How do you deal with the stress of the job (too busy to take a break, etc.)?

gwlillith · Jan 23, 2005

When I was new I had the worst time trying to manage my time! It does, in fact, to reiterate all the posts' good advice take a while to get into your groove. I remember as I sat crying at home waiting to leave for work, how I was going to get thru another night with this kind of stress, when the phone rang. It was a good friend of mine who had been nursing for years, she said it, and I'm going to say it....Nursing is a 24 hour job! What doesn't get done on your shift will have to be turfed to the next one. Simple as that. That's where prioritizing comes in. If the oncoming nurse doesn't understand this, then maybe a gentle reminder is in order. Remember, one day she will be turfing something over to you as you come on duty. That will happen, believe me.

So don't think everything HAS to be done on your 12 or 8 hour shift.:balloons:

PHTLS · Mar 6, 2005

You should only worry about your documentation.

Cherish · Mar 15, 2005

HillaryC- Have you thought about working evening or nights? Maybe a change in the shift hours would be beneficial. Also, you applied for the ICU job yet? How did it go, did you get it? If not, you might try the changing hours and seeing how that works, or better yet, work evening, nights on your ICU job if you do apply and get it. Hope that helps. :twocents:

HillaryC, RN, CRNA · Mar 15, 2005

Hi Cherish,

Yes, I got the Surgical ICU job and started 3 weeks ago. So far, it's been much better than my old unit :) I think part of the problem was the old unit was Intermediate Care and pretty boring, but an equally big problem was the lack of morale and teamwork on the unit. The unit was also constantly getting shafted on staffing (a nurse was always being pulled to one of the SICUs). Some of the management really sucked, and there was absolutely no sense of teamwork between most of the nurses. On my new unit, when a new patient comes in, it's automatic that 3 or 4 nurses come to help admit your patient so you can get report from the transferring nurse. People on this unit seem for the most part to be very friendly and professional. I'm cautiously optimistic that I'm going to be much happier there. I've had some 1:1 patients and some 2:1, and so far the 2:1's don't seem worse than my 2:1's on SIMC at all. Not to mention, on SIMC we frequently got 3:1 on nights and occasionally on days (which is almost impossible to do).

So, like I said, I'm cautiously optimistic that this is going to be much better :) It's still going to be busy and I need to continue to work on my time management (and particularly, figuring out how to get a lunch break at a reasonable time), but I think this new unit's going to make a big difference. Thanks to all of you that gave me advice :)

Hillary

HillaryC- Have you thought about working evening or nights? Maybe a change in the shift hours would be beneficial. Also, you applied for the ICU job yet? How did it go, did you get it? If not, you might try the changing hours and seeing how that works, or better yet, work evening, nights on your ICU job if you do apply and get it. Hope that helps.

stidget99 · Mar 15, 2005

I work 12 hour shifts on a very busy med/surg unit. I force myself to take 4-5 mini breaks (even if just 5 mins) every nite that I work. I find that I am much more organized in my work and thoughts if I do this vs. not taking the time. What really made me look at this in this way? I would come home in the morning and find it very hard to get to the bathroom on time and realized that I hadn't even taken a potty break. After several near misses, I decided that I absolutely must take that time for myself. Since then, I am much more organized, less stressed out, and more able to go into work w/ a positive attitude.

Either way, make sure you give yourself ample time to adjust to your job. I agree w/ the above posts that it takes a solid year to totally get in the swing of things. Good luck!

KimberRN1 · Mar 20, 2005

Don't get discouraged....you already know you're an ICU nurse... you like intubated and sedated patients!!!!!.... It takes a good year in the ICU to figure out which end is up........Here's my routine....get report...with a cup of coffee in hand eating a breakfast bar.....on occasion to save time...eat the breakfast bar in the car on the way to work.... (multi task multi task multi task)........Finish report...stand at the door and look at the pt... yea they're still breathing...go for a refill.....chit chat with the coworkers for a few before starting the assessment (nix this step and continue on with the assessment if one of your pts is scheduled for a CT etc)........you could possibly need a refill at this point....Assess the 1st pt.....we have to write out our assessment...chart the gtts.....VS.....narrative.....then I give the meds.....Then off to the 2nd pt....but get a refill before beginning....same routine with the 2nd pt.... I try to finish as much of the charting as possible from the start...except for your narrative of course....then concentrate on charting your hourly vitals and taking off the new orders after the first rounds without thinking you have to go back and write out your assessment later....DO NOT forget your q 1hour coffee refills (the breakfast of champions)...haha

foxairelynn · Mar 27, 2005

I'm a nervous wreck on ICU orientation and find myself forced to take breaks at times just to regroup! I've only got a year of med-surg behind me, and that was 12 hour nights. Boy, are days different!

