How do you deal with untherapeutic situations on the unit?

[RNdynamic]

We've all been there. Imagine your unit suddenly turning into a battlefield. Many bad things are happening at once. There is a crashing patient coming out of the OR or ED. An acute bed crunch is taking place and nurses are being pressured to transfer patients elsewhere in order to make room for sicker ones. Patients are climbing out of bed everywhere. The tele alarms won't stop going off. Phones are ringing off the hook and the secretary, as usual, is nowhere to be seen. It's 5pm and all the managers have left for the day. Now someone falls, then maybe a rapid response or code occurs. The entire pace of the unit has shifted dramatically. The small talk has stopped and people are shouting commands across the unit. Everything is amped up for the next two hours, and the environment is no longer therapeutic for you or for the patients.

For some of us, depending on where we work, this sort of shift in the pace of the unit happens seldom. For others, it happens every other day. It all depends on what type of unit we work in and the shift. However, regardless of those factors, most of us have experienced it on at least a few occasions and by the end of the day, we feel pretty run down.

The purpose of this thread is to discuss how you deal with these situations. What do you do when people are shouting at you and pressuring you to move patients. Do you tune those people out and keep doing what you're doing in order to maintain focus? Do you inadvertently start rushing tasks that require deft hands, patience, and focus? Does it cause you to make mistakes?

One of the things I will do when the unit picks up and people start going crazy, people are shouting, and tele alarms and bed alarms are going off non stop is to take my break, if I didn't do it already. I'll find the least busy person I can and tell them I have to go do something and will be off the floor for fifteen minutes, and can they please watch my patients. Then I use that time to sit down and gather myself and prepare for the rest of the day. I find that that kind of "pause" helps me function enormously better for the rest of the shift and makes me far more productive and able to contribute to my coworkers better. In really acute situations, like a code, I'll go to the bathroom and wait there for a bit so that the initial dust can settle. In those situations, people are shoving each other around the bedside, carts and furniture are being flung, linens are flying, and people are charging down the hall to do compressions and that kind of situation is just not therapeutic for me. So during those times I tend to go to the bathroom until the situation has calmed down a bit. Then after things are under better control I'll help with compressions, transferring, and so forth.

Use this thread to discuss the challenges you personally have faced in these scenarios and your strategies for making the situation more therapeutic for you.

[idialyze, BSN, RN]

You can't be serious, although I'm afraid you are, after reading some of your posts. I remember being a brand new 21yr old RN, and seeing my charge nurse do that during a very bad code on Stepdown. I lost every bit of respect I had for her.

i still run towards codes rather away from them, although they are few and far between in Outpatient Dialysis.

Shame on you.

[elkpark]

My therapeutic strategy is to strangle my coworker who always disappears just when things are getting crazy and leaves the rest of us to deal with the situation. That makes me feel so much better ...

[Pepper The Cat, BSN, RN]

Yeah, hide from the emergencies and leave the unit when all hands on deck are needed to accomplish everything.

i bet you are really popular with your co- workers.

[HouTx, BSN, MSN, EdD]

The daily stuff you get paid to do isn't supposed to be "therapeutic" for you. That's why it's called work.

[emtb2rn, BSN, RN, EMT-B]

You hand off your pts to the "least busy rn" you can find & take your break when it lights up?

Running from a code? You'd last maybe 1 shift in the ed.

And what's with the job being therapeutic for you? That makes absolutely no sense whatsoever.

You are in the wrong profession, at least from the bedside perspective.

[macawake, MSN]

I'm not sure if your post is serious or if you're eagerly anticipating a bit of drama Anyway, I'll treat it as a serious question.

Use this thread to discuss the challenges you personally have faced in these scenarios and your strategies for making the situation more therapeutic for you.

I'm don't believe that the purpose of our job is for it to be therapeutic for the nurse. However I do believe that in order to proficiently handle stressful situations when many potentially serious or even life-threatening things happen all at once, you do need to keep your head cool. Perhaps that's what you mean by therapeutic? Are you saying that you find it difficult to perform the necessary tasks/skills when things get hectic? If you/we can't work out a strategy that makes you/us able to function and get the required job done in these high stress situations, then perhaps you'd/we'd be better suited to work in a lower-acuity setting.

In really acute situations, like a code, I'll go to the bathroom and wait there for a bit so that the initial dust can settle. In those situations, people are shoving each other around the bedside, carts and furniture are being flung, linens are flying, and people are charging down the hall to do compressions and that kind of situation is just not therapeutic for me. So during those times I tend to go to the bathroom until the situation has calmed down a bit. Then after things are under better control I'll help with compressions, transferring, and so forth.

If there is enough staff present to properly handle the code then perhaps you could make yourself useful elsewhere and devote your attention to the patients climbing out of bed or check on the tele alarms?

Even though I think that it can be good to take five somewhere quiet to compose yourself and recharge your batteries once in a while as it usually results in (as you mention) a more focused mind, the scenario you describe isn't a good time for it. Too much going on, it's all hands on deck-time.

One of the things I will do when the unit picks up and people start going crazy, people are shouting, and tele alarms and bed alarms are going off non stop is to take my break, if I didn't do it already. I'll find the least busy person I can and tell them I have to go do something and will be off the floor for fifteen minutes, and can they please watch my patients.

I don't really see that going over all that well Chances are that even the least busy person in this situation will be plenty busy and not at all impressed by your timing (up to and including elkpark-unimpressed ).

What do you do when people are shouting at you and pressuring you to move patients. Do you tune those people out and keep doing what you're doing in order to maintain focus? Do you inadvertently start rushing tasks that require deft hands, patience, and focus? Does it cause you to make mistakes?

I work PACU and anesthesia. We don't shout. I think that the ability to remain calm and focused comes with practise/training, experience, clear communication and well-defined roles for all team-members.

Screaming and furniture-flinging would most likely negatively affect my focus so I strive to keep it to a bare minimum

[Natasha, RN, BSN]

Um... I can only hope you're not serious that you abandon ship when all heck breaks loose... ...though I can understand one needs to gather their thoughts, but not at the expense of others.

On my unit, we jump in and help each other out, looking to see where the help is needed. I guess I am lucky to see that this is done respectfully, even during chaotic times.

[ThePrincessBride, MSN, RN, NP]

Whip-Its...every single time.

Duh.

[Extra Pickles]

I just responded to a post of yours on another thread where you talk about this poor fellow drowning in his own secretions and how annoying it was for you and how it was not therapeutic for you. And now you're talking about running to hide in the bathroom while other people attempt to save the lives you can't be bothered to step in time for??

Are you for real, are you actually, honest-to-goodness a nurse??

This is either a practical joke sort of thing, where you post messages you know will incense other people, or you are among the worst the new crop of nurses has to offer. Shame on you indeed!

[jojo489]

I could kind of excuse the taking 15 when things get hairy. Although, I wouldn't be happy about it. At all. But hiding in the bathroom when there's a code on the floor? I'd be careful who I admit that to. That could probably land you in some hot water.

[Farawyn]

His reply to a Code Blue is a Code Brown.