New Nurse Nerves

Penelope_Pitstop, BSN, RN · Apr 3, 2010

I might not be the person to come to for a pep talk. Maybe what I'm going to say will help you, but maybe it won't.

You are NOT ALONE. Those nerves are part of the package. I don't know anyone who didn't experience those feelings at the beginning. Some nurses have it worse than others when it comes to nervousness - I, for one, became physically ill before work.

What helped me was routine. As long as I carried out my pre and post work routines, I felt a little better because those things I could control.

It could be as simple as using a certain type of pen during report. (I don't know if ER nurses write during report; I've never worked or even shadowed in an ER). I always use my special pen, and it makes me feel better. I used to make my bed before I left for work and have my pajamas sitting out on my bed. That way I could look forward to those warm pajamas and my comfy, freshly made bed! Then I changed up and looked forward to my microwavable miniature Weight Watchers pizzas and watching Dr. Oz. Just thinking about those pizzas got me through some tough shifts! Now I have a nice car and look forward to driving it to and from work. The smell of the leather gets me through.

Maybe you could incorporate some uplifting music on your drive to work...or watching a funny TV show as you get dressed and ready! Putting your mind at ease before work can help a great deal. And I think a big chunk of our nerves as nurses comes from the unexpected and knowing we can't control everything that happens during our shifts. That's why routines are so helpful, because even if we can't control what patients' bodies do, we CAN control what socks we wear and the book we read right before going to sleep after a long shift.

The bad news? If you're an anxious person by nature (like I am), the nerves may never go away completely; but...even I (queen of nervous Nellies) have learned to adapt.

You can do it. If I can, you can, too!

CFitzRN, ADN · Apr 3, 2010

You say "just homecare, 1 client" - what type of acuity did your patient have? Did you practice skills (I'm guessing you had to have training in vent/trach)? That's nothing to sneeze at. You were being a nurse!

I -totally- understand where you are coming from. I am fairly bright, can do most things I try, and yet I am a bloody basket case at work sometimes. It's all about confidence. I have seen nurses who really don't know much of anything but they have this amazing confidence on the floor, which truly makes them seem competent. The truth is, I'd rather have YOU as my nurse. You're not as likely to make a major, life-threatening mistake.

It is possible that the ER is not for you - and you will have to work there for awhile to truly get the answer to that. One thing I've learned in this profession: what does not kill you makes you a TON stronger! Every time you go through a scary situation (be it a skill you had to do, or living through your first several months of being a floor nurse on a new floor) and come out of it alright, it adds exponentially to your confidence and abilities as a nurse. You really sound like a good nurse who just needs a little confidence boost. Keep pluggin away. I can't promise it won't be scary, but I can promise that if you take any challenge that comes your way head-on and don't try to hide from them, you will learn a ton and will come out a much better nurse.

fiveofpeep · Apr 3, 2010

just remember, you are new...you wont be the best at everything and it's totally okay to ask for help.

I suck at venipunctures and IV sticks and you can bet I rely on help from my coworkers and I dont let myself feel bad or nervous about it.

Im new, I dont have a lot of experience...this is normal. You are normal! :)

Crocuta, RN · Apr 3, 2010

I'm glad that you're nervous. It means you know your limitations. It's cocky new grads that scare me.

I've had the privilege of orienting several new grads to my ED. Toward the end, most are feeling the same way you do. I tell each of them the same thing - you're going to feel like that for the first full year that you're in the ED. I did too - I came in every day thinking that I didn't know what I was doing. An amazing thing happens, though. So slowly that you don't even notice it, the anxiety drops away. The realization usually happens after the fact. "I just realized that I was running that code." "I knew when that guy walked in that he had a neck fracture." "The doctor listened to my advice and it was an MI and not just indigestion."

Relax, ask lots of questions, listen to the nurses that know what they're talking about. I also encourage my new grads to go in and listen while the doctor interviews and examines the patient. I still do this. It helps get you and the doctor on the same track, you'll pick up a ton of great tips for physical exams, and you'll learn how each of your doctors thinks and you'll be better able to anticipate which direction they'll head in which will help with your time management.

