Rocky Start/Orientation and Nurse Confidence

[Curious1alwys]

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! 

[marsbar37, BSN, RN]

I couldnt believe when I read your story! It was a mirror of me. I have been a RN for 6 years but have very little bedside experience. I'd have crippiling performance anxiety and draw blanks at the worst moments. It changed when I became a Summer camp nurse and discovered how much I loved working with kids. I started school nursing and have been a school nurse for 3 years. Im an agency nurse so the pay is very nice (although pay is falling). Im long term contract so I usually stay at a school for a year. It's nice because I meet new people and kids and get to work with different grades. Downside is nothing is guaranteed so there is always uncertainty of securing a position. 

[Curious1alwys, BSN, RN]

Wildcats9 said:

I'm probably not going to have the most popular opinion here and while I wholly understand GAD, I would suggest finding a job in nursing that immerses you in and forces you to practice the skills you're most lacking confidence in. On a daily basis! EVERY nurse goes through that.  If one tells you they didn't, they're lying. Or they are seriously lacking empathy and probably shouldn't be in the medical field if they aren't concerned about hurting a patient. I am fairly new to nursing- have only been working in it a handful of years, however, I was a nontraditional student and went back to school for a second degree nursing program in my mid-30s.
Like you, I was scared to death to take blood pressures, because my sister complained about her arm hurting the very time I attempted to practice. I still don't like starting IVs. When I graduated, my first job was purposefully in dialysis, because I knew it would force me to get comfortable sticking patients multiple times a day. Luckily, their veins are like straws.... But it was great practice and I got very confident. I learned to give medications in their CVCs and how to clean them, change the dressing— none of which I would have had the skills to do prior to the job.

Fast forward a couple years, I've been working in orthopedics. I have now just finished obtaining my RNFA certification (first assist) so I've learned to suture and assistin surgery. I was completely intimidated in the operating room but I have grown leaps and bounds over the past year. You are not going to learn anything overnight and I still get anxiety every night before I have a case the next morning. But I know as I continue to gain experience and do it regularly,I get more confident and comfortable. 
Yes, you need a supportive team. Instead of letting floor managers interview you, interview them. How supportive are they? Will they help you grow and be successful? How? You have a lot to offer based on your background. The skills will come, but you have to practice and believe in yourself.  It is not easy. It will induce anxiety, but you can do it!
Stop letting GAD hold you back and becoming a scapegoat. You went through a lot to earn a nursing degree, I would fight to keep it. Yes, there are other career avenues to explore but you've obviously done something well to be getting these opportunities. While the cardiac gig may not be the right choice, I do believe you could do it.  Again, with practice and with tine to learn.  THe EKG readings and pattern recognition will come in time as you see them regularly.  Again, just my 2 cents but don't discount your ability to learn skills. 

Thank you. I just feel like skills come so unnaturally to me. I was terrified all through nursing school. Would run from nearly every experience because of performance anxiety. I even had a gig as a nurse in an ambulatory surg center where I had to start IV's. I sucked at it there too. They often had to call the other nurses in. Even tried to remediate me. I didn't get let go but I felt so inadequate and couldn't understand why I couldn't get it, even with practice. It's like I'm all thumbs with everything. So I struggle...is it lack of experience or is it just not for me and my personality?  Now I actually have anticipatory anxiety when I have to do a skill, nearly ANY skill. Heart rate ramps up, breathing quickens, mind goes blank. I have to take propanolol to even begin to stay calm now but even this habit is dangerous since my resting HR is so low. I just feel tired of fighting. I have a lot of good qualities and definitely have worth to an employer but is clinical nursing where it's at for me? That is the question. 

[Curious1alwys, BSN, RN]

marsbar37 said:

I couldnt believe when I read your story! It was a mirror of me. I have been a RN for 6 years but have very little bedside experience. I'd have crippiling performance anxiety and draw blanks at the worst moments. It changed when I became a Summer camp nurse and discovered how much I loved working with kids. I started school nursing and have been a school nurse for 3 years. Im an agency nurse so the pay is very nice (although pay is falling). Im long term contract so I usually stay at a school for a year. It's nice because I meet new people and kids and get to work with different grades. Downside is nothing is guaranteed so there is always uncertainty of securing a position. 

I did the school gig for a few months.....again, not long enough probably to get comfortable of course.....but even in that role I was anxious about what COULD happen to the kids and emergencies and responding inappropriately. Especially since I had no peds experience. Left for a higher paying gig. Everyone thinks school nurse is all band-aids and ice packs but the acuity can actually be pretty high. I had a friend who worked at a school where she had to take care of nearly 2000 high school kids! OMG!  

I so appreciate your comments though. Makes me feel less of a freak. Thank you! 

[Curious1alwys, BSN, RN]

mdsRN2005 said:

Before you abandon ship from nursing altogether, consider other specialties that might be a good fit.  I personally think you'll be stressed in any inpatient position due to the chronic understaffing and ever increasing patient acuity.

Have you considered postpartum? Compared to L&D, it seems much less acute and busy.  I've never worked it but I have a friend whose preferences are similar to yours who loves it.  She doesn't do as much "technical" skills but focuses a lot on teaching the new moms.   Since it'd be a new and very different specialty for you, you should definitely get an orientation (albeit likely a brief one).

You also may want to consider preop in an outpatient surgery clinic.  You do have to hurry a bit but it's hardly every life and death.  Just quick IV and assessment.  And you get to chat with them while they're still awake.  
 

Also if you like kids, consider school nursing.  I've not done this either but know a couple nurses who have.  It has more of a focus on prevention/wellness and very few technical skills.  With your chatty personality, I'm sure the kids would love you!  I think the pay is often a bit lower, but  many school nurses in my area get Summer temp jobs to recoup the difference.

I hope you are able to find a job you love and excel at.  We have so many nurses leaving the profession right we don't need to lose a good one!  Good luck with whatever you decide and keep us posted! 

Totally suck at IV's, even after experience, unfortunately. I'm not 100% on leaving the profession entirely. Would just like to find a better fit. Thank you so much for the last paragraph. I have to remind myself that even if emergencies and clinical skills are not for me that I still have value and things I'm good at. Just gotta find what job helps me showcase the best parts of me so I don't have the anxiety issue. Inpatient patient education was so great but that is really a dying thing in nursing. 

[mdsRN2005, ASN, BSN, RN]

londonflo said:

I am not trying to hijack this thread but I think in the last month I have read a minimum of 10 posts from RNs wanting to get out of nursing. We all probably feel  like that at some time but few can find a financially viable alternative because of skills that are honed for a our job classification may not transfer easily without more significant university education..

I am wondering if it would be helpful to have a thread where people who have moved to non-nursing jobs or become entrepreneurs or just found a part time job that helps them go part time in nursing can describe what they did?

 From the last couple of years I have read of someone who became an employee of an animal feed store. I was able to cut down a few years ago (retired now) through selling antiques and still doing that. Anyone become a realtor on the side, interior decorator?  Drug rep, NCLEX tutor, blogger/writer? nurse recruiter, community educator, a minister, construction worker ???, I am not talking about MLM. 

Any suggestions beyond these?

Very interesting idea!  I'd love to read this!