On probation for being too "anxious"

[fskye]

My NM called me into her office yesterday and informed that they have extended my orientation for two more weeks and was asked to sign a formal statement placing me on an extended 30 day probationary period because I am too "anxious", that they worry that I won't be able to handle stressful situations. I was told a before that I "looked anxious" so I focused on appearing calm but have been told that while I appear more calm, my preceptor can still sense that I am anxious. My preceptor believes I am "suppressing" my anxiety now, and it is causing the serious health issues I have been having. It's plausible since suicides and mental illness are common in my family, and I have inherited the severe depression and GAD that was well managed with medication until I became a nurse.

My NM said my preceptors report that my nursing skills are good, that I'm a quick learner, and my charting is excellent, but I don't handle stress well when all the orders come flying in, when I'm admitting a patient, another is puking and wants Zofran, another needs stat labs and radiology is on hold about my patient in CT. And it's true. I do feel flustered and unsure of what to do although I'm slowly learning how to prioritize what needs addressed first. My NM has been very supportive, but I feel humiliated that I am the only one of the new hires being put on probation (although I know that I am almost twice as old as and aware that I don't multitask half as well as I did in my 20s.) Some of the other nurses have made unintentional comments that undermined my shaky confidence. I give 100%, coming in early to prepare, rarely sitting or eating in 12 hours. I come home exhausted after every shift and ice my swollen knee and study drugs or complications that I was unsure of. The other nurses I started with tell me I should just say, "**** them" and be confident, that I worry too much about what other people think, that I'm too hard on myself, but then again, I'm the only one on probation.

My anxiety, however, really stems from the fact that I am still learning how to do some procedures and need to get someone to help me or, if I know how to do it, I'm not as fast as a more experienced nurse. This slows me down considerably and I feel panic rising that I simply cannot do everything that needs done in the required time frame because I am new, unsure and have to get someone to help, the patient's family is watching me and my hand shakes and I fail at lab draws and IVs or putting in a Foley. And, yes, I did ask if I could possibly transfer to a less intense floor and was told that they usually require a full year before you can move. I don't want to take Xanax or Ativan when I'm working because I fear it would slow my thinking even further.

I need advice from experienced nurses on how to get a handle on my anxiety coming off orientation on day shift on a high acuity unit with the added stress of knowing I am being carefully watched and may not have a job in 30 days. She said to relax and go home and enjoy my holiday before I go back into work, but I'm spending Christmas stressed out and depressed. I have kids to support. I desperately need to get it together.

[SarahEAW]

There are alternatives to meds. To cope w anxiety. Perhaps some positive affirmation recordings, cognitive therapy, etc. Many nurses "shake" and have confidence issues, so don't beat yourself up. In the end if the floor you are on is too chaotic there are many types of nursing. In our dept. If a new nurses isn't working well in our dept. We work w HR to find a better fit for the nurse.

[WereBadger]

I'm a new nurse myself, but what initially stands out to me in your post is that you mention that your "severe depression and GAD...was well managed with medication" previously. Have you spoken to the person who was managing these medications for you regarding your concerns about taking them while working?

[hppygr8ful, ASN, RN, EMT-I]

Hang in there - Use the extra time to build on the confidence you need. There are videos of most procedures on you tube. You say your anxiety is mostly controlled with meds but you don't want to take anti-anxiety meds at work. I have PTSD and have suffered from crippling anxiety at times - I have found that a good routine of stretching, meditation and diaphragmatic breathing to start my day helps greatly. Try not to skip you breaks or meals - you need those breaks. Use the extra time to really focus on your skill set. The fact that they are giving you extra time is a sign that they like you and want you to succeed. After all they could have just let you go.

Hppy

[KatieMI, BSN, MSN, RN]

Well, with my own experience of the very similar situations, I would say that you better prepare to get the heck out of there.

I wish that would be wrong, but it is borderline impossible to change human perception of things. If people THERE see you as "anxious and lacking confidence", then whatever you do, they will continue to see the same. The guilty feel of acceptance one's mistakes is a very powerful and very negative emotional blow. It sucks to say, even for yourself only "gee, this gal is actually great, too bad I was seeing her for so long in that completely wrong light and then gossiped about her to everyone not too lazy to listen". Instead, the tendency is to seek and, low and behold, find one fall after another. They already painted a target on your back, and even cared to create a paper trail.

I hate to be a naysayer, but, again, from my experience, only one effective way to overplay it is a resignation note on the table before they create one for you. Dust off your resume and start looking. If you can, get VERY friendly with nurses from other departments you might meet, preferably ones who manage one patient at a time, like hospice. And, yes, get professional help for your anxiety.

