Sentinel Syndrome - Does it Go Away?

[HealSpec]

It's happened before. And I've had a reprieve for a while--my preceptorship went well. I settled into an area where I felt knowledgeable, comfortable. As a nursing student, that's such an unusual feeling! But that time is over now, and as I look toward my first job as a tech or new grad, I know it's going to happen again. Another attack of Sentinel Syndrome.

Maybe I should back up, and explain this disorder a bit. I made the name up, I'll admit it, because naming things seems to help make them less scary. So, what is Sentinel Syndrome? It's an acute anxiety response that makes you feel as if, quite literally, you are a walking sentinel event waiting to happen. A time bomb made of never-events and things-not-covered-by-insurance. As if despite every good test score and productive clinical day, tomorrow, things will be different. Tomorrow, you're going to walk onto that floor and mess up--and this time, no one will catch it, and you will hurt someone. It doesn't even feel like a "could happen" at the time--you know it, with the same certainty that you know the sun's coming up.

The symptoms start between twelve and sixteen hours before the shift starts. They gradually dissipate within the first 20-30 minutes of the clinical experience, even if there are minor setbacks or mistakes during the shift. By the day's end, the symptoms are gone--but this doesn't make them less intense during the next attack. I think the worst one was the night before, and morning of, my first shift in the ER. I can vividly remember getting up an hour early to make sure I had extra time... and spending forty minutes of that hour in the parking lot of my dorm, sitting in my car, bawling. I was convinced I was going to mess things up so badly that it would need at least five incident reports. Such is life with this syndrome.

I've asked around a bit--people tell me it goes away, but no one is sure about when. Most of the people I've talked to didn't have much experience, but were already over it. I realize it must be different for each person, but there has to be a ballpark. When on earth do these attacks stop? Is there a cure or treatment for Sentinel Syndrome? Or is there just a time frame, in which it runs its course and eventually leaves you alone?

[la_chica_suerte85, BSN, RN]

You're having panic attacks. If you can get this under control, you shouldn't even be having trouble when something goes awry. If you aren't able to get this very well under control, you need to see a doctor. I used to have panic attacks resembling the exact issue (though not related to clinicals or, really, anything in nursing) and medication helped immensely. I had to do a considerable amount of work on my own thought processes as well to get through it. I still have them occasionally but I have managed to get over the terror they used to cause.

[Pat_Pat RN]

Yes, what they said ^^^.

Panic attacks. I have them, usually when I have to travel more than about an hour from home. Or if doing something "different" than my usual routine. It is horrible, terrible thing and I DON'T have mine under control. There are many things in my life that I don't do that I want to but can't/won't because of these feelings. Medication will help but won't do it all. You have to put in the work also. I haven't put in the work.

Hang in there, it does get better over time.

[canigraduate]

I agree with PPs. Panic attacks.

They don't go away until you deal with them, either through therapy, lifestyle changes, or the passage of time.

How much time? Too many variables to predict. You're better off seeing a therapist or doctor.

[NotAllWhoWandeRN, ASN, RN]

Sounds like a variation of something I've suffered from: Impostor Syndrome! Throughout nursing school and earlier in my nursing, I struggled with a great deal of fear that I wasn't good enough and people (school, licensing board, employers) simply hadn't figured it out yet.

Here are some signs of a panic attack:

• Shortness of breath or hyperventilation
  
• Heart palpitations or a racing heart
  
• Chest pain or discomfort
  
• Trembling or shaking
  
• Choking feeling
  
• Feeling unreal or detached from your surroundings
  
• Sweating
  
• Nausea or upset stomach
  
• Feeling dizzy, light-headed, or faint
  
• Numbness or tingling sensations
  
• Hot or cold flashes
  
• Fear of dying, losing control, or going crazy
  

I've had them, and they are not fun. But panic attacks are usually sudden and brief. Anxiety is more of that constant buzz in your head that Something Is Wrong.

You're still a nursing student, right? So you're never in contact with patients unless a clinical instructor or licensed provider is there guiding you? The good news is, this is the time when it's totally ok to be nervous. Someone else is ultimately responsible for the patient's overall care; you are only responsible for behaving responsibly within your learning environment.

So how do you manage?

Cold water sends messages to your body that tell it to calm the heck down. Deep breathing exercises can do that as well by activating the parasympathetic nervous system.

Sometimes I'll do that for several minutes and have a measurable drop in heart rate. It's pretty cool.

There are also some gifs with a deep breathing exercise that you can repeat with each loop. Some people find the visual helpful.

Cognitively, know what you know and what you don't know. Know what you are allowed to do independently in clinical situations and what is a no-no. If you stay within your school's guidelines, you are doing things that are safe. If your instructor or a nurse are with you, they are there to be your safety buffer and make sure you do things the right way.

If you're not sure about something to do with the patient's condition or what you are doing (or even what another staff member is doing!), ask. This is your time for learning, and asking questions facilitates learning. Learning helps reduce anxiety.

In my final clinical rotation, we went home after each shift with the assignment to investigate our patient's diagnosis and teach our classmates about it at the next clinical. We learned SO much through researching on our own and from each other. When we put together our documentation and care plan homework, we had to note each abnormal finding, its cause, and what was being done to treat it. Learning about what and why helped.

Talk to your classmates if you can work up the courage. You're symptoms are severe, but everyone deals with some level of anxiety. It means you care. I guarantee you are not alone.

Talk to an instructor if there's someone you trust to deal appropriately. I could not BELIEVE how much better I felt after I cracked and talked to one really phenomenal nurse/teacher. Nobody knows it all. Nursing school teaches you a tiny bit of everything - just enough to teach you to think for yourself and get you off the ground. You learn and grow through your experiences after graduation, too.

I'd be remiss if I didn't also recommend talking to a mental health professional to help with coping skills, but it makes me a hypocrite. I did settle into my confidence, but it took a solid three years. Three years that could've been a lot better if I'd figured out how to deal while I was still a student. Don't be me.

TL;DR Yes it can and does go away, and you're catching it early enough that with some proactive steps, you can get it under control before you end up a miserable trembling new grad nurse.