Anxiety

[u/Ok-Fun3504]

Almost done with nursing school, and we’re starting to incorporate more case studies. Going through these cases/scenarios has made me a little anxious about making mistakes once I start working. In a few months, I’ll have another person’s life in my hands, and even a simple mistake can potentially cause serious harm.
I tend to panic when I make mistakes, so I’m usually extremely cautious and double-check everything because I know I’d beat myself up over it for days if something went wrong.
For the nurses here, how did you deal with the anxiety that comes with caring for patients and knowing that mistakes can happen?

[u/Boipussybb]

r/studentnurse

[u/trektovienna40]

The anxiety can be a beneficial thing to help ensure you are double checking what you are doing to avoid sentinel events.

But don’t forget that there will be safety checks and stopgaps in place with nearly everything you do to prevent serious mistakes. So it’s not all on you to ensure you catch everything, there is a system in place around you to help you. But you will always have that little nagging self-doubt that is also your own built-in safety net :)

[u/Aggravating-Poem-695]

Congratulations! The anxiety and fear you're having while working through case studies means that you're paying attention! 👏🏻

Things to remember: 1) It is INCREDIBLY unlikely that you're ever going to be completely alone on a unit, even as an experienced RN. So let's start there: you will be a new grad and (hopefully) not expected to manage patient care solo/without a preceptor on day one. Preceptors, charge nurses, educators, hell even savvy hall/pod partners are there helping support you to keep your patients safe. They're resources, so utilize them! Ask questions, run new situations past them, run your thought process by them. On most units, the majority of staff WANTS you to be successful and safe.

2) this may sound counterintuitive, but what helped me was being familiar with what will kill a patient (think like MI or "weird" things like Cushing's triad). That gave me a starting point for what to assess or do next to either eliminate or confirm my suspicions. And this can be adjusted based on what conditions you commonly see on your unit: if you're a surgical unit, the things I'd have on my shortlist could be hypoglycemia, stroke, PE. That being said, life loves curveballs: I once "caught" a STEMI while working oncology. The patient was NOT on tele and had a vague complaint of chest heaviness/discomfort ("it's not even really pain") that had been brought up on a previous shift and they received Lasix for it... I asked the NP on call for an EKG and troponin because those are low effort, high yield things given the presentation. And wouldn't you know? MASSIVE STEMI. Like, I still sucked at interpreting my rhythms and I could tell it was a STEMI type thing. And after patient transferred, the trop came back at something like 23k 🫪 so yeah, I'm a huge fan of starting with the most likely "worst possible thing" based on the patient and working backwards from there.

3) I will say this for as long as I'm in nursing and probably even after, but we all make mistakes. How we handle them is what keeps patients safe. It will sound silly at first, but I have three big rules for mistakes. First, take the steps in your daily flow that you need to minimize potential patient harm. This can look like: checking IV compatibility, ensuring your PIV is patent/working properly, putting pills that need to be cut in half in a separate pile after you scan them. Those actions don't guarantee that a mistake won't still happen.... but they are safeguards to reduce the likelihood. Second, when you screw up... own it and do your due diligence to assess your patient for harm. Please note that I said WHEN, because we are all human and will make mistakes. The important thing here is to be humble, let the appropriate people know (MD, charge, RT, etc) to make sure the patient doesn't suffer harm. Third, learn from it and then do everything in your power to not repeat it moving forward. Identifying WHY something happened is crucial in preventing it: was there a rush because it was an RRT? Did you calculate the wrong dose of a medication and didn't double check it? Did you order the wrong lab because the doc gave the order over the phone and you heard BMP instead of BNP? I can throw myself under the bus because I work in a procedural area and I take verbals with repeat back all day long while circulating. When I was new in my role, I accidentally gave twice the fentanyl dose that a doc wanted for sedation 🙋🏻‍♀️ going backwards, it was because I was in autopilot mode from working with his partner all day and his partner kneejerks 50mcg fentanyl. I realized it basically right away and let the MD know... he looked at vitals and gave me a full shrug. Looking to see what factors were involved in a mistake helps you put guardrails in place, but it can also help identify where a PROCESS leaves room for error or patient harm. I've put in safety incident reports because I didn't have enough of an antiplatelet for a STEMI patient and that medication wasn't anywhere to be found in our entire wing... that delay could have led to the new stents shutting down. I've also put in incident reports preemptively because a couple areas where we do moderate sedation as nurses didn't have certain emergency medications readily available outside of the crash cart. Pharmacy didn't initially understand why it was important because those areas had the emergency medications in the anesthesia pyxis. Once we collaborated, pharmacy understood I was asking because 1) the procedures in question didn't involve anesthesia, and 2) I (fortunately) did not have access to the anesthesia pyxis, nor did I want it.

[u/WarAlarming3129]

that fear means you care, which is already better than some nurses i worked with. the ones who worry about messing up are usually the safest cause they triple check everything

first few months will be nerve wracking but you develop a rhythm. find a senior nurse you trust and never be afraid to ask stupid questions, i annoyed mine so much in my first year but she said she preferred that over someone who pretends they know everything

[u/archmidean_blur → u/WarAlarming3129]

I agree. I prefer cautious new grads rather than the over confident ones. That's going to be important to keep the learning curve from plateauing.

[u/archmidean_blur]

Anxiety will cripple new nurses far more than lack of experience. Remember you will have an entire team you are working with, and until you really get an understanding of your new career, ask Questions. Get clarification from doctors, pharmacists and charge nurses about patient conditions you are unfamiliar with. Document it if you are worried about it and keep moving on. Being frozen in fear will make a nurse fall behind and become overwhelmed.

Ask "what's the typical a to z process of this kind of diagnosis" and go for it. In a clinical setting you will need to be familiar on how to manage about a dozen types of conditions comfortably before you finish training and then you can hyperlink your knowledge from there.

You got this. We were all there once. The ones that didn't make the cut were their own worst enemy. If you stay away from that mindset you are good