New nurse terrified of harming pts

[Robin1990]

Hi allnurses!

I am a new nurse, 2 weeks into my orientation on a very busy med-surg unit. I know this season can be very stressful for most people, so I'm trying to take it all in stride and take it one day at a time. But I am finding myself haunted by a nightmarish fear of making a mistake that will harm a patient. Particularly a med error, or in the area of IVs. I am not yet comfortable dealing with IV medications, and my unit has PCAs, TPN, central lines galore. My unit has been understaffed and I feel like I'm being pressed to be more independent than I feel safe being, and this in turn makes me shaky, distracted and fearful.

I believe in my heart that it will get better, and I know that in order to be cured of the lurking fear/horror around the idea of harming a patient, I just need to keep going to work and learning and facing my fears....but do you have any tips for me? Is this normal? When does this terrible feeling start to go away??

Thank you so much allnurses! These threads helped me so much through nursing school.

[TheCommuter, BSN, RN]

I never had the fear of harming or killing a patient that you seem to have. However, I can assure you that things will become easier as you learn more clinical pearls of wisdom and develop some confidence. Good luck to you!

[Jules A, MSN]

How anxious are you at your baseline? Harming someone has lurked in the back of my mind throughout my career but I feel it is within the normal realm and serves to keep me focused and alert. I do not however feel this inhibits my ability to function so that is probably the line. If you are normally not an anxious person and feel this is over the top perhaps your unit is unsafe and not a good situation for a new grad. If you are normally fairly anxious I think nursing will be challenging but doable and I'd encourage seeking a therapist to bounce ideas off and learn effective coping skills. Good luck!

[Galendria]

If you are only 2 weeks into your orientation, then as a new grad (ideally) you should still be receiving quite a lot of support and assistance from your preceptor. Do you have a consistent preceptor that you feel comfortable talking to? Are you receiving feedback? Does your nurse educator meet with you to ask how things are going and what you are learning?

I've been a nurse for 11 years, and have been precepting for about 8 of them. I want to say first of all that being nervous is completely normal. I still remember being absolutely terrified when I started my first job (on a very busy post-op unit whose patients had tubes coming out of every bodily orifice). I actually worry if my orientee has an apparent complete lack of nerves or doesn't call me with questions and/or to come check that they "set an infusion up right" before starting it. I tend to follow those orientees a bit closer, go in behind them in rooms to check their work, etc. because it is *normal* to want your preceptor to check after you for the first 2-3 weeks. Its normal to ask her questions your entire orientation (which will ideally be at least 10 weeks). It's normal to still have questions after you finish orientation (especially during the first 6 months). Being a nurse is serious business, and even now, even after 11 years, I triple check my work and bounce questions off my co-workers if I am doing something I haven't done in a while.

That said, your confidence should slowly increase over the next few weeks. If, after the half way point of your orientation you are still feeling mind-numbing fear, talk to your preceptor, and/or talk to your nurse educator. In the meantime take full advantage of the safety features that are in place for med administration. Follow your 5 rights to a T, use bar code scanning, guardrails on your IV pumps, 2nd nurse verification for high risk meds, and any other best practice safety checks that your hospital uses. We are all human, and those features are in place to protect us and the patients. Best of luck!!

[Robin1990]

Thank you so much for your comments! I am now 3 weeks into orientation, with 3 to go (6 weeks feels too short!). But my fear has abated a little. I think the vast sense of the unknown was really scaring me, but now that I've worked with PCAs, PCEAs, and forcing myself through my issues with IV's it's getting better. I have feedback from my preceptors that I'm a safe nurse and that I'm tracking mentally with what they're teaching so I'm learning to trust myself too. This is hard though!!! I can't wait until I have a year under my belt.Thanks again for the comments!

[~PedsRN~, BSN, RN]

I am going to be the person that tells you that that fear is a good thing. I work in pediatrics, so we do all the weight based dosing - and when I first started I was absolutely petrified that I would make a mistake when drawing up and dosing meds. As a result? I checked my calculations over and over again. It is OK to have a healthy fear like this - because it's true! You could very well harm the patient if you make a mistake. So what can you do to prevent that? Be cautious. Be safe. Once you get the hang of things, it won't seem like such a heavy burden to carry. You will get better at it, you will get comfortable reading orders and drawing up meds.

But you will probably be like me with a few of the big dogs.... I check my insulin orders and do the math at least 6 times before I even get a verification from a second nurse. Insulin is the drug that scares the poop out of me. HA!