Post-shift anxiety

[rnash679]

Hi all,

I am a new nurse who has been on my own for about a month. I am struggling with severe post-shift anxiety; running through everything I could have possibly done wrong.

For example, I d/c a patient with a foley- provided supplies, educated on care, what to look out for, etc. They declined home care and will be following up with urology outpatient for removal/surgery for bladder removal. I covered with documenting it was okay to discharge with foley. I provided a leg bag and night bag, but what happens if they sleep in a leg bag and don't change it out? Or she gets a UTI but does not recognize symptoms? 

I left another patient who had critical electrolytes. I replaced everything per protocol on my shift, notified physician, and then passed all of the results to the next shift. 

I just worry if something were to happen to any of my patients, how much could come back on me? I constantly worry about my patients and making sure they are okay... when will this get better?? I know I am new, and learning. Any advice would be appreciated! 

[JBMmom, MSN, NP]

You'll always worry about patients, because you seem to care. However, you will find a balance that keeps it from interfering with your life when you realize that when your shift ends, your ability to influence that patient also ends- for the most part. 

If you provided a patient with appropriate education, you can't do much beyond that to ensure their compliance, and you cannot prevent complications from arising. You're not responsible for that. 

For things like replacing electrolytes, we are a 24 hour business. You handed off to another nurse after doing what you could during your shift, and they will take it from there. You'll get more comfortable as time goes on, try to take your time off to focus on your non-work life. Good luck!

[Nurse Trini]

Yes, I'm concerned as well in situations.   I tell the patient (teenager) about foley care, give them the care notes, and do the same spiel to the parents, and I still fret that nobody is listening.

At least I tend to see these kids on a regular basis and can ask them how its going (though they mostly carp about their situation in general, guess I can't blame them).

["nursy", RN]

Really pay attention to your documentation.  As you document, it should be evident if you have taken all necessary measures.   If you document that you instructed on Foley and patient verbalized understanding, then your job is done, and if something happens you are covered.  If you document that electrolytes were covered and provider and oncoming nurse were informed, then your are done.  On patients going home you can also document that there was a return demonstration (if applicable).    You position is not a 24 hour job.  You have enough to worry about during your shift, so try to let go when you are done.  

[JKL33]

I can remember reviewing things in my mind after getting home and occasionally calling back when something popped into my mind that I wanted to clarify for the next nurse or wanted to tell someone something I'd forgotten to pass on or forgotten to tell them that I didn't get done.

What I didn't do, though, was ruminate on unknown "what ifs" even when I felt fairly comfortable with my nursing actions and my report.

I wondered about my patients sometimes, but didn't worry with respect to something unforeseen coming back on me.

I'm just thinking out loud; not sure if any of this could help you. Can you try telling yourself that if some significant oversight should happen to come to mind, you're still okay--you can take care of it by calling the floor and letting them know. Tell yourself that. You don't need to review every action, you don't need to worry that you're going to get blindsided when you return about some big wrong thing. Worrying about stuff like that is to voluntarily exchange peace for angst--and the worst part is that you aren't going to change a single thing by worrying about it anyway!

 

[Corey Narry, MSN, RN, NP]

OP, regarding your scenarios:

1. Home with a Foley is not unusual...that patient was given all the resources needed by you.  That's where your responsibility stops.  The provider sent the patient home with an indwelling catheter and should have also discussed the risks involved with that patent.  Complications will happen to some patients but you followed the standard of care so there is no fault on your part.

2. You replaced the electrolytes...and you can only give those at the prescribed rate or frequency they are supposed to be given.  There is no reason why another nurse on another shift can not follow up on whether those electrolytes have been repleted adequately.  There's a reason we have RN's 24/7.

Not saying that you didn't do these but it may help ease your mind that next time in these scenarios:

1. Check with a senior colleague or a mentor that you trust that you did all the right things for the patient who went home with a Foley.

2. When you give report, make sure you mentioned that a recheck of the electrolytes have not been done.

[Davey Do]

Excellent advice from the other members, and like JBMom said, "you care".

However, mash679, I sense this anxiety is more of a result of a personality trait than it is with not being a capable nurse.

We neurotics tend to often focus and ruminate on situations whether there is grounds for concern or not. We conjure up possible outcomes and recount them over and over again. Adrenaline is secreted and our bodies get all anxietied up with no place to go.

How do we deal with this anxiety? The other members gave the nuts and bolts to logically deal with the situations, but we're still going to question ourselves and the anxiety cycle will repeat itself. We need to give ourselves a time out after doing what the other members suggested.

As one Therapist I knew would tell herself, "Okay, I'm going to allow myself to be upset with this for 10 minutes" and then she'd move on.

Emerson also had some good advice:

"Finish every day and be done with it.
You have done what you could.
Some blunders and absurdities
no doubt have crept in;
forget them as soon as you can.

Tomorrow is a new day;
begin it well and serenely
and with too high a spirit
to be cumbered with
your old nonsense.

This day is all that is
good and fair.
It is too dear,
with its hopes and invitations,
to waste a moment on yesterdays.

Good luck, mash679!

 

[Corey Narry, MSN, RN, NP]

15 minutes ago, Davey Do said:

We neurotics tend to often focus and ruminate on situations whether there is grounds for concern or not. We conjure up possible outcomes and recount them over and over again. Adrenaline is secreted and our bodies get all anxietied up with no place to go.

That's a good assessment from a Psych Nurse.  I have to agree with you especially since I do have family members with this trait.  We "linear thinkers" have a hard time understanding these traits in others and try to help by bringing logic in which may not be that helpful.  I find that especially with the family members involved, they have to keep talking about it to lessen the anxiety.