Good luck - and did I mention relax? ;-)

Ruby Vee, BSN · Apr 4, 2010

in my case, "new nurse nerves" lasted a good several years, but lessened gradually over time until, without realizing it, i felt confident and was competent. i, too questioned whether i should even be a nurse, and i cried all the way to and from work every day. that gradually lessened, too. had i had an easy "out", i might have given up nursing altogether in my first few years. i didn't, and i'm awfully glad i didn't. (read my "when i was a new grad" article for a good laugh!)

perbd · Apr 4, 2010

Thank you all for the advice! I really appreciate it!

The homecare patient I cared for had a traumatic brain injury. He wasn't on a vent, but he did have a g-tube for a few months. I used my skills. You are right CfitzRN, I was being a nurse. So I do have 4 years of experience. It was just a long time ago (1998 - 2002). I shouldn't minimize it. It was great experience.

I have only been in the ER for one week. I guess I'm just too hard on myself. I have to give myself some time, and I am sure the confidence will come. I just have to be patient.

I am also having trouble with IV starts. When I was on the med/surg floor, my preceptor told me to just pretend I've been doing them for 20 years. She was right. When I did that, I was able to start an IV the first time.

Maybe the ER is not for me, but I will give it a chance. When I was hired, my nurse manager told me that if I wasn't comfortable in the ER, she will have something else for me. I really liked the ICU.

I will take all of your advice. I know it will take time to feel comfortable. Thanks again!

perbd · May 2, 2010

Well, I am now going in to my 6th week in the ER. I work three 12 hour shifts per week. I thought it was getting better, but now I'm not so sure. I know it is expected to have good days and bad days. I had a couple of good days, but more are bad. I feel so inept. My nerves are still getting the better of me.

I was trying to put a non-rebreather mask on a pt who just had a seizure, and dropped the mask right in front of the doctor. Then I fumbled for the tubing. He made a comment that we have to be quick here. I felt like such an incompetent fool. On his way out, the doctor said goodbye and I made a comment that I may not come back. I said I am so afraid I might hurt someone. His comment to me was that he comes into work everyday feeling that way. We talked for a few minutes and he said "Do you mind if I give you some advice?" I said please do. He said that it would probably be good for me to spend a year in the ICU where the pace is not so fast, but the patients are critical. Then come to the ER.

I was hired for the ER, but to be honest, I liked the ICU much better. I spent 5 weeks there, and the last two days I was on my own (preceptor was there, but let me fly). I felt confident.

I recently had a tragedy in my life (a close relative died, probably suicide). I know that this is having a huge impact on me right now. I try to put it out of my mind, but it's very hard. I'm going to a support group meeting this week. Hopefully that will help me.

My question to you is this. How long should I stay in the ER before I make a decision as to whether or not it is my niche? One of the night shift nurses told me to give it 3 months (which is the entire length of my orientation).

I dread going to work now. I don't want to feel that way. The people are terrific, they make work fun. But my lack of confidence is getting the better of me.

CFitzRN, ADN · May 2, 2010

Dear girl, you have half the battle won! If the people with whom you work are supportive and you feel okay with that, YOU HAVE TO STICK IT OUT! This will give you amazing confidence down the road. I wholeheartedly agree that you should give it at least the 3 months of orientation - THEN and only then should you make the decision whether to move on to something else. Unless you are finding it impossible to function in your daily life because of it - but if that's not the case, I truly feel you would be doing yourself a huge favor to stick it out for orientation at least.

