New nurse tips on anxiety

malenurse69, MSN, NP · Dec 11, 2016

Keep going, it gets better.

Also when you are on your own take the sickest patients and learn as much as you can, that'll cure your anxiety real quick.

Only thing I have an issue with is a 6 week preceptorship, that's too short. Newgrads in an ICU require minimum 12 weeks in my opinion. Id ask your manager to extend your preceptorship and use that opportunity to get the hardest assignments

Medicalicurn · Dec 11, 2016

I feel like we also need longer. Theres a few of us who told the program directors that we feel like we need longer in orientation and they said "everyone is saying that. We'll keep it in mind for next time"

vintagemother, BSN, CNA, LVN, RN · Dec 18, 2016

You said that you use a checklist. I do, as well. I'm a new grad and the checklist helps to relieve my anxiety. I actually check off/line through items as I finish charting them.

I also used to spend time at home researching things that I'd come across that were unfamiliar to me. I'd google YouTube videos, NIH and CDC articles,etc. Then I'd hand write a short summary. (Felt like school again)

I also would talk with other nursing friends I did not work with to vent /get tips.

At one point, I also wrote myself SMART goals for work: Measurable and Attainable, etc.

Eventually, I learned how to look up and print company policies and kept copies to read and review.

nutella, MSN, RN · Dec 18, 2016

There are several things.

One is that it is normal to go through an adjustment phase when you are off orientation as a nurse. Now the pressure is on and you are still learning and will continue to learn for the first 2 years, with the first year being the most stressful. If generally speaking you are a good fit for the ICU and you get along with the other nurses, helps to stick it out. The more practice you get the more confident you will be and the less stressful you will feel.

It is normal for some people to be worried about the potential things that can happen, the "unknown". That feeling tells you that you have not mastered all skills and are not aware what to do in all situations, perhaps there is some knowledge gap as well.

The way to go about this is to make sure you have the right literature and spend time outside of work reading and memorizing including algorithms. And in addition, you can go through scenarios in your head to help you think through it so when it happens in reality, you have already through about it and hopefully feel more confident. You probably noticed that when you did the CPR course, they drilled a certain sequence into your head - that kind of process is similar for a lot of other problems/situations in nursing as well.

Lets say you are nervous about a sudden drop in blood pressure to the 50s systolic - so you go through it in your head :

is the patient extubated or intubated? already on positive inotropics? needs fluid resuscitation? did I just switch out the syringe with levo?

The other big part is more of a coping thing. You should be working within a team and not in total isolation. Theoretically speaking, if something bad goes down you should be able at all times to call for help and people should just come and help you. Everybody needs help when things go downhill. When I was a new grad in the ICU, people were very good about helping each other and I could ask anything without being judged. When I switched to cardiovascular surgery CCU, I had to learn different things and there were things I had never done before. So I went through some scenarios in my head and asked the experienced nurses "what if I get a patient from the OR and they suddenly loose 1 liter blood through the chest tubes?" - the re-assuring answer was "you are new - all you have to do is call "I need some help in here" and step to the side, let one of us run it for you the first time or first times so you get familiar with what is needed" Good I asked because that is exactly what happened after I was off orientation. The patient's chest was opened in the bed in the ICU with the OR nurse running to the bedside, the anesthesiologist putting the patient under right there (we had a mobile anesthesia machine with gas for exactly that purpose in the CCU), nurses hanging blood and FFP with level 1 and the MD searching for the source of bleeding right there. All I had to do was stand by and push meds as instructed and keep oversight over the IV /central lines, VS, documentation. The patient survived, no problems after waking up. Was I nervous - yes of course - but I also had the full support and was not afraid, just a bit nervous because I knew I could rely on everybody. Next time this happened I was more confident , still of course needed help but felt more in control.

So lesson from this is - know your team, key players and talk to them before things happen. My experience from working in several ICUs/ CCUs is that as long as the new nurse is generally speaking capable, keeps up with knowledge, has some humility and treat everybody with respect, most more experienced nurses will help when things go downhill. You can not turf off stuff but when you are new can can expect reasonable support. Also, offer your support to the senior staff - take the initiative. If your assignment is ok you may be able to say to the nurse next room "hey - if you need help washing and turning or if I can help you hold the ET tube while you re-tape it -let me know" or if you go to get something ask the nurse next door if she also needs some linen/wash basin. Even if they do not need your help - I am sure that they will appreciate you reaching out and that will make for a better team.

The coping part is to re-structure your thinking around your anxiety. A lot of nurses have some initial anxiety, which is normal, and after some months suddenly notice that it has gotten less and they feel less anxious. If you can take control over how you think about anxiety and your job, think about it more rational. Free floating anxiety can be hard to deal with and for some people it helps a lot to re-structure the automatic thinking process from "all the things that could happen and what if I am not able to do it and what if everybody hates me and what if the patient dies" to "yes, there are unknown things but that is also the beauty - never a dull day, and I will be able to deal with it because I have the knowledge and I have a team I can fall back on" and "Other nurses are working in the ICU - obviously it is possible".

If you feel generally down and low mood - it is also winter and some people struggle with some sort of mood disorder during winter - you might want to look into that as well. Perhaps see a therapist, look at your living and if there is anything you can improve - better sleeping habits, regular exercise, less caffeine, and so on. Perhaps see a MD/NP mental health to sort things out.

If you are generally a more anxious person, it is really essential that you learn the right coping skills as anxiety can get worse or can make your life miserable. There are good strategies like CBT and a therapist experienced with anxiety problems would be able to teach you some strategies.

Medicalicurn · Dec 18, 2016

Thank you for the reply. I do try to go over scenarios in my head pretty often and jot stuff down to ask later on, but honestly. I am doing my BSN right now so I do homework all day on my days off, besides my own errands, laundry, cook, clean etc, that I cannot possibly drown myself in anymore nursing related stuff. I keep hearing everyone say the 1st 6 months are the worst. I'm trying to push through. Thank you for the support!