Rory Miller writes in his book called Facing Violence: Preparing for the Unexpected about glitches. Rory Miller is a former corrections officer and jack of all trades who writes extensively about self defense principles that can be easily applied to any walk of life (such as medicine). Two things that he discusses are glitches and the OODA loop (Observe, Orient, Decide, Act). If people freeze, it is generally because of a combination of those two factors. Glitches occur for various reasons (Miller talked about one developing for him because he didn't have life insurance; once he got that, he was no longer thinking about his children and family during a violent encounter with inmates, and the developing glitch was diffused), and can occur in anyone at anytime. A good way to fix glitches is to examine why you freeze to begin with; is it because you over analyze when you should fix what you can at that time? Is it because your past encounters with failure are interfering in your present trust in your skills? That is for you to examine on your own and come to an understanding on why you freeze. You say that it is a fear of harming patients, but is that because you don't trust your skills and education? You could precept new RNs, that would very clearly show you where you are strong and where you need work. You could also imagine these disaster scenarios and think about what you would do. In my spare moments working the ambulance, I like to think about my stable patient suddenly crashing on me. What do I do first? What is next? What do I tell my partner who is driving? I picture myself performing the physical actions of cutting the shirt, placing the pads on, turning on the defibrillator, beginning compressions, and everything else that goes with that particular scenario. That way it feels like I've already done it before.
Another aspect is the OODA loop, which stands for Observe, Orient, Decide and Act. Sometimes, your brain gets stuck on the observe and orient part, and you are unable to Decide and Act. This can happen for a few reasons. The fix for this, generally speaking, is to go back to basics. I've frozen multiple times in my short EMS/RN career. Several times I've encountered situations that are just so foreign that I don't know how to handle it. What I do is tell myself that I'm frozen, that I have to do something, and remind myself of ABCs, quite literally. Is there a patent airway? Are they breathing? Is there a pulse? If I can answer those questions, I know I have some discretionary time to think. If I can't, I have to fix what is broken. I think that any action that attempts to correct an ABC is not going to harm the patient, even if it may not be the best one. It is simplistic, especially considering you work in an ICU, but starting from the ground up gives traction and allows you to clearly assess the situation. If you have a minute, you should buy his book and read it. It is mainly about understanding the dynamics of self defense, but much of it can be applied to daily life. Just my $0.02.