New grad in L&D with severe anxiety and stress

[Neohippy]

Hi guys,

I'm a new grad who has been working for a few months in L&D--I was hired as a new grad. I received 2 months of classroom time and am now in my 3rd month of a preceptorship on the floor, working at first two 12 hour shifts and now for the third month three 12 hour shifts per week. I had to sign a 2 year contract to agree to work in L&D for 2 years in return for the training. My problem is I am extremely anxious at work and because of that, I sometimes forget things or make stupid mistakes and feel that makes me look even more stupid to my preceptor, who already intimidates me. I did well in nursing school and even in clinicals received praise from instructors. I worked as a tech for 9 months before becoming a nurse and did very well and my employers were pleased with my performance on busy floors, so I know I can handle multitasking generally. However, I'm really struggling here. There is so much to know and the highly litigious nature of L&D has been drilled into my head by my preceptor and others so much that I am gripped with fear. I have been told that the doctors will turn on me in a heartbeat and throw me under the bus so to watch my back and make sure I now what I'm doing. My preceptor basically sends me on my own to do things now and I appreciate that in some ways because I feel so nervous around her (she has a strong personality), but when I forget things instead of helping me in a kind way she is hard on me and I feel degraded and shamed. She is very knowledgeable and skilled and has been doing this for like 25 years, so she knows her stuff, but personality-wise, it is a mismatch. I can truly say I've been doing my best but I feel like I can never measure up. I beat myself up as well because in my anxiety, I know I space out sometimes. I don't want to get too specific in case anyone in my dept reads this. I don't know if it is the nature of the work in L&D that isn't right for me (the slow one minute, fast paced and potentially very serious the next), just being a new and inexperienced nurse, or both. I wish I could transfer to postpartum, where it is slower paced and more predictable, but I signed a contract to specifically stay in L&D for 2 years. The anxiety is intense and I find myself sometimes crying at work and when I get home, which is getting old. I made an appointment with a doctor now that my health insurance is in effect because I believe I have had untreated ADD (inattention, forgetting things, etc., my whole life) and definitely have anxiety issues. I am not sure what else to do. I guess I'm just needing support or advice. Thanks.

[anewsns]

My heart really goes out to you reading this .. Just be easy on yourself , you are a human being .. If the preceptor isn't going to be considerate that you are new and have feelings then you'll have to find a way to comfort yourself.. Is there someone on the floor you feel comfortable with? Even if they aren't your preceptor, it would be nice to find someone more relaxed. Just to be a friend !! I think you'll find those people over time. As far as covering your butt, just keep the nursing process in mind at all times. If you're unsure about anything at all,it's better to be a few seconds behind the ball to get that help or information you need.. (I know it's a really fast paced environment) .. but just be as calm and safe as possible.. Deep breaths in emergencies. I would focus at first on whatever you need to know for those critical cases.You are a very bright promising nurse who wants the best for your patients and nobody should let you think otherwise! If possible, change preceptors. Experience is necessary in a preceptor but you need to feel comfortable asking questions and have mental space to learn. Extreme anxiety is not a good state for learning as you know.. Maybe get a low dose prn from that psychiatrist too.. Xanax is your friend. So is exercise! Maybe give yourself time after work designated to debriefing and going over the mistakes in your mind on what you can do better.. Suppressing those worries only worsens those 3 am haunting thoughts I find ..

[Neohippy]

Thanks so much for your kind words. I needed to hear that. I was able to speak to the instructor who taught our course today and get some support too. Going in tomorrow and just going to do my best. I've got an appt. in 3 weeks with an MD to talk about the anxiety issues. Will hang in there until then. Thankfully I have a wonderful, supportive boyfriend and family so at least at home I get lots of comfort.

[iPink, BSN, RN]

We can relate to you on how we felt as a new grad, no matter what floor you start on. That transition from student nurse to primary nurse can be steep but we eventually get there. The anxiety, stress, and feeling like you are clueless are normal feelings for GNs. There are those who are cool as a cucumber and that's fine too. When I started, I also went to speak to a counselor and was self diagnosing myself as having ADD but I realized all I had was "New-nurse syndrome." Didn't need anything from the Benzo family except something called a little time.

