Rocky Start/Orientation and Nurse Confidence

[Curious1alwys, BSN, RN]

I am not a new grad. But I only have had probably a collective year total in bedside work, likely including orientation. My orientation years ago was disorganized and complicated. I was hired as a new grad float....to around 6 different units at 3 different hospitals. No one to count on, no friends, everyone was pretty much new every shift. Many different preceptors. I received several months orientation but I hopped around all those places. So yes, the first year I was terrified, sick before every shift. Plus, I have GAD and performance anxiety. Hence, was pretty terrified in nursing school too all during check-offs and clinicals. Generally,  I love helping people, and am great with them, but feeling competent in hard clinical skills (seems even with practice I suck) and overall nursing judgement eludes me. 

Fast forward to now, I've held several different positions. None of which I've ever really felt confident except the one in which I was simply a inpatient clinical educator with no hands-on skills. This is what I do now (6 years) but they changing my job and moving me to the outpatient cardiac clinic where I am very unfamiliar with the charting system and the overall procedures. I know the patients can be pretty acute (severe HF, LVADS, heart transplants, artificial hearts) even though it is outpatient. Things can go south quickly, I know it, and I would be the ONLY nurse there, the one in charge essentially. This position is less stress than bedside but still somewhat acute since it is cardiac.

So I'm toying with the idea of leaving nursing altogether for a position more suiting of my personality where I am not the one responsible should things go south. That's the critical part that gives me so much anxiety! I know this change coming for me in my job is going to be with no orientation back...sink or swim...because they will be short. That's also freaking me out. 

I also sometimes think I should find a floor nurse new grad type position or a position in which they are willing to train me again, hopefully this time, adequately. Maybe I could one day really excel in this position? I need to figure out where it all went wrong. Is it me or the crappy orientation I had that has given me zero confidence and sent my GAD/performance anxiety out of control? What's your opinion? 

Thank you! 

[nursej22, MSN, RN]

I used to work with a very anxious person (I don't think she had formal diagnosis) who would overthink situations to the point where she just couldn't take action. She was quite experienced and knowledgeable, but would get so caught up in the what-ifs and worse case scenarios, and everything that had ever gone wrong. I spent a lot of time pointing out to her the likelihood of things going wrong, and reminding her of how really competent she was. And that no one is good at everything. 

I feel this is what you are doing. I hope you are getting treatment for your anxiety and have someone to talk to. Perhaps your EAP can help. If you want to continue nursing, you need a new inner dialog about what you know and what you do well. 

As far as working in a cardiac clinic, you will not be alone! You may be the only nurse, but there will be providers and techs present. And if someone presents as acutely ill, as what happened to my sister, you call 911. No one thinks that you and you alone will be managing severe HF or an LVAD. But you likely will be doing  a lot of patient education, and with your experience, this could be a good fit. 

I also suspected my anxious coworker had ADHD. My daughter has this, and with the proper medication and counseling, she has turned her life around. 

Best wishes. 

[Curious1alwys, BSN, RN]

nursej22 said:

I used to work with a very anxious person (I don't think she had formal diagnosis) who would overthink situations to the point where she just couldn't take action. She was quite experienced and knowledgeable, but would get so caught up in the what-ifs and worse case scenarios, and everything that had ever gone wrong. I spent a lot of time pointing out to her the likelihood of things going wrong, and reminding her of how really competent she was. And that no one is good at everything. 

I feel this is what you are doing. I hope you are getting treatment for your anxiety and have someone to talk to. Perhaps your EAP can help. If you want to continue nursing, you need a new inner dialog about what you know and what you do well. 

As far as working in a cardiac clinic, you will not be alone! You may be the only nurse, but there will be providers and techs present. And if someone presents as acutely ill, as what happened to my sister, you call 911. No one thinks that you and you alone will be managing severe HF or an LVAD. But you likely will be doing  a lot of patient education, and with your experience, this could be a good fit. 

I also suspected my anxious coworker had ADHD. My daughter has this, and with the proper medication and counseling, she has turned her life around. 

Best wishes. 

Thank you for replying. I have a history of depression and anxiety, yes, and also likely ADHD, but not the kind where you like thrilling stuff, LOL... I guess the problem is that there is no provider in this clinic to turn to and the others staff freeze and just look at the RN if any little thing happens with a patient. My EKG skills lack. I can pass a test, sure, but real time EKG I cannot always recognize rhythms. This bothers me because, again, I'm the ONE, even though everyone there has their ACLS and is EKG proficient. I realize there is rapid response (we are liked to hospital) but I just fear I'll miss something or not have all the answers. And without another nurse there to bounce things off of I feel lost. ? To make it worse, I'm a panicker. In emergency situations. This is bad, I know. I just can't get my mind to think straight at those times. It's like anticipatory anxiety now. I get same way for IV's, since I fail alot. Now before I even try my heart rate and breathing rate skyrockets....Let me put it in perspective for you: I get anxious even taking a manual BP! Fearing I'll let the air out too quick (which does happen!) So yeah, that's where I'm at. 

