Coping with a difficult shift

  1. On average, my job is quite enjoyable with reasonable patient:staff ratios, fair distribution of acuity in assignments, etc. I like my job and might even say that I love my job. Most shifts, a few unexpected/unplanned things pop up and need to be addressed -- chest pain, new afib / afib RVR, nausea, breathing difficulty, new confusion, etc. -- and that's not a problem. I adjust and address as needed.

    But some shifts - maybe 1 shift every couple of months -- some shift seem to be a never-ending pile up of multiple patients having issues that need to be addressed. Getting calls within minutes of each other for every single one of my patients wanting something addressed right now. (Often, I can see the clear priority, but I can see why it would be distressing for a patient in pain or vomiting to have to wait while I check on a chest pain or new a-fib RVR patient. Sometimes it's not so clear cut which patient is a priority which makes me feel guilty about the waiting patient.) As an added bonus, sometimes even after the initial storm settles, it sometimes seems to continue through much of the shift with new problems popping up seemingly every time I sit down to try to chart anything that I did (or if I try to eat or visit the bathroom, LOL).

    I start out feeling a little stressed, but capable, and am confident that I am prioritizing correctly (and asking for assistance when truly necessary -- whether delegating to an NA or getting help from another RN), but as the night goes on, my coping reserves get depleted and I start to have the urge to scream or cry when there's yet another unanticipated patient need / demand on my time. It starts to feel like the universe is against me. Objectively, I know this is not true and I am generally a positive person, but when my coping reserves have emptied by repeated challenges.... ugh.

    What do you do when there are so many demands on your time to keep yourself from going crazy? What do you say to yourself to avoid spiraling into negativity when it's seemingly one challenge/problem after another? How do you deal with the patients who can't be your first priority but have legitimate concerns/problems?

    Thankfully, this doesn't happen often, but I'd love some advice to help me keep those coping reserves from running out during challenging shifts.
  2. 2 Comments

  3. by   Ruby Vee
    Self-compassion and good self-care!

    There may not be much you can do DURING the shift, except to remind yourself that you're doing the best you can. But afterward, take some time for yourself. Play your music as loud as you can stand and sing along as you drive home. Walk your dogs -- I once walked 11 miles after an extremely awful shift! I ended up having to call someone to come and get me and the dogs because they weren't able to keep going. Exercise helps. Journalling helps. Even if you don't think you know what to write. Sit in front of your blank page or blank page for 20 minutes, and write whatever pops into your head, even if it's only "I don't know what to write. I don't know what to write." I've only found one time that I went for the whole 20 minutes without something emerging from my brain. That's in 40-some years of journaling.
  4. by   SarahRN2013
    Thank you for the suggestions, Ruby Vee. I already do post-shift processing in a variety of forms. I am hoping to figure out some things that might help during the shift too. Some people just seem so chill no matter how much crap is being dumped on them. I'm wondering what they're thinking and doing that lets them be relatively relaxed despite the storm.