Bouncing back after a bad shift

[mph53953, BSN, RN]

So about two nights ago, I had a really awful shift. I’ve been a nurse for about two years and I’ve been in the ICU for about 10 months. This patient was my first 1:1 assignment. I was in an awkward position because the patient was admitted under an aggressive cardiologist (they were family friends or something?) and one of our more righteous intensivists was on that night. Neither the cardiologist nor the intensivist were willing to step back and let the stroke doctor run the show, so I was bombarded by orders from all three doctors competing for control over the patient. Long story short, I was screamed at by the intensivist once in the middle of the unit, and again over the phone. There were two nurses on that night with several years of experience on this unit, and they assured me I wasn’t doing anything wrong, the intensivist was just “in a mood”. I did Q30min neuro exams until midnight, and then Q1H exams for the remainder of my shift, just as the protocol states. The repeat head CT was stable. The patient’s exam at 6am was consistent with previous exams. Then at 7am, I went in with the dayshift nurse to do a neuro exam as part of our handoff. New mouth droop. No commands. Nonverbal. Stat head CT. At this point, I’m emotionally and physically exhausted, and I became upset and began to frantically wrack my brains for a sign I must have missed at 6am. The oncoming nurse insisted that with the microhemorrhages, there’s a very good chance things DID change within an hour, but I can’t stop feeling like there’s something I must have missed. I offered to help take the patient to scan, but the oncoming nurse insisted that I had a rough shift and she could take things from here. I started crying as soon as I got to my car, and I’ve been crying on and off my two days off. I’ve gotten really good about “leaving it all at work” and I haven’t been this upset about a shift since I was a new grad. I’ve dealt with a lot of unpleasant people, but I’ve never had a doctor publicly degrade and humiliate me like this before. And I can’t stop feeling like I missed something and I failed the patient because of it. I feel like my confidence was shattered, and I feel so ashamed I don’t know how I’m ever going to show my face at work again. Does anyone have any tips for bouncing back from a bad shift? Usually I’m fine but this night just broke me. My management’s super approachable, so I’m on the fence about asking someone to talk with me privately and help me debrief. Any advice is much appreciated ?

[ptier_MNMurse, BSN, RN]

It sounds like you definitely need to debrief. Talk with your other nurses and definitely talk to your manager about it. What you are experiencing is definitely understandable and you are not alone in how you feel about this! Many of us have had similar experiences, where you get that gut rot feeling like you did something wrong and someone suffered for it. This doesn't sound like your fault. Talk to your manager and see if there is anything else that could have been done differently, talk with your colleagues to see what their experiences have been, and maintain some HEALTHY coping mechanisms (workout, yoga, tea, meditate, pray, walks, music, etc.) to get your mind right. I have definitely been through some tough things where I felt like I had done something wrong, but things turned out to be out of anyone's control. Critical incident stress management is important! Keep your chin up!

[flo136]

We've all had shifts like that. I find as much as I dread returning to work, it really helps to find out what happened to the patient. And talk to a trusted friendly colleague, someone whose opinion and work you admire for a different perspective.

I like to go out in my local area and see healthy people out and about. As a change from all the distress and drama at work. Be out in the 'real' world.

Do reach out to some support service if you can't shake this off. Reflection on critical events also counts for annual professional nurse registration (in UK and Australia) so writing a statement of the events and what you have learnt afterwards count too.