New nurse needs help, please

[aussiemom]

Hi everyone,

I'm sure this topic has played itself out many times in this forum but it seems appropriate to ask for some guidance and reassurance here. I hate to put this on my co-workers, because we're all in the same very busy boat together. I'm a new grad as of May and have been working on a busy hemodialysis unit since June (passed boards in August:yeah:). I'm very fortunate to have found such a great, supportive unit in which to begin my practice. My co-workers are wonderful and my manager has been 100% supportive from day 1. My trouble is this: every day before work I get the most terrible nausea and assorted GI problems. I feel so sick anticipating what my day will be like. When I leave, I rehash my day and replay every detail where I might have missed something. Dialysis is not an easy place to begin nursing (not that anywhere is "easy"!) and our patients can have very challenging physical and psychosocial needs. I fear that I will miss something crucial, will blow an access, will make a med error in the midst of the craziness...the list goes on. I think about work on my days off. I even dream about work and hear machine alarms in my sleep. Everyone I have talked to says that this will get better and that I will become more comfortable, but how do I live with this discomfort in the meantime? Thank you in advance for your assistance.

[SlightlyMental_RN]

((hugs)) Doesn't the first year suck? It does get better, but I know how bad you feel, as I remember it all too well. Here's how I made it through the first year:

1.) Learn how to forgive yourself. You will screw up, and it is okay.

2.) Find someone, be it spouse, significant other, friend that you can talk about your feelings with.

3.) Work on time management and organizational skills. I was amazed how much better I felt about my work day when I could feel more in-control with my lists, etc.

4.) DO NOT be afraid to admit you don't know the answer. Ask for help.

5.) Make your getting ready for work as stress-free as possible. Give yourself plenty of time. Don't rush. Keep all work stuff together and organized. I get up early enough so that I can drink my coffee, respond to emails, and read some allnurses.com.

6.) Avoid thinking about nursing before bed. Read a romantic comedy, or something else that's light. Take a bubble bath.

7.) Repeat many, many times to yourself: It will get better. Just give yourself time.

[Neonurse2012]

Thanks for this post and for the person who replied. I'm a first year nursing student and I've experienced a similar feeling of anxiety before clinicals and afterwards tend to go over the days events and think about things I could have done better or would have done differently. It's nice to know I'm not alone.

[rdsxfnrn]

I had to have a chat with myself..... I no longer "second guess" every decision I make. I was driving myself crazy........ So whatever decision I make, I know it was the best decision I could make at THAT TIME. Sometimes it turns out that it was not the best choice, but I learn and grow and move on. Do the best you can, that's all anyone can ask for. :)

[noahsmama]

When I was a new nurse, I actually allowed myself to think about my shift after it was done, but I put a time limit on it -- 30 minutes. I sat down with a notebook, and FIRST I made a list of all of the things I thought I had done well on that shift -- usually I was so focused on the negative that it took some effort to do this, but once I thought about it, I realized I had done a LOT of things right! Then, I would make a list of what I could have done better, and exactly HOW I would do it better next time. Most of the time I found that I could do all of this in less than my allotted 30 minutes -- it also helped me stop going over it endlessly in my head -- and, I realized that I hadn't done nearly so many things "wrong" as I had initially thought. It also really helped me to think explicitly about how I would learn from my experiences.

Gradually, I found I felt less and less need to sit down with my notebook, and after the first 6 or 8 months, pretty much stopped. A year into my first job I switched from PMs to days, and had to go back to this practice for a while, because the rhythm of the shift was different and there were some things that happened much more often on day shift (e.g. getting documentation ready for a pt going to surgery). Another month and I was able to stop again.

Good luck!

[canesdukegirl, BSN, RN]

Sweetheart, the fact that you are replaying your actions and dreaming about your day means that you are a thoughtful, careful and caring nurse. FIVE stars to you!

I know it is difficult, but it will get better. I think that Noahsmama makes a great point and dealt with the stress of a new job in a very effective and healthy way. I would try this. I think you will find that you are better than you think you are.

Without going into too much boring detail, I was recently at a very important crossroads in my life. I did exactly what Noahsmama did, and took a "personal inventory" of the things I did well and the things I could improve upon. I was surprised at how much I had accomplished and it made my decision easier. It is odd how when you put your thoughts on paper, the clarity of your thoughts seem to streamline and you focus more on what you CAN do. I don't know about you, but I am motivated by positive reinforcement. I have to be my own cheerleader, and the action of writing out my thoughts makes me see things in a better light. I actually have learned how to uplift MYSELF. It took some learning, but it works.

I like the idea of getting up extra early so you can center yourself and get ready for your day. This helps tremendously. Try to eat some protein for breakfast. The anxiety you are feeling will abate, but it will take time. You do need to try to put something in your tummy before going to work, though.

Think of your situation this way: if you knew a new nurse that did the whole "shrugging their shoulders, haven't-a-care-in-the-world attitude", would YOU want them to take care of your family member? Of course you wouldn't! The fact that you care makes you an awesome nurse. You are already stellar in my book!

[aussiemom]

Thank you, everyone, for your thoughtful replies to my dilemma! I appreciate having some concrete, tangible ways to manage my anxiety and uncertainty regarding my practice. This will definitely ground me and rein in my free-floating anxiety, and give me a sense of perspective. It's nice to know I'm not alone! Hugs to all. :redbeathe

[ms.heart]

Even seasoned nurses mess up sometimes. Just learn from your mistakes and move on.

[JustKeepSmiling, ADN, BSN, RN]

I am the same way!

I can't always help it but I'll pull myself aside or wait a few minutes before getting out the car and just take deep breaths, focus on the sound of my heart beating or my breath sounds. Doing this completely clears my mind (I also do this to fall asleep, works better than benadryl!!)

I tell myself we will take it as it comes, we won't allow stress and anxiety to overcome the day (which could lead to a yuck migraine).

I do have prescription PRN meds, it sometimes boils down to that. Especially for test anxiety.

Thought, last test I was 100% perfectly fine. It comes with experience.

Try the quick meditation, the listening to your own body in a literal sense was taught to me by a counselor. It really can clear your mind.