Orientation Not Going Well

[coffeeandvendingmachines, BSN]

Hey all. First of all, thank you for this wonderful website I have to say. 

So I'm trying not to write an entire long drawn out story but, I'll end up doing it anyway. I am struggling. I recently got an outpatient nurse job. I have high anxiety levels at times, and my coworkers noticed it and, I would literally shake, thinking to myself that I will fake it til I make it. 

Well the (on top of many) problem is, that, despite outwardly thinking I was improving, it was not enough for everyone else. I now am in the stage where, if I don't succeed, I think getting fired could be around the corner. I'm an anxious person and, getting comfortable in a new job for me is going to take time. It really is just like, fake it for awhile until you make it. However, I haven't been faking it nearly enough because my coworkers can see my getting stressed, anxiety times come on at work. Even when to me I'm having a good day, because I'm not perfect at being relaxed and not anxious, they notice and don't think it's a good day. 

So I'm currently stuck in a difficult like self-fulfilling prophecy situation. I'm not sure I'll make it but, I want to try. I wish that I didn't have to fit in perfectly with the group and, be completely relaxed and look like I'm relaxed and enjoying and interacting with my brand new job, I wish I could just survive for now and then eventually with time I'll get it. It's like, if I don't retain knowledge the first couple times it's told to me, I'm out. Is this making any sense? In the past with nurse jobs, I have been so anxious during the first few weeks of orientation that I probably retain about, say, 50% or less of what I'm supposed to compared to a normal person. But I make it. 

So the next literal few weeks depend on whether I keep this job or not. My performance. I cried on my way home today because, this job was supposed to be like a "dream" compared to an inpatient or high stress hospital job. I feel like, if I can't succeed in this job, how can I succeed as a nurse at all? I know it's negative self talk but that is the crap that I mentally have to fight when I start thinking about it. 

Yes, I am aware I need therapy. I'm seeing a therapist. I'm on meds. I'm not on any high level anti-anxiety meds. I'm scared if I ask for them, my brain will be in a fog and that won't help my case at all. Plus my psychiatrist would take so long to prescribe them, it would be too late anyway to trial taking them. I just needed to desperately vent this to the nursing community because I am feeling crippled that I can't succeed and, I wish the health system weren't like this where you only have so much time on orientation, you have to fit in with the group of coworkers, you have to fit in with the doctors, etc.,  or you're out. Please help if you are able. 

[JKL33]

If you really think your job is on the line...

Is this a situation where you can have a heart-to-heart with your supervisor?

Could you say a careful version of what you have written here? Along the lines, "I know I will be able to succeed..."/"I have successfully navigated things like this before; I will be more natural and at ease as I continue to learn my role..." Or even..."please give me a chance, this is not all there is to 'me'...I am getting the hang of things and gaining confidence each day..."

?

Sometimes it takes asking other humans to acknowledge your humanity and just give you a chance.

Also, I know the negative self-talk can seem like a hopeless or insurmountable situation. Sometimes people are so, so terrified of what could happen if they mess up. At that point, it's worth asking yourself "well, on the other hand, what's the worst that can happen if I just go with the flow?" You know what I mean? Chances are EXTREMELY good that everything is gonna be okay if we don't worry about 95% of the things we find to worry about! ?  I know that's easier said than done, but....just....let go.

I hope it works out for you.

 

[CommunityRNBSN, BSN, RN]

Can you give us more detail about what your coworkers' concerns are?  You mentioned "shaking"-- but that doesn't have anything to do with your job performance.  (In fact, I vaccinated children for four hours while my hands were visibly shaking from anxiety and hunger. I used a two-handed approach because of how unsteady I was.)  Nobody would say "We are going to have to let you go because you tremble too much!" (I'm trying to be lighthearted, I know it's hard to tell through a comment thread).  Same for being relaxed and socializing: you don't have to do that, and nobody is required to be relaxed at work.

You did mention not being able to retain information-- can you write things down instead of trying to remember them?

I also work in an outpatient clinic so I feel like I can understand your situation and maybe help you make a plan if you can give us a little more info on what the concerns with your performance actually are.