Give yourself time and please don't try to measure up to your preceptor's 25 years of experience. You're on year one so you won't be able to catch up. I've worked with tough preceptors but handled it because I knew it was going to come to an end. As long as they were depositing a wealth of knowledge that would help me succeed on the unit, I was appreciative. Even if I didn't necessarily agree with their style but as soon as I was on my own, I developed my own style that worked for me which inevitably will be forced upon another student if and when I start precepting. See how that works?

I speak to seasoned nurses all the time who still remember their first year as a nurse and many of them don't have wonderful memories of their experience. But they sure can look back 25+ years later and say they've proudly been there, done that, and stretched out the t-shirt.

Hang in there. Sending you some hugs.

[Pixius]

I can relate to what you are experiencing too. I have been on L&D for 15 months. I am a new nurse too and I had a preceptor who was hard on me too. There was definitely a mismatch in personalities for me too. I just took one day at a time. A lot of people say it is normal for new nurses to cry a lot in the beginning. I think this is unacceptable. However, I always told myself that this hard preceptor also has something to teach me, I just need to listen and learn. Once I was off orientation, I discussed my hardship with other nurses on the floor and they all said I should have gone to leadership and asked that my preceptor be changed. I don't know if this is an option for you or not. Also, we just started this mentor program. Because I am one of the newer people on my floor, they asked if I would mentor some new hires during their orientation process. Its a time when they can ask questions about experiences and situations that come across during orientation. Maybe if you can't change preceptors maybe you can ask your leaders if there is someone who would be able to mentor you. In other words, good luck and keep going. We all have our hardships and its important to just stick with it. Once your off orientation, you'll make your own groove and you'll prosper!

[Neohippy]

Thanks, guys--it is comforting just hearing that you went through the same things (unfortunately!) and survived. Today I am going to work. I hate asking my preceptor questions because she gets this little smirk on her face as if to say, "are you stupid? I can't believe you're asking me this" and then gives condescending answers or her body language sends the message that she thinks it was a stupid question. However, I am going to force myself to ask anyway and be grateful I have this forum to vent on if I need to. Again, thankfully I also have a great family to vent to as well. Namaste to you all :)

[anewsns]

Yes certainly come back and let us know !

[NurseNora, BSN, RN]

One question you could ask is how does your preceptor think you are doing. What are your specific weaknesses that you need to work on. What are her suggestions to improve in these areas. What are your strengths. How has she seen you grow since you've been there. If she can't think of any strengths or growth, then you need a different preceptor. It costs a lot to orient an L&D nurse and rather than waste the money already spent on you, most management is willing to make that change. You'll get there, be gentle with yourself.

[BSNbeauty, BSN, RN]

I'm so sorry you are going through this and being treated this way. Being a new nurse on any unit is tough, and L/D can be really stressful. You are taking care of 2 patient, one you can see and one you cannot see until they are born. Talk to your NM to see if you can get a different preceptor. I did this once and it worked out for me. Also, I would get insurance from NSO and don't let your employer know. OB is a high risk area for health care workers so make sure you are insured. Take a deep breath, it will get better. If it doesn't, you can always go to Mother/baby, less stress.

[Neohippy]

Update: I talked to my nurse manager, who was extremely supportive and understanding and gave me a different preceptor on the spot and also a lot of encouragement, telling me I was doing fine and was where I should be, etc. She also validated my observations of how I was being treated, as well as other coworkers, who have noticed. I am very relieved because I know my new preceptor, who is wonderful. Looking forward to things getting better now.

[NurseNora, BSN, RN]

So happy to hear the good news. You'll do well.

[L&Dnurse14]

I just started my first week of L&D orientation. I feel very rushed since I only get two DAYS of education classes and only 9 weeks on the floor. I seriously don't know if I will have this all down by may but reading up on my old notes from nursing school has helped some. I hope to hear soon that you are learning much more with a preceptor who is a better match for you! Good luck, I'm sure you are doing great!