Serotonin2

I work as a triage nurse in a clinic once a week. I started this position about 6 mo ago and have been triaging on my own for the last 3 months. As viral season has picked up, I am getting out later and later. My supervisor spoke with me and said that the doctors and my coworkers are stating that I am "too thorough" and finish late because of this. I feel frustrated because I have been told that I struggle with OCD, perfectionism, or being slow since I was a young child, bybtrachers and peers in school and at any job including my nursing jobs that I have held. I can see that I am slower than others but I do not know how to fix it. Trying to "be fast" has lead to errors in the past. I know my thought process and workflow must be different than others but I do not know what the difference is. I know the problem exists but I can not see clearly enough to fix it. I want to change but do not know how. The anxiety about losing my job only worsens the situation.

Hello, I am continually frustrated by the fact that I am often getting out late by an hour or two. My patient care is done on time, but during my shift, I never seem to find time to chart. There is always something that needs to be done for a patient, and I'm charting after my shift. I try to delegate what I can to the CNAs but still find that I'm running about like a chicken with its head cut off. This leaves me feeling frazzled and overwhelmed. I've reviewed how I prioritize things and am not sure how to improve. The other nurses around me do not seem to be struggling like I am. I have been a nurse for 4 years and currently work in pediatric psychiatry. I generally get out on time if I work day shift, but if I work pm shift or am floated to the adult unit I'm consistently out late. On the adult unit I have a load of 7-8 patients, one or two of whom will be on CIWAS or COWS. As a side note, I seem to be struggling with a similar issue at home-that is the management of housework, caring for a toddler, a side business, garden etc. I constantly feel behind and overwhelmed. I struggle with anxiety and major brain fog as well. Any time management, prioritization, or mind management tips (for work and home) would be greatly appreciated! Thank you!

My director is very supportive and plans on initiating education for everyone including the physicians. He's getting push-back too though, even from the physicians.

Thank you. I do stand my ground but I end up working outside of and around my preceptor. It's super stressful. All the nurses, and I mean all, are practicing this way.

Hello, I recently started a new position and have several concerns regarding the way orders are received on the mental health and addictions floor I am working on. I brought my concerns to the director who took them seriously and is trying to initiate change, but the process has been an uphill battle. I'm concerned about the following: 1. Nurses giving a med they think the patient needs without getting an order, verbal or otherwise, before administering and asking for the order after. (example: a RN gave Ativan without an order because the pt was getting anxious and agitated. She asked for the order after. ) 2. The behavioral health liasons, who are not nurses, will often receive "orders" from the physician, and will write "Standards, CIWA, H, T" on top of our intake form. The nurses will then throw in orders based on this. The problem is. They are selecting other items in the standard order set that aren't preselected, will use another physicians standard order set rather than the admitting physicians order sets, will assume the doses of the meds even though the only info they received regarding meds were the letters H and T. Basically, there is rarely communication between the doc and the nurse regarding admission orders, nurses are assuming the doses of the meds without verifying, and independently selecting other items within the order sets that were not preselected by the physicians. The physicians also don't know what is in their own order sets. Some will order "Standards " but they don't have their own standard order set and the standard admission order set has not been standardized. When working with my preceptor, she became angry that I wanted to talk with the physician first before entering orders. I'm not going to accept the letter "h" as a med order LOL. How do I navigate this?

Hello all, I apologize in advance for the long post. I am trying to process some feedback and determine what is valid and what should be let go. I am currently starting a new position as a mental health nurse in drug and alcohol rehab. I'm thankful as this has been my goal since I started nursing school. Previously, I was a pediatric neuroscience nurse for two years, and before that, I worked as a CNA on a Neuro/Trauma ICU floor for 4 years. As a bit of background about myself, my whole life I have been told by those around me and by my supervisors that I am considered to be very caring and compassionate, but also perfectionistic. I also have OCD and anxiety. However, the feedback I received from my last supervisor was quite different. First it was feedback that she heard from the other supervisor who heard from other nurses that some nurses were afraid to give me report. I asked if she could get clarification on what this meant and she didn't. I tried to see if I had offended any of the nurses I typically get report from and none of them had an issue. I relayed this info back to my supervisor who responded, "well they might not be telling the truth". Then I was talked to about a pts mom who was livid because she felt I was cold towards her, "gave her false information" ( which I definitely did not), and didn't answer the call light after three tries. (I was very busy in two other pts rooms. I do feel responsible though because this pt was a new admit in the middle of my shift, but in the craziness I forgot that our new phones require us to assign the room number to our phones so that we get the call bells). I tried to apologize, but the mom was too busy swearing on the phone. As a new grad, I was placed on an improvement plan for incidents regarding a ventricular drain that I wrote myself up for. Some were valid, others, I was told by other nurses were not worthy of being written up and that I was being overly scrupulous. I successfully passed that plan and haven't had any errors since. However, ever since the plan, my anxiety and OCD skyrocketed. I felt as if I were having a mental breakdown. I ended up taking out some time for mental health help. When I came back, everything seemed to decompensate. The week I returned, a family asked that I not be the nurse because they were uncomfortable with how much I rechecked things. (I'm still working on that OCD). Then a week after that, I was fired by another mom (historically known to be dreaded by every nurse and doctor because of how difficult she and the pt are to work with and how manipulative the mom is. For example, the pt took her meds mixed in apple juice. I mix up the meds, but she complains the juice is too cold. Then I warm it up but she complains it is too warm. I cool it off but it is still the wrong temp. This was a 20 min process. Meanwhile I have other pts I need to attend to). Despite trying to advocate for her, clarify questions and concerns, get the pt laughing when she was otherwise sad, this mom fired me for " being cold towards her daughter, leaving a side rail down (even though I fixed it when she asked and the pt was not in danger of falling out of bed), and recommending that the pt pick a less saltier dinner option due to her sodium being high. So again, I was called into the office and talked to about their concerns for "inconsistencies in my practice" due to these complaints and the fact that I get out 30 min late half the time. I guess I'm flabbergasted because never in my life until this position have I been told that I act "cold towards people". I also don't understand how these two complaints point to practice inconsistencies. I admitted that my anxiety and OCD had affected my practice and that I was getting help for this but they did not speak to this. All I received were vague responses and the above examples. I explained that putting me on a PIP would only increase the anxiety and essentially paralyze my performance. They gave me time to decide if I wanted to stay and be placed on the PIP or leave in good standing so I began looking for other jobs. Then a very traumatic incident occurred. The physicians say I saved the child's life and that I did nothing wrong, but I still feel so shooken up by what happened. I was given time off to basically work through what occurred, during that time I received an offer for another job so I resigned. But now I am really bugged by the feedback that I am "cold, intense, and unapproachable ". This is the last thing I want to be especially because I will be working in mental health. I've also never been told this until now so I'm confused. Also, my first 2 years as a nurse in this position were hell. I feel I have lost all confidence in my nursing and people skills and I'm feeling afraid that I'll fail in this new position. I start my job in a week am getting married in 3 weeks and am battling other life stressors. I'm feeling numb, overwhelmed and a bit depressed. Any advice?