That doc may have been right, but he may also have been dead wrong. He doesn't know better than you do. Trust your gut. MY gut tells me you are in a very good place to do some serious learning right now and you shouldn't let this opportunity pass you by.

perbd · May 10, 2010

Thank you for the great advice CFitzRN , but I talked to my nurse manager and told her I don't feel ready to work in the ER at this time. I have been feeling so stressed out just thinking about going to work. In fact, tonight I feel like vomiting thinking about what my day will bring tomorrow. I don't think I can go on feeling this way for two more months. I'll be working 3 more days in the ER and will do my best, but I feel like a fish out of water. When I got to work on Saturday, the preceptor I was with told me to take my own patients and that he and another RN would be available to help me if needed. I acutally did ok on my own. I was slow though. Of course, I did not take any urgent or emergent patients. I still forget to ask certain questions during my assessments and have to go back and ask, but some of the seasoned nurses told me they still do that too. I will be going back to the med/surg floor starting 5/19. The nurse manager on the med/surg floor told my manager they would be glad to have me back there. They will orient me for a couple more weeks on the night shift, then I should be on my own. Unless I don't feel ready for it. They will give me more orientation if I need it. I know I will learn a lot in the ER, but my gut tells me I'm not ready for that pace yet. Especially since I'll be working the night shift and there are only two nurses staffed from 11 pm to 7 am. All of the nurses in the ER support my decision. Most of them think that an RN should have at least one year of med/surg or ICU experience before working in the ER. I will learn a lot on the med/surg floor. They told me they will float me to train in ICU on slow nights on the med/surg floor. I think I made the right decision. I am just a bundle of nerves in the ER. I felt more comfortable when I was orienting on the med/surg floor and ICU. Maybe once I have gained more experience and feel more confident, I'll return to the ER. :confused:

perbd · Aug 1, 2010

Well, I need more advice from you all.

There ended up being an opening in the ICU, so that is where I have been working since the 3rd week of May.

They gave me two weeks of orientation (I had 5 weeks of orientation in ICU prior to going to the ED). I have been on my own for two months now. They do not schedule me by myself. There is always a seasoned nurse scheduled with me.

I still am very nervous. The nurses I work with are totally understanding about my nervousness and help me all the time. There is one nurse, however, who has no patience and gets mad at me. Friday night we were scheduled to work together. There was no monitor clerk scheduled to watch the telemetry monitors, so the other nurse assigned herself to that job and gave me the two patients we had on the unit. Things were going ok. She talked to me about being nervous and told me to just take some deep breaths, that I'm doing well with my patient care.

One of my patients who was on a vent, kept moving his legs so they would hang off the bed. I was charting. She noticed his legs off the bed and went in to put them back on the bed. Then the other patient began to have audible congestion so the nurse helped suction her (oral and nasal). She wasn't bringing up a lot of secretions, so the nurse suggested I call the doctor to get some Lasix ordered. I did. I gave the patient the Lasix, and it was helping.

Then all of a sudden, and I'm not sure what set her off, the nurse got mad and made a comment that "you have to get over your nervousness, especially at someone else's expense". I don't think she was referring to my patients expense, because they were fine. I was not neglecting them.

I got very upset over this. I hate to be this way, but I am very emotional. I tried to hide my emotions from her, but eventually I apologized for getting her upset. I said I cannot work like this and I had to talk about it (with tears in my eyes). She said she had a bad day and apologized for her actions.

I am doubting my ability as a nurse now. She said "lets start over" and we had some zucchini bread and coffee.

We talked later and I said to her that I may not be cut out for nursing. Or maybe I should get out of ICU and go work on the med/surg floor. She told me I will be a good nurse, I just need experience and have to get over being nervous.

She made a comment for me not to go to talk to the nurse manager. She said it would be worse for me on the med/surg floor. She said I'll learn a lot in ICU. Our ICU is small and we don't have really super critical patients. The critical ones are shipped out to bigger hospitals.

I am seriously thinking about looking for another job. I had a couple of issues on other days when I worked with this nurse. I did talk to the supervisor who was on the first time I had an issue with her, and she told me to take deep breaths and do my best. The other nurse gets overwhelmed sometimes, but has not complained to management about me.

I know I will get over the nervousness sometime, but in the meantime I'm stressing. I don't want to take any medication either. I am trying to have a positive attitude, but lately I can't seem to handle stress.

I'm seriously thinking about getting out of nursing. Please let me know if anyone has had similar experiences and how you coped with them.

Thanks.

