Will it get better???

[R!XTER]

I'm a pretty new ED RN with 1.5 yrs of experience, having some second thoughts lately. I got this (dream) position straight out RN School, went through some extra critical care training, then precepted for 3 months. I have been flying solo for 1 year now.

I have never known myself to be an overly anxious person until this job. I have been finding that my stress/anxiety levels are sky high, and I just don't think I am the same person I used to be. I am very anxious about making mistakes (which thankfully so far has not happened!) particularly med errors. I double and triple check meds which I have given numerous times even though I KNOW the order is safe. I can get through a standard shift with no problems, I am good at managing my time, and outwardly most people would not guess that I am this anxious, but it is spilling over into my personal life as well. I have become a bit of a hypocondriac, which I attribute to some of the bizarre/scary illnesses I see at work. Every time I feel a "twinge" I begin thinking of the worst possible thing it can be. I am terrified of contracting a communicable disease at work, such as HIV, HepC. I take all the precautions necessary, but I am still terrified. Recently we "coded" an HIV+ patient and some of her blood-tinged sputum sprayed on my arm. I had no open skin, and intuitively I know that is not considered an exposure, but yet I am still so paranoid about it!

At work I feel pretty comfortable taking care of the standard patients, but often I feel inadquate. I'm not sure if it is just a lack of experience at this point, but the ICU patients terrify me, vented patients terrify me, central lines terrify me. I think I have come to depend on the docs always at the bedside, whereas on the floor you learn to think things through since they are not always there. When I read posts on AllNurses I often marvel at the extent of knowledge that so many nurses posess and I wonder if this is just nurses with years and years of experience, or am I expected to know all this at this point in my career? I don't think I am unsafe, I ask a lot of questions, but I am starting to doubt if I am growing enough.

Believe it or not, I love my job. I do look forward to going to work. I love patient care. I love my co-workers. I am still thrilled to be working in ED. But I have been doing some thinking and I just don't know if it's worth it.

I guess what I would love to know is, has it been this way for everyone? after 1.5 years am I where I am supposed to be, or do I have a lot of catching up to do? And is the stress normal?

[Dixielee, BSN, RN]

I think you are finally getting over that new grad mentality, and realize what you don't know! That is an important milestone in a nursing career! That first year or so, you are still so new, you don't always realize how scary this job is. You have a tremendous responsibility for someone's care.

These next few years will be filled with some anxiety as you realize how much you still need to learn, but you will also grow more confident in what you do know! Don't be afraid to rely on others around you to help you learn.

You are finally to the point where you can absorb new concepts, meds, procedures. Now is the time to branch out a little. If you have not already taken TNCC, ENPC, PALS, ACLS, etc. you should think about it. Enroll in some of your hospital's online or class room learning classes on EKG's, wound care, etc. if you can.

Don't worry about relying on the docs at bedside for critical patients. The nurses on the floors without the docs are generally working with patients who have already been diagnosed, stabilized and treatment plans are already implemented. Yes, they can still go bad, but that is where rapid response teams, ICU staff, etc. come into play.

Take every advantage to learn that you can. As you take more critical patients, write down things you may be unfamiliar with. Discuss the vents with your respiratory therapists. As you stock rooms, ask more experienced nurses to show you what is needed for central lines, art lines, pacing, cardioverting, etc.

I can't address the hypochondria, but you are exposed to bad stuff in the ED and there is no way around it. Just protect yourself the best you can. Use universal precautions with everyone, and extra precautions with those you know have the bad bugs.

Good luck to you in your quest for knowledge and as you find your comfort zone. It takes a while, give yourself that time to grow and learn.

[R!XTER]

Thank you so much for your response...it is really reassuring!

[Hagabel]

OMG...you should have seen me, a nurse with 15 yrs experience inc 13 years ICU, my first few months in the ED. I was scared to death, not of the trauma pts or vents, or central lines but pelvic exams, splints and starting IVs(did not start too many IVs in ICU).

I think you are expecting too much of yourself too soon. PP gave some great advice.

Ask your more experienced staff as much as you can and defintely catch up on some courses. TNCC is especially good.

Good luck.

PS I just emmigrated and am now working in the ED in another hemisphere, like being a new grad all over again!!!!

[Medic2RN, BSN, RN, EMT-P]

You've received some excellent advice so far.

I got over my lack of knowledge and comfort by actively seeking out those patients that terrified me. For me, it was pediatric patients. The more experience you get under your belt, the more comfortable you'll feel. I think with time, exposure, additional classes and researching subjects you come across, you'll get to that comfort level.

We've all been where you are now. I'll think you'll do fine.