 If the orientation would be adequate or calmer I might feel different. But I won't be functioning as only the RN. Also the monitor tech and floor tech at times too since it's all about cutting staff to bare minimum. I wish it was not that way but I guess it is like that everywhere now. 

The only med I have for anxiety is Xanax PRN which clearly I'm not taking at work (and rarely ever do anyway since it's sedating) and propanolol, which helps with the flight or fight but isn't really ideal for me at this time (low resting heart rate). I won't work in there without it though. I don't know what else to ask for? I've taken SSRI's in the past and they all sedate me really badly. I have a history of trauma and I feel like I'm wired this way but I don't know how to change it. 

[nursej22, MSN, RN]

I am confused about how your clinic works, so I can't comment on that.

But, you deserve an accurate diagnosis and effective treatment plan. There are more treatments for anxiety than what you have listed. A psychiatrist visit could be helpful to explore those options. 

[Curious1alwys, BSN, RN]

nursej22 said:

I am confused about how your clinic works, so I can't comment on that.

But, you deserve an accurate diagnosis and effective treatment plan. There are more treatments for anxiety than what you have listed. A psychiatrist visit could be helpful to explore those options. 

I hear you. There has been layoffs and some questioning on whether the clinic will be closed altogether, ultimately.  So I might go through all this stress for nothing. 

I will speak to my provider. 

Again I really appreciate your feedback! Thank you so much. 

[JBMmom, MSN, NP]

It sounds like as you describe things, this would not be a good position for you. Even if you're clinically competent for the job, it doesn't sound like you would be comfortable, or even enjoy, the position. Perhaps you would be better seeking a nursing education position in another area of nursing? You have experience in education and if it's something you enjoyed that might be a good fit.

Finding a new grad position that will take someone with six years of experience, even if it doesn't feel like experience to you, might be difficult. But these days many areas are looking for ways to hire nurses, so if you can find someone in a facility to talk with, maybe they would work something out that included better training. It sounds like your first job was particularly poorly suited to your personality, it's unfortunate that it may have had an effect on your career. Good luck. 

[Googlenurse, ASN, BSN, RN]

Yeah not sure how you are going to get trained as a new grad.

Hospitals really do themselves a disservice by not wanting to train non acute care nurses to acute care. I feel my 8 weeks of training wasn't enough. I only spent 7 weeks in the floor between all of the classroom crap( which didn't help me one bit on the floor)

Maybe try a non acute care position like a school nurse or private duty home care? I get virtually  few anxiety attacks working in private duty. When I do it's related to seeing a roach or a rat, not patient care. 

[CrunchRN, ADN, RN]

I would pass on that position. Just not a good fit at this time. However, I think if you applied to lots of hospital floor nurse jobs you might find a manager willing to give you the kind of training that would enable you to build your skills and confidence. Worth a try. 

[Curious1alwys, BSN, RN]

CrunchRN said:

 

 

Googlenurse said:

Yeah not sure how you are going to get trained as a new grad.

Hospitals really do themselves a disservice by not wanting to train non acute care nurses to acute care. I feel my 8 weeks of training wasn't enough. I only spent 7 weeks in the floor between all of the classroom crap( which didn't help me one bit on the floor)

Maybe try a non acute care position like a school nurse or private duty home care? I get virtually  few anxiety attacks working in private duty. When I do it's related to seeing a roach or a rat, not patient care. 

OMG rat or roach, I would die. This is what freaks me out about going into other people's homes.  Well, that and bed bugs.......aaaaaaaahhhhhhh!

[Curious1alwys, BSN, RN]

nursej22 said:

I am confused about how your clinic works, so I can't comment on that.

But, you deserve an accurate diagnosis and effective treatment plan. There are more treatments for anxiety than what you have listed. A psychiatrist visit could be helpful to explore those options. 

I'm going to ask but I'm not taking pills that make me dependent, sedated, and/or fat just to stay in this career. I really hate that I have to do this and can't just find some career that fits. What type of career would fit a Type A, high strung, anxious but sociable person? ha ha! 

[NRSKarenRN, BSN, RN]

Private Duty home care --1 on 1 care, much less stress.

[nursel56]

Curious1alwys said:

 

OMG rat or roach, I would die. This is what freaks me out about going into other people's homes.  Well, that and bed bugs.......aaaaaaaahhhhhhh!

Yeah, but ants aren't so bad...? we private duty nurses love to trade war stories to a certain extent.  There is also Home Health Case Management if you can handle the driving.

I found private duty worked well for me, and I was determined to avoid situations that amped the anxiety level, and ended up taking cases with people on ventilators, and I was the only one there.

The recruiter wouldn't stop "encouraging" me to give it a try, and it worked out well, with just enough challenge, because part of me wanted that, despite the anxiety symptoms I had which sound very similar to yours.

I found the overall good fit was a combination of acuity, pace and unit culture.  A scary unit can be offset by a supportive and approachable nurse manager, and a "safe" job can be hell with too much too fast, and indifferent or hostile co-workers.

Anyway, I don't think it's time to give up on nursing, wish you the best and am amazed you handled job number one as well as you did. Feeling panic before every shift is awful.