New Grad feeling depressed, anxious and hopeless

[MedSurgRN193]

Hi everyone,

I still consider myself to be a new grad - I've been working in med/surg and orthopaedics since March 2014. All throughout nursing school, I always felt like I didn't deserve to be there; that I wasn't smart enough, hard-working enough or talented enough. Even though I passed all my clinicals and graduated with distinction, I still felt like I fell short of my classmates. Throughout nursing school and the past year as a new grad, it has both astounded and scared me how little I know and how much I have to learn - how can I feel competent to care for patients feeling this way?

My work related anxiety over the past year has been high and low at times - however, recently it has become almost paralyzing. Last month, I called in sick four times due to anxiety and stress related headaches. I've also developed terrible insomnia - I used to be able to fall asleep within minutes, if not seconds. I've just all of a sudden become terrified of the possibility that I could cause harm to a patient, either through something I've done (i.e. a med error) or something I haven't done (i.e. failing to assess a patient properly).

Any time I think about going into work I start to cry and my mind starts racing with all of the "what ifs" that could happen on a shift. I find the thought of day shifts especially anxiety provoking, as I usually have a team of 5 patients, which means 5 sets of assessments, vitals, meds, labs to check, doctors to deal with, etc. And the patients are so sick and dependent I never feel that I'm giving them the care they deserve, which makes me even more anxious and depressed.

I know that everything I've described is the bread and butter of bedside nursing - however, I know in my heart that med/surg nursing is not for me. It's my dream to work on a postpartum ward, and eventually in public health nursing. I am so, so passionate about health promotion and prevention but it seems so hard to get into public health without killing myself at the bedside for years...I just don't know what to do. I feel helpless, sad and anxious all the time. I've stopped exercising and seeing my friends because I have no desire to. I feel like I should be getting more confident as time goes on, but I feel the opposite...I feel like my fellow new grads are getting more confident, and I'm becoming more and more fearful and anxious I never, ever felt depressed or hopeless before nursing and it makes me feel like a failure. I feel like I wasted my three years in nursing school to become an RN...even though I do love being able to help patients, I don't know how much longer I can do this for...I just feel like I'll never know what I'm doing because I'm crippled with anxiety. Is is really worth it to suffer this way?

[fourthtimesacharm, CRNA]

I am a little surprised about all the people wanting you to jump right to medication. I agree with the posters that suggest getting back into eating healthy and exercising. Start applying for new jobs. Medsurg is obviously not a good fit for you, nor should you torture yourself because some people say everyone needs medsurg experience. So many people do not follow that usual path and are still successful. Good luck to you on your journey to better health and a nursing job you love!

[canigraduate]

I am a little surprised about all the people wanting you to jump right to medication. I agree with the posters that suggest getting back into eating healthy and exercising. Start applying for new jobs. Medsurg is obviously not a good fit for you, nor should you torture yourself because some people say everyone needs medsurg experience. So many people do not follow that usual path and are still successful. Good luck to you on your journey to better health and a nursing job you love!

Why? If she had an infection, shouldn't she "jump right in" to antibiotics?

It is the resistance to warranted medication that causes worse problems and often delays recovery for those of us with mental health issues.

Diet and exercise are great in the long term, just like PT for the post-surgical patient, but they aren't quick enough to stop somebody from slitting their wrists or shooting a neighbor in an acute situation. I'm not saying that's where the OP is, but if she was, I would want her to get the medication she needed and not feel like a failure for it. Or feel judged by her fellow nurses.

[hppygr8ful, ASN, RN, EMT-I]

Taking medication is a very personal decision - As a former Psych nurse I can tell you that everybody's brain chemistry is different and every person will react differently to each medication. I have suffered from Clinical depression my whole life stemming from being physically (beating) and verbally abused ("your fat and ugly and no decent man will ever want you") by my mother. I too was reluctant to take medication figuring if I could have survived my childhood I could do anything. When I started nursing the anxiety and depression piled up and in 2003 I attempted suicide. Fortunately I did not succeed. However I come in contact with a great therapeutic team who helped me on the road to wellness. I therapist to help me deal with past emotional scars and new emotional fears, and a psychiatrist to help me get my brain chemistry balanced. I think I tried about 7 different antidepressants before settling on celexa. The normal dose is 20 mg daily - but I didn't like how I felt on it and told my doctor and we dropped it to 10 mg daily. When I told my doctor I didn't like chemicals messing with my head he told me "Chemicals are already messing with your head - Taking medication is just fighting back"

If the OP doesn't want to take medication I support that decision - OTC supplements like SAM-E and St Johns Wort can be good options but you must be careful where you buy them since a recent investigation or Target, Walmart and Wallgreen's showed that most of the store brand supplements were mostly just grass and weeds ground up in a powdered form and the supplement was not present in any of the pills. Also even if you are getting quality supplements they too can have severe side effects.

The best thing is to start with a complete physical and Labs CBC, Chem 7, Complete Thyroid panel (including free T-4) and inflamatory markers such as free cortisol and SED rate.