Medicine Eagle · Aug 7, 2007

Breaks???? What is that! LOL In the ER everything seems STAT. I can go for 12 hours with just a 5 minute smoke break once in a while. I can count the times I have had a 30 minute lunch break on one hand in 10 years of nursing. And hey don't feel bad I have had shifts where I wanted to choke a pt with the call light. LOL Everyone likes Propofol (Mother' Milk as the ER calls it). I always ask the ER doc for meds for my ER pts. Makes everybody happier. Pt quiet and wait is easier, I am happy cause no pts cussing me out, and family goes to eat so I am not standing there answering questions for an hour. Having a sense of humor is how I have survived. You can take 5-10 minutes unless somone is actively dying or soon to be! When I worked the floor years ago I would start out by pulling pain meds for each pt right off the bat. I would offer it to them right away. Saved a lot of steps. And again happy pt. happy nurse. If they did not want them now they usually did sometime in the nest hour. I also watched my pain pumps if they were getting low go ahead and get the next one ready, otherwise you will be in the middle of something serious when the pump goes dry. Try to plan ahead as much as possible. Relax... I can't even count the days I have left the ER thinking you can all just bite my butt, I hate my job. Only to get up and do it all over again. Sometimes it is a love/hate relationship. There is no where else I would work, but that does not mean that I am always a happy camper. Also I hate days. I can't stand having Administration up my butt and do my job. I am strictly a nights worker. People are usually cooler and the F bomb does not shock anyone including the Docs. Not arround the pts of course. It isn't just that it takes time, most of the time it is finding where You fit the best.

Good Luck and Take it Easy,

Tired Brave Heart

RNnewgrad · Aug 7, 2007

I can only describe how it is on my unit. Fortunately, we have the staff to cover breaks keeping within the max ratio in the state of CA of 1 nurse to 2 patients. We take turns being the "float" nurse for the unit. There can be anywhere from 1-3 floats depending on the census.
Float nurses do not have an assignment except for the rooms that they cover for breaks, to help out in emergency or code situations, and to just help out the nurses they're assigned to with general things like baths, turning, etc. The float nurse is in the count and is usually a mentor type of person who has experience and can help out with problem solving with the newer or less experienced nurses (the way the floats are assigned make for a good match with the less experienced nurses).
When my breaks are covered (or when I'm a float), the RN covering is looking after ONLY my patients so I'm able to delegate things while I'm away such as doing blood sugars, gases, suctioning, etc.
I know I've said this before, but we take all of our breaks that are afforded us by law, we're practically forced to take our breaks. Rarely do we miss a break, I mean rarely! And if we do, we are paid for the 30 minute unpaid break and a report is filled out (don't remember what kind of report, that's how rarely). I think my hospital (or at least my unit) takes the law seriously (probably because of the union).
The float asks each RN (not more than 3-4 nurses beside themself) what time they'd like to go and coordinate all breaks making sure everyone gets all of their time before the end of shift. For a 12 hour shift, that's 3-15 minute paid breaks and a 30 minute unpaid lunch/dinner break; 8 hour shift is 2-15 minute breaks and a 30 minute lunch/dinner break.
When I first started out, I felt really frazzled. I felt so behind all the time. It took time for me to utilize my resources...like my float. It's hard to learn to delegate and what can be delegated and to who. It took me a good year at least to feel comfortable being kicked out of my room to take my breaks!
I've been known to tell docs that I really genuinely wish I could get everything done at once, but I just can't. Usually that disarms them and they realize where I'm coming from. With our docs, if you don't get defensive, they're cool.
It really makes me sad that nurses everywhere don't get those so important rest periods, even if for only 10 minutes. Sometimes, I think, one gets so bogged down, they really need to just step away or a mistake will happen. I find this especially when I'm orienting new grads or new nurses to the unit - I have to literally tell them to GO, I can do the gas, or GO, I can turn your patient, or GO, that can wait 15 minutes!
With this great experience, I don't think I would work anywhere that doesn't encourage an RN to get out and regroup.

Wow! Where in CA are these hospitals?? I moved here to do an ICU intern program, which I've since completed, under the impression that I would be encouraged to take breaks and have someone to relieve me. If it's a busy night, 2 out of 3 usually, I do not get a break. I may be able to eat during charting or after baths or between brown codes or during a doppler or family visit, but I can never leave the floor. Unless I make a quick trip to the kitchen to get Jevity and use my cell for 10 seconds.

I consider the reason to be that all the rest of the nurses around me, my 'buddies' as our hospital calls them, are all super busy too, and not taking breaks either. We have mentors, but they are not allowed to give breaks. Don't ask me why. That would be ideal. But, I def do not want to be a boat-rocker because I learned not to make a fuss about the way things are done while in nursing school. I want to stay on people's good sides so my work life doesn't become miserable!

Is my hospital terrible?? I'm starting to wonder!

jjjeep4 · Aug 12, 2007

be encouraged.....20 plus years of active level1 and 2 icu experience here......and I still truly enjoy my job....!!!

icu has different stressors....but...here are a few pointers......

-try to keep perspective...and prioritize.....

- incorporate physical cares with assessment....so that you do not have to do both separately....try to make your assessment seamless with your interaction with patient....

-have a basic plan.....learn to quickly read the previous 24 hr of md notes and orders.....use those nursing care plans that you studied so hard....

- practice circling all abnormal labs.....do it quickly without looking at the hi/lo limits.....then double check to be sure that you got them all...it will help you rapidly identify abnormals...and will help you later..

.

-make a true report sheet....including spots for....

name/age/dx/primary md/consulting md/hx/allergies/date of admission/hx of hospitalization/shift report/review of systems(ie. resp/cardio/vent settings/nutrition/tx......especially labs to be done and pertinent tests and results.....and especially....a place for questions for the doc...you can add to these questions both in report and throughout the day.........practice taking report and putting things in the same place every time....within 2-3 weeks, you will probably revise it but also develop habit so that you get fast....and it will just go better......try not to use the premade kardex/sheet....when you write it, it helps you remember.....

-keep a couple protein bars in your bag.......drink water.....

agan......................be encouraged...there are those of us that still like it.......alot!!!

j.