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Words of wisdom for the anxious nurse

Patients, families and physicians look to nurses for a lot of things: intuition, compassion, strength, knowledge and—certainly neither last nor least—calm when things really (sometimes quite literally) get messy.

Of course, that’s not to suggest that the best possible care can only be achieved in the absence of fear or panic, which are just two staples in a nurse’s wide-ranging emotional diet. It simply means that a nurse’s fear of failure must, in time, be defeated by a stronger desire to help, along with hard-earned skills and the confidence to execute those skills.

Needless to say, conquering on-the-job (or even in-class!) anxiety can be a process—but it’s doable. Below, with the help of a few of your fellow nurses, Kati Kleber offers a handful of advice that you can use to finally start taking fear to task:

 

After being in the field for a while, I’ve noticed a common theme: anxious nurses. We see people die during a normal day at work. Our normal day is someone’s last. At any moment, someone’s heart can stop and we’re responsible for restarting it. Someone can stop breathing and we’ve got to know what to do to get air back into their lungs. No wonder we’re anxious!

Many nurses struggle with anxiety, whether it’s something that was there before nursing school, developed in school or after being in the field for a bit. Using various social media outlets, I asked to see if anyone who struggles with it had any words of wisdom. The response was amazing—there is some really good stuff here, guys.

Below is advice for nurses from nurses who work at the bedside. This is real and practical advice…not from a research study in research-y language, from a pamphlet or from a doctor who doesn’t know what it’s like to be a nurse. It’s from us.

Here are some themes that I’ve noticed across the responses:

  1. Prepare. Preparation is important because if you have everything together, you’re minimizing the unknown. You’ve got what you need. You’re ready for what’s ahead. If it’s your first clinical in a new place, make sure you know where to go. Do a test run the night before: drive there, check out the hospital, walk in to see where you need to go the next morning.
  2. Breathe and focus. I thought it was interesting…basically everyone talked about how important it is to remember to breathe and also to focus on your breathing.
  3. Make sure your clinical instructor knows. “I tell my clinical instructors that I have anxiety at the beginning of each rotation so they are aware and are a little more understanding if I need an extra second to answer questions (if my heart and mind are racing, it is a little harder to concentrate when being quizzed while completing a task/preparing medications…this helps them understand that if I need a second, it isn’t because I don’t know the answer, it is because I need a second to breathe and bring my heart rate down). The last thing I want is someone getting frustrated and attacking me with a ton of questions while my heart is racing faster each second, my face is burning red and I can hardly concentrate on what they are saying, let alone spit out a coherent answer. I have gotten to the point where I can now say, ‘I just need a minute’ and they give it to me…no questions asked. It really helps me be able to calm down.”
  4. Get enough sleep! “A tired me is a me with more anxiety.”
  5. Identify a support person in your class or on your unit. They can tell by the look on your face when it hits you. When things get rough, they can hold you up if you’re crashing down.
  6. See a school psychologist or a personal psychologist if you think you need to. They can help you to identify specific coping techniques for in-the-moment stuff, go over certain situations (there’s a lot of trial and error in figuring out what will work for you!) and help you prepare for particularly stressful things (coughNCLEXcough).
  7. Schedule reviews with your instructors to combat test anxiety. “I have really bad test anxiety, and (as suggested by a psychologist once) I review every test and quiz. It really helps because I can see where I made stupid mistakes, and I can see if my errors were knowledge gaps or me just reading the questions too fast/not being able to concentrate properly because of an attack. Knowing this helps me be able to calm down a bit before the test, and even during. If I know my mistakes are not knowledge gaps, I can remind myself that I know the information, and if I can breathe, I will have the ability to think clearly and get the right answer. If it is a knowledge gap, I just study a ton until I am convinced I’m prepared, and that also helps because I just tell myself that I have done so much to prepare that I couldn’t have done anything more to get ready for the test.

Most professors/universities are pretty strict about test reviews, but I just tell them that I have anxiety and reviews help me, and they are eager to help. I swear by reviews. I always do all right on my first test, but once I see what the prof is looking for, and where/why I made my mistakes, I do much better on the next ones. My very first nursing midterm in first year, I got 57 percent (not even close to a nursing pass), went for a review and received an 87 percent on my next one. It has worked so far throughout my three years of nursing (one more to go!) and I have been able to ace most of my classes.”

 

Powerful Nursey Quotes

These are all from messages I received directly from bedside care providers.

“Don’t let people minimize your anxiety. It is real, and it is something we anxious people have to deal with…but you can overcome it; it doesn’t have to define you.”

“Anxiety isn’t going to stop you from being a great nurse. If you love what you do, you will find ways to be the best nurse you can be…and passion overcomes anxiety. Your patients will see that you care before they see that you are anxious. Just breathe.”

“Don’t feel ashamed of your anxiety. Yes, there are people who won’t get it who will judge you. They aren’t nice and they aren’t worthy of your time. Try to ignore them and turn to someone you trust who accepts your problems. I find it easier to have someone I trust who knows about my struggles. It makes me feel safer and that will make my anxiety easier to handle.”

“Dealing with the life-or-death situations we see as nurses can really help us put our own lives in proper perspective. I know it has helped me a lot in realizing that a lot of the things that used to give me anxiety (and still sometimes do) are truly not worth worrying about. When I was a new grad nurse, I really worried for a while that even though I loved my new career, the anxiety might ‘do me in’ in the long run, but it’s actually turned out to be quite the opposite. I think being a nurse has actually encouraged me to become a less anxious person. Or maybe I’ve just better learned to handle it.”

