new nurse anxiety/mistakes

[shipsahoy]

I recently graduated and have been off of orientation for about 2 months now. I try so hard everyday to make sure I get everything done and not to forget anything. I always go over my charting at the end of the shift and look over orders, but it seems I always realize I forgot something when Im giving report or while im on the way home. This gives me extreme anxiety. It ruins my days off because I can't stop worrying about any mistakes that I made or things I forgot to do and I second guess myself about all the stuff that I did do. After my last shift I realized when I got home that my patients home medications hadn't been signed off by the physician and started. Now i'm playing the what if game and thinking of the worst possible scenario that what if nobody every starts this pts home meds and what if the patient is harmed and/or I lose my job because I forgot to follow up with home meds. Even though there are other nurses taking care of this patient and the physician is responsible for starting the home medications also, I feel like this is all going to fall on me.

I get frustrated because each shift I do the best that I can but without fail, I get home and have horrible anxiety and can't sleep. Some days are great and other times I feel like this job is making me live in fear and I can't take it. Any advice out there for how to deal with the stress and anxiety and leave work issues at work?

[Anna Flaxis, BSN, RN]

This is completely normal for a nurse in the first year of practice. I've been at it for close to six years, and I still occasionally forget something and then beat myself up for it. Granted, I don't forget much, and I have gotten a lot more forgiving of myself, but it's taken me the last five years to get here.

If you forget something important, you can always call the nurse you handed off to, and you can do late entries in the chart. If it's some bit of minutiae that doesn't really matter except to you, then work on learning to let it go. Nursing is a 24 hour job, and some day you will be the experienced nurse catching all the little omissions and mistakes of the new nurse, and you will have the opportunity to be a mentor and handle it in a supportive way.

One strategy that I have used for curtailing the dwelling on of everything I could have done better is to give myself a time limit. For example, I might tell myself that when I get to the freeway off ramp, I will be done thinking about work.

[psu_213, BSN, RN]

I too was in the club of beating myself up for thing I realized I forgot after I left work. I have come to realize, however, that every nurse forgets things. We are human, it happens. There have been times I have followed a really good nurse, then realized that they forgot something. Nothing life threatening, but something none the less. No big deal--I do it and then move on with my shift.

If it is a really big thing, you can always call back. Otherwise, go home, take a deep breath, and enjoy your time off.

[SionainnRN]

Sounds very typical for a new nurse, or any nurse on a new floor. Hang in there it gets better. And know that you will make mistakes, you are human. My rule of thumb is just to make sure I never make the same mistake twice.

[trueblue2000]

I am in the same boat as you, but just one month off orientation. The worst part for me is when some (not all) of the other nurses, instead of showing/telling me what I forgot/did wrong, simply report my omissions/mistakes to the unit manager. I am finding that one of the most important things a new grad needs to learn is who are the backstabbers in the unit, which of your colleagues will throw you under the bus and be extra careful with them.

[AlaBro2010]

I think we have the same exact thoughts. I work at a clinic, it's not very stressful (not acute care) but I am still so scared I will mess something up when it gets super busy. I'm the type I really beat myself up over mistakes so I get anxiety hoping I didn't forget anything. So I think it has to do with being a new nurse.

[NursieNurseLPN, LPN]

Maybe you should try making a list of all the things that should be done on your shift (from blood sugars, med pass, treatments, charting, orders, assignments, etc) & prioritize what absolutely must be done. Make copies & bring with you everyday, and cross off what youve done while you go. That way you can check to make sure the most critical things are done prior to leaving. You can also add important things that come up during your shift ( such as the home meda you mentioned). Give yourself a break. And tons of nurses call work to report something they forgot. I did it my first week & everyone else said they get those calls all the time. Like someone else said, just try not to make the same mistake twice. Relax & enjoy this beginning of your career. You can do this!!!!

[chinacatRN]

Everyone forgets things. Life happens - especially on a hospital floor or LTC facility. Pts are demanding. Things need done. Sometimes things get missed and no one is perfect.

What works for me is getting into a routine. After report, go through the mar and make note of when meds are due. Make note of any treatments that need done and if certain pts need assessed at certain times. I carry highlighters in a couple different colors to hilight certain things I'm afraid I might miss. If you have time, check out lab values and other petinent data and make note of anything out of whack. Then assess the pts for the first time and go from there. Each facility runs a little different so my typical day may not run like your typical day. Carry a "brain" sheet where you can write everything down to remember later. Use sticky notes or colored pens or whatever helps you best. How did you stay organized in school? Use the tools you learned in school to help in the workplace.

As just try to learn from your mistakes. I agree with pp who said to give yourself a time limit - definitely before you walk through your front door, you should no longer be thinking about work. If it helps, talk to yourself in the car ride home or sing loudly to music or whatever. Write down your mistakes that you remember and put them with your work stuff (I have a work "bag" that is organized and full of pens, supplies, and stethoscope) and make a rule that after you write it down, you can't think about it anymore.

Nursing is a 24 hour job and if you stayed after your shift every day to finish the things you didn't get done or forgot, you'd be there forever.

[AnonRNC]

I have two thoughts.

First, apply some of the tools suggested by previous posters. The one that worked very well for me was to write down concerns when they came to me at home. Once I had done that, I was able to relax. Of course that only works if it's something that you can address on your next shift.

Second, if you find that anxiety and sleeplessness persist, you should consult with your medical provider.

Okay, one more thought: Kudos to you for worrying about how you are doing! You are showing signs of becoming a competent and consciensious nurse.

[nurseprnRN, BSN, RN]

I'm sorry not to be all warm and fuzzy, but it is NOT OK to keep forgetting things "because everyone forgets things." No, they don't, not all the time, not every shift. They figure out a way to know what they have to do and then check and double check to make sure they've done it.

Perhaps Esme could share the links to some of her "brains" again? These are the pieces of paper you carry around with you all day to prompt you to get everything done-- as it is done, you cross it off. Most people develop their own-- it's like a shopping list. When you are new to shopping for yourself, you write down everything: Milk, OJ, dinner x 4, cat food x7, whatever. After awhile, though, you have a good idea what you always get every time you go to the store, so you don't have to write it all down every time. You ALWAYS get milk, OJ, entrees for 4 dinners, and cat food, so your list is just the outliers or the things you don't want to forget, like the flashlight batteries, the laundry soap, the special ingredient for the potluck, and the bay leaf you used up last night.

So write your list at the beginning of the shift:

Pt A Dx________ MD______

VS 08 12 16

Meds 08 12 16

PRNs __________________________

Daily wt: ___________

I:_____ O:_______

Accucheck 0730 _____ 1130______ 1730 ______ Sliding scale:

Dressing change

JP drain output ______________

PTT at 1400

+

add whatever you need to learn/do for that patient

Then do another for B, C, D, and whatever you have to do or check for the CNAs' patients.

Fold up your paper so it fits in your pocket and refer to it often.