CFitzRN, ADN · Aug 2, 2010

Well, I need more advice from you all.
There ended up being an opening in the ICU, so that is where I have been working since the 3rd week of May.
They gave me two weeks of orientation (I had 5 weeks of orientation in ICU prior to going to the ED). I have been on my own for two months now. They do not schedule me by myself. There is always a seasoned nurse scheduled with me.
I still am very nervous. The nurses I work with are totally understanding about my nervousness and help me all the time. There is one nurse, however, who has no patience and gets mad at me. Friday night we were scheduled to work together. There was no monitor clerk scheduled to watch the telemetry monitors, so the other nurse assigned herself to that job and gave me the two patients we had on the unit. Things were going ok. She talked to me about being nervous and told me to just take some deep breaths, that I'm doing well with my patient care.
One of my patients who was on a vent, kept moving his legs so they would hang off the bed. I was charting. She noticed his legs off the bed and went in to put them back on the bed. Then the other patient began to have audible congestion so the nurse helped suction her (oral and nasal). She wasn't bringing up a lot of secretions, so the nurse suggested I call the doctor to get some Lasix ordered. I did. I gave the patient the Lasix, and it was helping.
Then all of a sudden, and I'm not sure what set her off, the nurse got mad and made a comment that "you have to get over your nervousness, especially at someone else's expense". I don't think she was referring to my patients expense, because they were fine. I was not neglecting them.
I got very upset over this. I hate to be this way, but I am very emotional. I tried to hide my emotions from her, but eventually I apologized for getting her upset. I said I cannot work like this and I had to talk about it (with tears in my eyes). She said she had a bad day and apologized for her actions.
I am doubting my ability as a nurse now. She said "lets start over" and we had some zucchini bread and coffee.
We talked later and I said to her that I may not be cut out for nursing. Or maybe I should get out of ICU and go work on the med/surg floor. She told me I will be a good nurse, I just need experience and have to get over being nervous.
She made a comment for me not to go to talk to the nurse manager. She said it would be worse for me on the med/surg floor. She said I'll learn a lot in ICU. Our ICU is small and we don't have really super critical patients. The critical ones are shipped out to bigger hospitals.
I am seriously thinking about looking for another job. I had a couple of issues on other days when I worked with this nurse. I did talk to the supervisor who was on the first time I had an issue with her, and she told me to take deep breaths and do my best. The other nurse gets overwhelmed sometimes, but has not complained to management about me.
I know I will get over the nervousness sometime, but in the meantime I'm stressing. I don't want to take any medication either. I am trying to have a positive attitude, but lately I can't seem to handle stress.
I'm seriously thinking about getting out of nursing. Please let me know if anyone has had similar experiences and how you coped with them.
Thanks.

Honestly? I think you're going to be a kick-@ss ICU nurse. You are exactly the kind of nurse I would want to have if I were in the ICU. You're the kind of nurse who isn't going to overlook something major because of the trepidation you have. Now, that same trepidation is biting you in the butt because it's so stressful. But quitting and doing something different right now is not the answer. I have learned from first-hand experience that doing that will only make things worse, no matter what you end up doing. I was having very similar issues (and you remind myself of me, very much) and I bailed. Huge mistake. Actually, I was having very similar issues while orienting on days (I was hired for nights). It actually started to get easier but mostly I felt like an incompetent loser. I am NOT used to feeling that way so it was very hard on me. I truly needed to get around my ego (not that you are egotistical and I wasn't either, but I do think the ego gets in the way) and just press on, hard and steady. There will be good days and bad days. Unfortunately, just a few days after changing over to nights I crashed and burned really bad. I wasn't sleeping at all, and I was still very stressed out and feeling incompetent and it was too much for me. I still regret bailing though - and I always will.

Now about that nurse. She sounds like a b*tthead. She sounds a little unpredictable and not a good source of support. I'm really happy to hear most of the other nurses are supportive and kind. That's huge.

You could always talk to your supervisor and request that she not schedule you with that nurse because of "personality conflicts". You sound like a very easy-going, rational person. You do not sound like a trouble-maker. I think it would be totally reasonable to make that request.

I hope you stick with it. I really, really believe you are and will be a great nurse.