 

A Few Stories

  • “I’ve had problems on and off with anxiety since high school, but totally hit the peak in nursing school. I honestly can’t pinpoint the biggest cause, whether it was bills, family or school itself, but there were so many moments sitting in class feeling like I couldn’t breathe or I might pass out for no reason at all. I think the perfect example for the current student in question [of whether they can be a nurse even though they struggle with anxiety] is when I walked out of my cardiac lecture in school because of a panic attack. For whatever reason, I couldn’t center myself and just felt the anxiety building and ended up leaving in the middle of the lecture.

However, now six months post-grad, I am working as a cardiac step-down nurse in a prominent teaching hospital. All is possible! I think so many people have anxiety and some don’t even really recognize that ‘feeling’ as anxiety itself. I still get anxiety, but being able to recognize it and tell myself ‘This will pass. You’ve felt this before and it’s not something that will hurt you’ helps immensely…that and my dog. Hope this helps someone!”

  • “The first time I did a clinical rotation in the ER I was terrified. All day I kept wondering if I was doing things wrong. Then late in the afternoon, a little girl came in with a dislocated kneecap. As I stood by watching the doctor at her feet, her mother at her head, boyfriend by her side, and the nurse I was following trying to start an IV, I felt useless and afraid because I didn’t know how to help her. After a minute I realized that the nurse was having a hard time starting the IV because the girl was shaking too hard. She was crying and so afraid, and in so much pain. So I reached around the nurse and took the girl’s hand. She squeezed (hard), and after another minute she stopped shaking.

The nurse got the IV started and we got her some pain meds, and the situation progressed normally from there. I went around to the other side of the bed and tried to catch her attention so the doctor could reset the kneecap. I told her a joke and she laughed, and then she realized the doctor was done and she didn’t feel any pain, and she wasn’t scared anymore. She turned to me and said, ‘Thank you.’ That felt so awesome. That was the first time I had made a decision that was entirely my own, based on what I thought I could do for a patient. That was the first time I knew what it felt like to be a nurse instead of just a student.

Now I know we don’t do what we do for the thank-yous, but from then on, every time I got stressed over a test, angry at one of my instructors, afraid at a new clinical site, or frustrated and ready to give up, I thought of that little girl squeezing my hand and thanking me, and suddenly it was all worth it, and whatever anxiety I was feeling would melt away. Find your moment. That was mine.”

Here is a blog post about nursing and OCD written by another nurse blogger that I found really helpful, interesting, well-written and insightful. Check it out here!

I hope this helps those of you who struggle with anxiety. Whether you’re preparing for nursing or you’re post-graduation or on the job, remember that anxiety does not define you and will not keep you from being a fantastic nurse. You work your butt off to help your patients—please do the same for yourself.

 

Is there anything we missed? Do you have a great story about your walk with anxiety in nursing? Please share below!

To read more, visit NurseEyeRoll.com.

Nursey-123x18511Learning how to be a great nurse at the bedside while maintaining your sanity at home is no easy task. Becoming Nursey: From Code Blues to Code Browns, How to Take Care of Your Patients and Yourself talks about how to realistically live as a nurse, both at home and at the bedside…with a little humor and some shenanigans along the way. Get ready: It’s about to get real, real nursey. You can get your own copy at NurseEyeRoll.com, Amazon or Goodreads (ebook).

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Kati Kleber BSN, RN

Kati Kleber BSN, RN CCRN is a a nationally certified critical care nurse located in Charlotte, NC. She is the Nurse Advisor and Editorial Director of the #ProtectNurses initiative, and will be guiding the content we curate, create, and share back with you. Kleber, aka Nurse Eyeroll, is a popular blogger, the voice behind the wildly successful #ProTips series, and a frequent speaker on nursing leadership. You can buy her book "Becoming Nursey" at nurseeyeroll.com, Amazon, Barnes and Noble, and other sites. She also has two more books in the works, which will be published by the American Nurses Association and on shelves Feb. 2016!
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2 Responses to Words of wisdom for the anxious nurse

  1. tom combs

    Great post!
    I’m an emergency medicine doc- retired after 30 years including plenty of times when anxiety ran high. I don’t pretend to know the pressures unique to being a nurse but I hope the following might be helpful for some folks.
    When the E.D. was overflowing and I was caring for multiple sick patients it was easy to find my “holy crap this is out of control” factor skyrocketing. I found it useful (sanity preserving and effective) to pull back mentally for a moment and identify which of my patients were at risk of dying right now, which were worrisome but stable at the moment, and which had problems that were significant but had no crash-and-burn potential or significant immediacy and which were minor. The approach always helped me with my clinical priorities and helped to dampen down anxiety (definition – a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome).
    I think that time-pressure is a significant factor in fueling the anxiety based in concern for your patients as you feel everything needs to be done NOW (patient well-being concerns nurses most). One can’t do everything at once (though it is expected).
    By identifying which patients/needs are not critical (not at risk of terrible outcome) or do not immediate (they might want it now/would be ‘nice’ to take care of now but are receiving solid care/safe) it helped me deal with things better (i.e., I never ran out of the ER screaming maniacally)
    Of course I had the good fortune to be working with nurses, techs, and others who also always had our patient’s back.
    I recognize nurses are often on their own on the floors, units, etc. There is often “too much” for any one person to do right now. Sometimes some of that surging tide of responsibility is made up of things that are not critical or clinically significant…it helped to give myself a mental “time-out” and recognize that (not minimizing – just prioritizing).
    I hope the thoughts above might help some in those times when it feels like a tsunami of responsibility is hitting.
    I think stress and anxiety in health caregivers is a very important topic. It has often been minimized or denied. Really great to see you address it. Great stuff!
    Thank you.

  2. onlyme

    Worry is contagious. But so is calm, professional confidence!

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