[coffeeandvendingmachines, BSN]

Thank you so much. I wish I could private message you but I have to post more content for that. 

So I started writing things down and creating little "cheat sheets" for myself and it helped, but my manager wants me to not rely on that for "core content" if that makes sense. Such as education on certain topics, the interview type questions I ask patients' parents, etc. So I currently use my little cheat sheets by typing them into the computer in the patient rooms as a guidance.  

I guess I should directly ask the manager. I think that the main issue is patient safety. At this point she needs me to be working independently with the doctors. She said that other nurses have to rescue me or be very near me and that is what she is concerned about. Also she is concerned that I if I don't adequately perform the clinical skills of my job, that could be a patient safety issue.  I got the impression that since she cares about me as a person not just a number or a nurse, she wants me to enjoy this job, and she wants me to not be anxious. I just can't guarantee that I won't have bad days here and there and get shaky or freeze up on those days. The freezing up in the middle of being in front of a patient is a safety issue...what if I don't recover and adequately do my job. If I get so anxious that I freeze up, and get flustered, and then if I don't react and get going after that, my coworkers feel they must immediately step in and "rescue" me. 

Also as far as nurse performance goes, yes, at one point it was a concern for every single clinical skill that is required for working at this clinic. So of course any manager would be concerned about keeping someone hired if they can't do the basic skills necessary for the job. All these skills were generally new except for subcutaneous injections. So as I get more comfortable and experienced, I will do better in these areas. I guess I was getting so anxious that, I was freezing up and not adequately doing my job as a nurse. 

 

Sorry for the long rant. I appreciate you. 

[marsbar37, BSN, RN]

Is working with people giving you anxiety? or a fear of making mistakes? Or high pressure situations. You made it through nursing school and that is a big accomplishment. Give yourself credit for that! Maybe the environment is wrong for you. I found out early in my nursing career I did not like hospital nursing. Way too much stress and anxiety. I kept trying new areas until I found one that I love. If you want to stay in this clinic is actually performing skills on patients is what makes you nervous? I understand the shaking. I know how hard it is to overcome anxiety and trying to get a grip. It's easier said then done. Therapy is a good start and using this website too. Sending good energy your way!

 

[pinkandpurple]

What is causing the anxiety? Minor anxiety is normal and expected, when it interferes with your life you need to have it treated. What you describe is debilitating anxiety. Find an avenue of nursing that causes you the less anxiety. Some people work better alone in an office. Figure out whats heightening your anxiety and find something that fits you.

[CommunityRNBSN, BSN, RN]

On 5/4/2022 at 2:32 PM, coffeeandvendingmachines said:

Thank you so much. I wish I could private message you but I have to post more content for that. 

So I started writing things down and creating little "cheat sheets" for myself and it helped, but my manager wants me to not rely on that for "core content" if that makes sense. Such as education on certain topics, the interview type questions I ask patients' parents, etc. So I currently use my little cheat sheets by typing them into the computer in the patient rooms as a guidance.  

I guess I should directly ask the manager. I think that the main issue is patient safety. At this point she needs me to be working independently with the doctors. She said that other nurses have to rescue me or be very near me and that is what she is concerned about. Also she is concerned that I if I don't adequately perform the clinical skills of my job, that could be a patient safety issue.  I got the impression that since she cares about me as a person not just a number or a nurse, she wants me to enjoy this job, and she wants me to not be anxious. I just can't guarantee that I won't have bad days here and there and get shaky or freeze up on those days. The freezing up in the middle of being in front of a patient is a safety issue...what if I don't recover and adequately do my job. If I get so anxious that I freeze up, and get flustered, and then if I don't react and get going after that, my coworkers feel they must immediately step in and "rescue" me. 

Also as far as nurse performance goes, yes, at one point it was a concern for every single clinical skill that is required for working at this clinic. So of course any manager would be concerned about keeping someone hired if they can't do the basic skills necessary for the job. All these skills were generally new except for subcutaneous injections. So as I get more comfortable and experienced, I will do better in these areas. I guess I was getting so anxious that, I was freezing up and not adequately doing my job as a nurse. 

 

Sorry for the long rant. I appreciate you. 