In addition to the very small amount of medication I take - I follow a strict anti-inflammatory diet which has helped with my ulcerative colitis and fibromyalgia to the pain that I have stopped taking pain meds.

A collaborative approach is best. Once you know what you are actually dealing with you will know how to treat it.

Peace and Namaste

Hppy

[No Stars In My Eyes]

hppy,

I really, really like what your doc told you: "Chemicals are already messing with your head - Taking medicine is just fighting back."

That is one great​ explanation!

[fourthtimesacharm, CRNA]

Why? If she had an infection, shouldn't she "jump right in" to antibiotics?

It is the resistance to warranted medication that causes worse problems and often delays recovery for those of us with mental health issues.

Diet and exercise are great in the long term, just like PT for the post-surgical patient, but they aren't quick enough to stop somebody from slitting their wrists or shooting a neighbor in an acute situation. I'm not saying that's where the OP is, but if she was, I would want her to get the medication she needed and not feel like a failure for it. Or feel judged by her fellow nurses.

I completely agree that she shouldn't feel judged by her fellow nurses. It seems to me that many were advocating very strongly for medication when the OP was reluctant to go there first anyway. If my pharmacology serves me right, medication can be the catalyst for a depressed person to go ahead and commit suicide. Also, if my mental health course serves me right, I seem to remember hearing that medication doesn't have any better track record than therapy and modalities such as addressing exercise and eating healthy.

This is my own thought but I think a lot of the problem with healthcare today is wanting a little pill to fix us. If we take the time and look at WHY we are feeling the way we are, talk with someone about it and start to take care of ourselves appropriately such as getting enough sleep, removing ourselves from situations that are causing too much stress for our brain chemistry to handle and nourishing ourselves with real food and exercising to make endorphins, our bodies are quite capable of healing. But trying non pharmacological treatments first and then if your body needs some additional help, then look into medication. Please understand I am not knocking medication, but jumping to it with the expectation that it will fix all and it is the only way to approach the situation seems a little off base.

Additionally, I may have read incorrectly, but it seems like the OP was looking for people's opinion on whether or not she needed to continue in med-surg in order to be able to work in other areas of healthcare. I personally do not think this is the case. As I said in my original post, everyone's path in nursing can be different and what worked for one, may not work for another.

OP, again, I wish you all the best as you go forward in your nursing career. The passion you have for Community Health and OB should serve you well. :)

[Tommy5677]

Get out while you can. All specialties are stressful but if you want to lessen it somewhat think about a less clinical position. There are lots of opportunities in health insurance and there are a lot of brilliant nurses working those jobs. Some of them, like the one I had, allow you to work directly with the members, mostly telephonic. I was a disease management nurse/health coach. If you don't do something about it now it will shave years off your life, or worse, kill you in the short term. If you need to do something different please don't think of yourself as a failure. You are anything but. And please don't think you are less a nurse because you don't put your hands on a person.

[canigraduate]

If my pharmacology serves me right, medication can be the catalyst for a depressed person to go ahead and commit suicide. Also, if my mental health course serves me right, I seem to remember hearing that medication doesn't have any better track record than therapy and modalities such as addressing exercise and eating healthy.

I think you are being disingenuous. There is a known risk for those with severe depression to recover from apathy enough to act on their suicidal impulses once beginning medication, but the medication itself is not a catalyst for suicide. It is better to get the medication on board before the patient is that far gone. I equate it to sepsis - it is better to catch sepsis at SIRS (equal to mild to moderate depression), or basically before the real trouble starts.

The benefits of exercise on depression are proven to be longer term than antidepressants, but the medication works faster. They are about equal in effectiveness.

JAMA Network | JAMA Internal Medicine | Effects of Exercise Training on Older Patients With Major Depression

So, it depends on the severity of the situation and the patient's willingness to comply with either.

I don't think that Med Surg is any worse than any other specialty, but it may not be the right fit for the OP. I hope the OP can find a specialty that engenders anticipation, not dread.

[Nurse_Shaakira]

I know this is a pretty old post but I wondering if your anxiety gotten any better with more nursing experience? I'm a new nurse and suffering from major anxiety and some depression. I can relate to this post so much! Its been almost a year and I can't seem to find my niche or stop over thinking everything. Its so frustrating!

[MedSurgRN193, BSN, RN]

Just PM'd you!

[elkpark]

I think you are being disingenuous. There is a known risk for those with severe depression to recover from apathy enough to act on their suicidal impulses once beginning medication, but the medication itself is not a catalyst for suicide.

I realize this is a v. late response, but the previous poster is not being "disingenuous." Since 2004, the FDA has required number of antidepressants to carry "black box" warnings about increased risk of suicidality precisely because numerous studies found that the antidepressants increased the incidence of suicidal thoughts in youth and young adults who had not previously had any suicidal thoughts, to a statistically significant degree compared with placebos (a v. different situation from people who have already been having suicidal thoughts recovering enough energy to act on them). It's a real thing; research has demonstrated that some antidepressants can be a "catalyst for suicide," or at least a catalyst for thoughts of suicide.