[ClaraRedheart, BSN, RN]

Oooh... Been there. I failed my foley checkoff in nurwsing school because of that. I shook so badly I broke my gloves and sterile field. It was awful. I talked to a doc and was put on fluoxetine... failed two classes and then realized that I probably NEED my anxiety as a driving factor. First year as a new grad, my doc put me on propanolol because my anxiety was through the roof, pulse constantly >120, BP high, etc. It got to the point where I only took it if I was working, then I didn't need it anymore. It was incredibly helpful IMO. Nursing can induce anxiety. Even now, if the orders are flying in like that I'm not above a panic attack in the bathroom... furiously fanning my face and hyperventilating. It's much less often than it used to be. It will be ok! Just give yourself TIME! Also, you might consider the night shift. It's a bit slower paced overall. I could not have survived as a new nurse working days.

[CrunchRN, ADN, RN]

I suffer from performance anxiety and Propanalal is a huge help. It is a BP med so no nasty side effects. Just shuts down the fight/flight hormones. The other thing is to fake it confidence wise and eventually that becomes reality. Best to you.

[Penelope_Pitstop, BSN, RN]

Well, with my own experience of the very similar situations, I would say that you better prepare to get the heck out of there.

I wish that would be wrong, but it is borderline impossible to change human perception of things. If people THERE see you as "anxious and lacking confidence", then whatever you do, they will continue to see the same. The guilty feel of acceptance one's mistakes is a very powerful and very negative emotional blow. It sucks to say, even for yourself only "gee, this gal is actually great, too bad I was seeing her for so long in that completely wrong light and then gossiped about her to everyone not too lazy to listen". Instead, the tendency is to seek and, low and behold, find one fall after another. They already painted a target on your back, and even cared to create a paper trail.

I hate to be a naysayer, but, again, from my experience, only one effective way to overplay it is a resignation note on the table before they create one for you. Dust off your resume and start looking. If you can, get VERY friendly with nurses from other departments you might meet, preferably ones who manage one patient at a time, like hospice. And, yes, get professional help for your anxiety.

yes, yes and YES!

I was in this same boat a little over one year ago. It was related to my mental health, too. That work environment was TOXIC. I didn't realize it at the time but now, looking back, I realize they would have dug my grave for me had I not left.

[THELIVINGWORST, ASN, RN]

My advice for anxiety and depression is two-fold; get on some med to help at least temporarily, I'm on elavil for insomnia and anxiety so I take it before bed, and be confident in what you DONT know. Don't pretend to know it all, don't fumble around trying to keep your weaknesses hidden. ASK QUESTIONS.

Remember that if no one is dying, it will all be okay. One thing at a time.

[Conqueror+, BSN, RN]

My two cents is to stop oversharing. Unless I am mistaken you have shared this info about yourself with your new boss. MISTAKE. You think it will help them understand but that is not how it works. Much like being arrested, anything you say will be used against you. They are your coworkers, not your therapist. If you can start fresh at a new facility do so and keep your personal business personal.

[fskye]

@conquerer, no, I didn't and would never share that with my nursing manager. While I have some serious and extremely stressful personal issues right now, I do try to leave my personal business at home as best I can and focus on work.

@werebadger, I too have PTSD for some horrific issues in my past, but I have done well with years of therapy. I just didn't realize how much it would affect me as a nurse. The stress of being a new grad on a high acuity floor has stirred a lot of that up, but I'm aware of it and working on it.

@hppygr8ful, I'm going to look into meditation and diaphragmatic breathing. Thanks!

I appreciate everyone's advice and have been thinking about the situation. I will try to remind myself that I can only do what I can do. I am not an experienced nurse and cannot do these tasks as quickly as one with years of experience. I have to remember that everyone started out where I am. My job is to keep the patient safe and that will mean asking for help when I don't know. And if my best effort isn't enough, then worrying won't change that. The challenge will be remembering that once the **** hits the fan.

[WereBadger]

I appreciate everyone's advice and have been thinking about the situation. I will try to remind myself that I can only do what I can do. I am not an experienced nurse and cannot do these tasks as quickly as one with years of experience. I have to remember that everyone started out where I am. My job is to keep the patient safe and that will mean asking for help when I don't know. And if my best effort isn't enough, then worrying won't change that. The challenge will be remembering that once the **** hits the fan.

It sounds as if you're a deeply caring and introspective person, and I admire your levelheadedness.