Hello all, I have been a nurse for a little over a year now. Some days I think that I am beginning to turn the corner. I feel a bit less anxious and little more confident. However, there are still days that I feel like a complete idiot and discouraged with my nursing practice or sense panic and anxiety taking over again. When anxiety hits my nursing practice suffers. I second guess myself A LOT even when I do know what I ought to do. I seem to have lost all confidence. I find myself asking for reassurance often and am afraid this behavior is beginning to annoy my co-workers. For example, yesterday I had to draw up a bedside rescue/load for a seizure pt for the first time. My brain froze and I found myself asking other nurses what I ought to do even though I knew what to do. I then felt like an idiot for needing someone to "hold my hand". I'm concerned that my co-workers doubt my competence and that I may get in trouble with my supervisor. Later that shift I had an anxiety attack which slowed me down from getting back into my COVID + AMS pts room who had flooded the bed. This caused me to feel guilty for not getting the pt cleaned up immediately. The next shift I felt like a failure because I got out late, forgot to do the 1st night before pre-op bath for a pt and had to hand it off to night shift, and had to hand off cathing a pt as they mysteriously began retaining urine and the deadline to wait before cathing co-incided with the end of my shift. I try to throw 110% into my work, but I still feel as if I'm failing! I'm also starting to feel very burned out. I'm experiencing multiple stressors outside of work as well and feel numb and exhausted. My brain is so foggy sometimes I can't think straight or speak clearly. I don't feel as if I recoup in my days off. I wake up tremoring with anxiety and have a hard time going to sleep at night. The smallest task outside of work seems to take immense energy and effort. I feel as if I am cracking. Help!

@JKL33 I am seeing a counselor and started on an SSRI a few months ago. Perhaps I need to see a psychiatrist or psychologist instead.

Hello, I have been a nurse for a year now but am still struggling with so much anxiety. I'm sick to my stomach before entering work and stay awake at night after my shift worried that perhaps I missed something or made an error. I find my OCD kicking in during my shifts causing me to check and recheck and recheck something I already double-checked. I'm starting to wonder why I ever became a nurse. I'm especially stressed when multiple important things all need to happen at once. I do my best to prioritize. I was placed on an improvement plan due to getting out late and some errors I made shortly after orientation. I have since successfully passed the PIP, but feel an ever increasing dread of going to work and making another error. I find myself asking for reassurance because I doubt my own judgement. This makes me either look paranoid or like an idiot. I struggle with anxiety when communicating with the physician (specifically neurosurgery) when orders appear to be either not placed or inappropriate for the pt. I'm pretty sure neurosurgery dreads hearing from me LOL. This anxiety is impairing my ability to be at my best at work and outside of work. Help!

Many of you have mentioned that you have never seen an order for ml only units. What about in pediatrics?

Hello, I'm a new nurse and gave blood today for the first time but am questioning whether I administered it correctly. An experienced nurse who was my second witness and did the double check with me helped me set up the infusion. From what I remember in school, I thought we were taught to prime the whole line with saline first. I asked the other nurse about this and she said that after filling the drip chamber with saline that one should prime the whole line with blood instead. Was this correct? Also, I set the pump VTBI for the ordered amount. However, once you run the flush bag at the end and flush the line aren't you then by default pushing whatever blood is in the line into the pt thus giving them more blood than ordered? I thought perhaps I should deduct the volume amount of the line from my VTBI so that it would equal out once the flush is run. I asked a nurse who has given blood often and she said that was not necessary and that giving the extra blood that is in the line (which adds up to about 30ml) is okay. Is this right? Am I overthinking this? I checked with 3 nurses to verify I was administering it correctly, but I'm kinda freaking out that I made an error if what I did was wrong.

Thank you. I did talk to my PCP and am seeing a therapist as well. My PCP also started me on medication as well.

I am a new nurse struggling with a lot of anxiety and OCD at work. I'm terrified of making mistakes. I did make several mistakes with an EVD and was put on an improvement plan. Now I find myself questioning every small decision that I make, triple checking again and again things I logically know I already double checked, asking other nurses for assurance multiple times that a certain action is correct even though I already asked the opinion of another nurse, or breaking into a cold sweat and nearly vomiting because I panicked thinking I made a mistake even though I didn't. This anxiety is causing me to have poor time management and practice less safely instead of practicing cautiously. How do I tone down my anxiety while maintaining attention to detail?