Your idea about typing cheat sheets into the  computer is great!  That gives you something you can glance at if your mind goes blank while you're talking with a patient. Do you also have patient handouts?  If so, or if you can find some, that will give you something to go over.  If I am training a patient to use a glucometer, I don't have to remember everything I need to say-- I have a printout of instructions and we go over it together.

One thing that I would do in your shoes is make a list of the actual clinical skills.  In my outpatient clinic, there aren't really that many-- we do a lot more talking than we do hands-on tasks.  So open a Word doc at home and write down everything you need to be able to comfortably do with your hands.  I think that if you do that, it might help you wrap your mind around what the skills actually are-- there are not an infinite number of things you need to be able to perform.  There's a manageable amount.  You might even be able to cross some off: You mentioned SubQ injections, for example.  Then you can tell yourself, "Okay, I need to be able to flush out someone's ear (or whatever the skill is)."  Go over the steps in your mind over and over when you're NOT at work, so that you don't feel totally flustered when someone asks you to do it. You'll know: Ear flush?  Step one is go to the supplies room and collect these five items.

And yes-- have a planned, direct conversation with your manager.  Go into the meeting with a notebook and a pen, and say something like:
"I know you're concerned because I am not meeting expectations yet.  I am committed to performing as an excellent nurse in this job.  As you know, I've already mastered (XYZ, name something very small if you have to! "The patients have told me that they appreciate how patient I am with them").  Can you help me identify the skills that need to be my top priority to master next?"

She might respond with something vague like "Improve your time management."  If she does, you can't really do anything about that, so just say Thank you, and move forward on your own.

ALSO: You mentioned "freezing up". So, MAKE A PLAN for what you're going to do when you freeze.  I'm not sure exactly what type of circumstance you're in when it happens.  But can you decide that you'll say: "Excuse me for a moment, I need to sanitize my hands again because I touched something."  (Can you step away to do that?)  Or "Just a moment, I think I'm going to sneeze, let me step away." Or, "Thank you for offering to help, nurse Nancy, but I'm fine, I just need a moment." Or... I don't know, because I don't know the exact details.  But instead of thinking, Oh god I hope I don't freeze in the middle of this procedure-- you need to reframe as: "I know I tend to freeze when I'm nervous.  It will likely happen today when we get busy.  So let me decide how I am going to handle it when it happens."

I feel strongly that you CAN do this.  You're overwhelmed because you feel like the job is overwhelming, but that doesn't mean it's actually impossible. 

[brissygal, BSN, RN]

Dear coffeeandvendingmachines,

RELAX, RELAX - ROME WAS NOT BUILT IN A DAY! You are putting too much pressure on yourself. You have been given some great suggestions and it sounds like you have a great nurse manager helping you.

If you know you are freezing up, step back take a deep breath and say I have got this! (Remember the person in the bed (patient) is more frighten than you) - smile, do your best, ask for assistance when you need it - but don't expect to know everything on the job - it will take time to grow into the nurse position. 

Say to patient great question, I don't know the answer but I will find the answer for you.

Be Kind to yourself- Just Relax - you will find your feet. 

[Keesha RN]

Hi I also just recently started a new nursing job in a rehab hospital. On a unit where we get a lot of traumatic brain injury patients. Im not a new nurse. I have almost 17 years experience but am fairly new to rehab nursing. I only write because I just finished only my first week on the unit and am still in orientation but have already got called in to the managers office, she mentioned being concerned with me. The nurse training me told her I was focused on the wrong thing in patient report. For instance asking the patients age. Which to me was a petty complaint. But she also mentioned that she noticed that I spoke with a couple of my patients about something I put on my fb about a time I recently spent in the hospital. Which worries me more than the age thing in report. She said I was getting too personal with the patients and shouldn’t bring up my fb. Which I do understand. I know this is something that I can correct and plan not to do again. But I’m just wondering if anyone thinks that this may be an issue that can affect my morale with the management. I just worry that with it being so early on with this job that management is already finding things “wrong”?? Or Should I worry that I already have a bad reputation with management because of this?? Is this something I should worry about? I’m just wondering if this is something I can come back from, and improve on and move forward. Being that I really want to succeed in this position.