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.
I have panic disorder and depression, and was put on a probationary orientation also. My number one recommendation-get back on your medication. I'm not sure how you are even making it without it to be honest. You're body is not only worn out from working a twelve hour shift, but it's worn out from going through so much anxiety/panic/stress throughout the day plus who knows how your even sleeping.
Put down the books after your shifts. You're brain can only take so much. Just focus on learning the procedures and time management right now. You'll pick up what you need to know on the job. You should know plenty from studying for the NCLEX/from school right now.
Learn about the job while you're at work, rest at home. REST AT HOME. Don't think about work...you may as well be there if you're thinking about it cause it's taking up you're time even if you're just thinking about it. Let your brain and body rest, let the medication help you through this time at work. I got through it...believe me, you can too.
I've been at my nursing job for over 8 months now and I'm still trying to practice not thinking about work while I'm at home and trying to get sleep. But it's okay to take your medication, give yourself a break...You have it to be able to function to your fullest capacity. Try it. Me and you worry way too much, I used to take out my book too.
Dont worry about pts or whoever watching you. Zone them out and pay attention to what your doing. If you can, get meds out and scanned before going over to your pt so they won't throw your focus off by talking. Do the easiest pt first. The list in your head of what there is left to do will be shorter. Pts who are talkers...always save for last.
Youre putting too much pressure on yourself. Just learn the job, rest at home, and take your meds. That's my suggestion from a very similar situation. You'll be alright.
I have been at my current job for a year now. My anxiety has not diminished since day one. I am an LPN working the 3- 11 shift so I am the only nurse on duty for that shift. It is in an assisted living facility so we don't have any skills to do, I mainly pass medications. The med pass is heavy and while I'm doing that I have to answer the phones, take care of new orders that come in, deal with family members, sign in the delivered medications, do assessments on new residents, handle any falls or illnesses, do skin checks.... the list goes on and on. No matter how I try to organize my time, that med pass kicks my butt. I would love to get a job where I could learn some skills but I don't know if I could handle the stress. Good luck to you!
If your preceptor or supervisor say something like: "I want to see marked improvement" just leave. Don't even look back. I just cannot understand why these supervisors and older nurses in general are so mean, uncaring, game players, backstabbers and don't have a drop of compassion for young nurses who are learning. You are wonderful and will be a wonderful nurse. Of course you are anxious! Nursing not only is a stressful job but in addition to that you have these mean people on your back like monkeys your shoulder. I feel so sorry for you and I know exactly what you are going through. I was there once and looking back now I see how ridiculous and petty these people are. Their lives are so empty and meaningless they take pleasure in picking on the young and defenseless, just like robbing a candy from a child. Don't worry you'll be a great nurse.
In OPs original post, she identifies her difficulty with multi-tasking. This can give rise to all the other stuff that is going on.
Sorry - going off on a bit of an academic journey here..... those of you who are research-phobic may want to look away. Recent cognitive research has provided evidence that there are significant differences in the amount of "cognitive load" abilities. Some people can effectively juggle 8 or 9 separate thoughts, while other people maxx out at 4. HERE is a nice overview. In addition, there are "switching costs" associated with changing from one task to another. Nurse researchers have taken this a step farther to study nurses' ability to "cognitively stack" information as part of patient care. Please note - This has absolutely nothing to do with intelligence. That's a whole different deal.
Bottom line?? A fast-paced, high intensity working environment is just not suited for some people if the associated cognitive load exceeds their natural capability. Trying to force oneself to do so would be like me trying to force myself to be tall, slim, and 25 years old again. I could do all sorts of things to try to achieve that end, but we all know it's not going to end well.
@HouTx, I believe I can "cognitively stack" tasks. However, as I stated, I am anxious because I feel the weight of trying to accomplish tasks within the necessary time frame. I'm still learning and know I am not as quick as a nurse who has been doing the same tasks for years.
I admit I find your post discouraging and unsupportive. Unless I misunderstood, you are saying that if a new nurse is anxious and struggling with multitasking, it is not related to inconsistent support, multiple preceptors or new grad anxiety but results from simply trying to do the impossible because one doesn't have the ability to cognitively stack tasks. If most new grads were able to seemlessly learn time management, prioritization and multitasking in twelve weeks in a high acuity environment, I would be more inclined to agree with you, but I think this is a very common learning curve. I'd hate to discourage other struggling new nurses reading this thread with your theory that reduces the issue to merely not having an innate "natural capability" to support such a "cognitive load."
SICU17
3 Posts
I have panic disorder and depression, and was put on a probationary orientation also. My number one recommendation-get back on your medication. I'm not sure how you are even making it without it to be honest. You're body is not only worn out from working a twelve hour shift, but it's worn out from going through so much anxiety/panic/stress throughout the day plus who knows how your even sleeping.
Put down the books after your shifts. You're brain can only take so much. Just focus on learning the procedures and time management right now. You'll pick up what you need to know on the job. You should know plenty from studying for the NCLEX/from school right now.
Learn about the job while you're at work, rest at home. REST AT HOME. Don't think about work...you may as well be there if you're thinking about it cause it's taking up you're time even if you're just thinking about it. Let your brain and body rest, let the medication help you through this time at work. I got through it...believe me, you can too.
I've been at my nursing job for over 8 months now and I'm still trying to practice not thinking about work while I'm at home and trying to get sleep. But it's okay to take your medication, give yourself a break...You have it to be able to function to your fullest capacity. Try it. Me and you worry way too much, I used to take out my book too.
Dont worry about pts or whoever watching you. Zone them out and pay attention to what your doing. If you can, get meds out and scanned before going over to your pt so they won't throw your focus off by talking. Do the easiest pt first. The list in your head of what there is left to do will be shorter. Pts who are talkers...always save for last.
Youre putting too much pressure on yourself. Just learn the job, rest at home, and take your meds. That's my suggestion from a very similar situation. You'll be alright.