Not long ago I encountered a new nurse with multiple questions, and while I adored the fact she sought answers to the things she did not know, I also sensed a self doubt within her. I totally got it. I saw myself in her wide, startled eyes, and even fifteen years later I could easily recall the hesitancy prevalent in being a new nurse. I remembered well the fear, worry, and realistic concern that I might do something wrong. I mean, it’s true. Hastily made mistakes could kill people. But I also could remember the irrational fear I had held, the anxiety that I would mess up even the things I knew how to do. For years that irrational worry had made nursing far more difficult than it needed to be for me. And though a whopping, healthy dose of attention to detail and awareness could save your license, as well as a person’s life, one step over the line into performance anxiety and bedside-care doubt could tire you quickly. No one could survive the burnout of that particular feeling. I saw that fear in this new nurse’s eyes.
As a newer nurse you have a choice to learn from your mistakes and press on, or you can crumble under defeat. You have the choice to build on your knowledge and gain much-needed confidence. I’ve seen the other side of the spectrum, mind you, as I’m sure most of us have. It’s that overly confident, cocky new grad who thinks they know everything. They don’t ask questions, and it’s usually the patient who suffers. They teach their incorrect knowledge to the new hires that follow, and safe technique goes out the window. So, I’m all for the pursuit of knowledge, asking questions, and taking an extra pair of eyes along. Heck, after twenty years in healthcare I still ask questions and seek new answers daily. That’s not what I’m talking about. I’m talking about doubting the knowledge you do have or anxiety over skills you hold under your belt.
This problem of bedside anxiety won’t go for everyone, and if it doesn’t pertain to you then I say, that’s awesome. Truly. Because it sucks. I think it’s the introverted, overthinkers who encounter this problem the most, and it will surefire make you resent your career. I used to be that nervous nurse, but no longer. I found my peace in patient care.
So, here’s what I said to this new nurse when she spoke anxiously about the continued stress of making a mistake in nursing.
You have no control over out of control things.
And that’s the truth of it, my friends. I used to be one of those people who desired control over all the things! I think most critical care nurses have that desire within them. I wanted everything just so-so, my ducks in a row, and my plans laid out. Basically, I desired a Mary Poppins kinda day, everything practically perfect, and anyone who’s nursed for like five minutes knows that ain’t happening. But it wasn’t just that. I also put too much pressure on the control I had over a patient’s outcome. And, yeah, while my performance could positively or negatively affect my patient, my ability to do well couldn’t stop someone from checking out to the great beyond. Somewhere around my tenth code, where the patient didn’t make it, I realized this.
I don’t care if you knock out your compressions like an ACLS guru, if a patient’s heart is tired of pumping, they will probably die.
I don’t care if you give every medicine correctly, checking allergy lists and the five rights, if a patient is too far gone to respond to the treatment ordered, it won’t matter.
It doesn’t matter if you give the best Diabetic education and insulin administration teaching on the planet. If a patient wants to chug Mountain Dew like it’s the air they breathe, they’ll be back next month in DKA.
It doesn’t matter if you provide the most encouraging and uplifting advice to the addict, you may find out they’re dead next week. I’ve had this happen.
It doesn’t matter if you provide the best care in the whole hospital, certain families will still complain.
I don’t care if you do everything right, catch every mistake before it happens, and think three steps ahead for your patient’s best outcome. If it’s their time, then it’s their time.
It’s not you. It’s not me. You can’t control an uncontrollable situation.
For me, I had to realize that I can only do what I can only do. I can’t get everything done. I won’t check all the boxes administration wants me to check. I can’t place myself in two rooms at once, no matter how much my charge nurse may wish it was so. I can’t control what a patient’s family does when I leave the room, and I can’t change what a person does when they wheel off my unit. I can’t save everyone. Sometimes because they don’t want saving, but most of the time it’s because healthcare is bigger than me. Life and death is bigger than me. Destiny, God’s will, or whatever you personally call it, is bigger than us all. We can only do what we can only do.
We come in and do the best we can. We work with what we’re given, which often times is less than we need. We do the absolute best we can, and to quote my favorite work-husband of all time (love you, Terry), we try and “leave em better than we found em.” But then we just gotta let go; let go of this idea that we hold life and death in our hands. I mean, yeah, how I titrate those three vasopressor drips can mean the difference between life and death for my patient! And giving the correct med or wrong one will have good versus bad outcomes. It’s my keen eye that catches a potential problem before it becomes a real problem, and that makes me feel very good. Yet I can’t keep bad from happening if it’s gonna happen. I can do my best, but that’s all I can do.
In nursing we hold much responsibility. As we’ve seen in the news, our mistakes can be costly, to more than just ourselves. That’s why we keep learning, keep asking questions, and keep trying hard. What we don’t do is fear. Fear, worry, and anxiety have no place at the bedside. Fear and anxiety will tell you that something bad might happen. Realistic thought will tell you that something bad will happen. Maybe not today or tomorrow, but one day it will. You can do everything flawlessly and it still will. You have to let go and just do what you know to do, realize that you’ll make mistakes, but you’ll learn from them. Sixteen years ago I failed a clinical exam because I didn’t give my patient up in the chair his call light before I left the room. Do you think I’ve ever forgotten to give a patient their call light since? I haven’t.
You’ll mess up, miss something, and forget plenty. Personally, each day before I work I pray in the shower. I ask God to “help me hear His voice and do no harm.” It has worked well for me thus far, but I also know I had trouble hearing that small, steady voice in my heart until I let go of the fear that I wouldn’t. I had to become confident in where God had placed me as a career, and each day I go to whatever floor and whatever assignment with that same peace. I’m going where I need to be, with the patients I need to have.
I can’t control everything that happens at the bedside, but I can control my own thoughts. After all, it’s my thoughts that drive me.