of the situation. I got the patient up to the ICU where he had invasive monitoring lines inserted and eventually had major surgical interventions. Once I had time to reflect on this whole situation I realized if it had happened a few months earlier in my career I wouldn't have been so confident and I would have needed other nurses to assist me more.

I compare that situation to one that had occurred a 4-5 months before it and I'm amazed at the difference in how I handled it. The earlier situation I recognized changes and knew something wasn't right with a patient. I'd been in contact with a provider who evaluated the patient then put in orders for imaging. I knew as soon as the patient got back from imaging that the situation had declined further and it continued to decline quickly, so we had to call a rapid response. I am so grateful for my wonderful nursing coworkers, because that rapid response wouldn't have gone near as well or smooth as it did without them. It was a definite learning experience and I know I grew from it.

I'm still continuing to grow and I know I have so much more to learn still. I reflect back and think about how I can improve all the time. You will get there too. You'll be able to look back at different scenarios and see how much you have grown as a nurse. Give yourself credit and room to breath- you'll get there with time and until then remember you have a whole team to help you.

[Lauraingalls, BSN, RN]

I am a month off orientation so I get your paranoia. I usually spend my drive home after every shift analyzing what I did and the mistakes I made or things I forgot to tell in report. I then go home and when I go to sleep, I dream about work and usually it involves me forgetting to take care of patient or losing a patient- crazy things like that. I think about my job alot. I over analyze and I feel very hypervigilant at work too. One thing I do is utilize my coworkers and ask lots and lots of questions. I assume nothing and ask and ask and ask. Good luck to you.

[nutella, MSN, RN]

Besides normalizing your experience (yes - it is normal to have anxiety and a lot of nurses take work "home" in the beginning) I have other suggestions.

If you are generally worried that you will forget something or overlook something make sure that you have a good cheat sheet in place until some stuff becomes automatic for you. Make sure that you have check boxes and in the beginning of the shift write down the name, code status, diagnosis, medication admin times, telemetry, diet, scheduled tests, and incorporate the staff that can get forgotten easily - for example check lab results at x time. Make sure you check vitalsigns especially if not done by you. When you see a patient first time in your shift, make sure you eyeball everybody and do a quick 5 min all over when you make sure they are breathing ok, not screaming in pain, agitated /confused, and confirm all drips. If there are drains or dressings - quick check. A quick round will ensure that all of your patients are hopefully ok.

Find a mentor /coach. Yes, you are off orientation - but you might want to have one or two people on the floor that you trust and where you can go if you need a second opinion.

Be familiar with policy and procedures.

If you tend to worry excessively, you could initiate a "worry time" - meaning you allow yourself to worry for let's say 30 minutes after you get out of work and after that imagine that you lock up the worries for the rest of the day until you go back to work.

good luck

[RNperdiem, RN]

Time to bring on all the coping skills you have and learn some more.

Being right off orientation is an extra stressful time. There is no quick fix to decrease your anxiety.

You can begin with good self care- protect your sleep time, eat healthy food, learn about positive self-talk, get some exercise on your days off, keep in touch with friends, write in a journal, meditate or do whatever customized combo of self-care keeps you healthy.

Second, look at your resources at work. Do you know how to find your nursing policy and procedures?. It is a click away on most nursing computers, it is a useful resource, and one even experienced nurses consult. Make use of your charge nurse. If you want a second opinion, use the charge nurse.

Best of luck on your nursing career.

[JadedCPN, BSN, RN]

... As a COB, I worry much more about new nurses who think that they don't need any help...

THIS!! I don't know if/when I qualify as a COB, but I can't like this enough. I am more worried about a nurse who thinks they know everything versus a nurse who asks questions about the things they don't know.

Even this far into my career, I still put down as one of my "strengths" on my yearly evaluation that I am aware of the things I know but more importantly aware of the things I don't know and have no problems seeking help and utilizing resources when needed.