Looking for some support on how to keep focused in the face of short staffing and pressure

Specialties NICU

Published

I know there is no miracle tool, however im having a rather hard time of it lately. Ive made quite a few mistakes of my own making, through distraction and loss of focus. I have been working for a year, i do not have years of experience so i am trying to build and develop skills on a unit which has been pretty much crippled by short staffing for quite a while.

Now i know how easy it can be to loose focus but i have been trying hard and it seems no matter how hard i try something somewhere trips me up. I gave some wrong labels to a mom for some breastmilk and i am so thankful she noticed but it made me feel so low as i was working a 12 hour night shift and this was right in the morning near to the shift ending. I wasnt happy. In fact i was mentally shouting at myself because ive worked so damn hard all night with short staffing.

Its building up on me, the tiredness and fatigue. My shifts at times i dont think have been spaced out. I dont feel ive had many days off either. I feel depressed with the unit and the situation and now its getting to the point where i think oh god what is it going to be like. Will we have 5/6/7/8 patients each.

It has been like that where my head starts to spin and i start feeling lightheaded and sick. Mistakes shouldnt happen but i know when im exhausted and tired thats when i can loose my focus.

Im very upset about the labels as ive been striving so hard to do everything right. I feel like somewhere sometimes something trips me up.

I dont know if i should look for another job ad i dont feel happy like i once did. Im miserable and find it hard to not think about work and worry.

I feel like a crap nurse who is trying to stay sane and in one piece. 😢

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Specializes in NICU.

You handle 5-8 patients each shift? Our maximum is 3 babies (feeder/growers), 2 babies (1 complex and 1 feeder/grower) or 1 very sick baby). Some nights, 3 babies can be a handful.

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Specializes in NICU.

Tinkerbell, I think you should look for another nicu job. You've stuck out your year at this place and working somewhere where you're short staffed to the point where you can't provide quality patient care is not worth it. Our unit was really bad at one point too in terms of staffing and I constantly felt like I was struggling to stay afloat in a sea of tasks. Like we're talking a ten minute food break the whole shift, running around like a hot mess, no one around you to help because everyone is in the same situation. It's not worth it. And if my place hadn't improved (luckily it did with our new NUA) I wouldn't have stuck around. That being said, I am single with no dependents so maybe I'm being naive.

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Well i think they want perfect nurses who dont mess up in imperfect conditions. Ive made 3 drug errors, one was a near miss as it was so busy i nearly got two babies breastmilk mixed up. It was an awful time. Then i wrote the wrong thing into the controlled drug book and the third was half of my fault as i was the second checker and my preceptor said that her baby was supposed to have gaviscon which is a type of reflux powder to be added to the feed and i said ok checked the packet but didnt really thoroughly check the chart. It apears thst the gaviscon had been crossed off and stopped but my preceptor was afamant the baby was still on the gaviscon on that shift so we both got told off and gad to do a drug assessment. We cant prove who crossed it off and when so unfortunately we both got reprimanded. It was a hard time seeing my preceptor cry in front of me saying she hates it on the unit and has had enough.

This happened about a week and a half ago. It left me feeling very down hearted and depressed. Also my shift patterns in my opinion are not that great. 3 night shifts with 2 days off then back on two 12 hour day shifts and a night shift straight after i think is too much.

I am scared they will take disciplinary action against me and say oh your just making excuses. Everyone is tired. That's neonatal nursing for you. Does that make it right?

And why are units so short staffed? As we have three new nurses but still seem short staffed. I don't understand why.

Do other people work the same shifts that i do? On the last night shift i did our unit was like the Titanic going under. In fact everyday we are buckling at the seams.

I dont want to be making mistakes but i struggle to keep my head on when its busy like that. Its hard. Its like the tiredness really kicks in towards the end of a night shift and i seem to go blind. Its like brain fog.

What can i do to keep my focus and clarity of mind? Does anyone have any strategies for interruptions and distractions. I find it hard when im tired to bounce off distractions. I realise that its a weakness i have and need help because i know im capable. The ward manager says ive got the knowledge but its like my brain and mind fall apart.

Ive asked my team leader who is a senior nurse to keep an eye on my shift patterns and rotation as she does our staff rota and ive asked if i could work with her for clinical guidance and supervision. Im doing everything that i can.

Another weakness i have is that i do not forgive myself easily. Its sometimes hard to let go off a mistake or near miss. It makes me feel like a failure.

I dont really want to go back to work. Im loosing the enthusiasm that i once had. And even if i do look for another job in the UK everywhere is bad. I almost feel trapped within my job. Ive got an exam to study for. The topics are intense. You've got neonatal respiratory, cardiac, thermoregulation, infection, embryology. My god. I feel like im a junior doctor doing a full time nursing job.

Am i suffering from burnout, fatigue, exhaustion and stress? I think I am.

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Just wanted to post an update..i dont know everything that is happening as of yet but i will be going on an assertiveness day. I think im not as assertive as what i can be..i think it can be hard with some parents, colleagues etc so it will help with delegating and realising that im not infallible but that i have the power to say no and to ask for assistance.

The problem is that everywhere is affected by short staffing. Is the solution to keep frog hopping from one job to another because the likelihood is that its bad everywhere.

Do the people that cope better and glide through the shift unaffected have stronger emotional resilience?

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Babywrangler,

Your very lucky your unit did a u-turn. I don't see that happening where I am, well not at the moment. When you were short staffed how did you stop it from bothering you? How did you cope emotionally? Do you do day shifts and night shifts in the same week? I think going from a long day shift to night shift could upset the balance. Just looking to see what others do regarding their shift patterns.

Do you have any solutions or suggestions apart from the obvious such as leave. I dont want to leave. Im sure many of us would like too but it would be taken as a sign of weakness?

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Specializes in L/D 4 yrs & Level 3 NICU 22 yrs.

Several things I want to comment on:

Rotating shifts within the same week is a problem. Can you ask to be on days or night totally, and not rotate around?

Your nurse to patient ratios (5-8 patients) are unreasonable and dangerous. What level NICU do you work in? Do you have government-mandated guidelines as far as staffing ratios? Do I understand you correctly that you are in the UK? How do other NICUs manage their staffing?

Making multiple errors (a sign of fatigue and stress) is quite concerning. You are jeopardizing the health of the patients, as well as your license and therefore the ability to practice elsewhere. Have you spoken to your manager? Can they get some travelers in for relief? Do you have any way to file a complaint with an overseeing organization (such as JCAHO, here in the US)? Patient safety is a big deal, and people tend to listen when bad things happen, unfortunately.

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I will admit that all of my mistakes bar one was down to the sheer chaos and stress of the unit making me loose my focus and making the near misses. I have tried and am trying as much as i can to stay focused so the most recent event of giving the wring levels and not even noticing it myself has really kicked me in the stomach. I know that i was feeling fatigued. It happened in the very final hour of the shift which is where you become vulnerable to making mistakes, low blood sugar doesn't help with focus either.

I am contracted to work 37.5 hours a week which is effectively three 12 hours shifts in a week.

I could request my own shifts but at the moment i have to work with certain people such as preceptors. If i dont know what they are working it makes it difficult so i leave it to the lady in charge of the rota. I have spoken to her regarding the rotation of shifts. I havent before as im not the most assertive person. I guess in a way i dont like to say anything but if im struggling with tiredness and feeling burnt out i have to bite the bullet so now i have.

I guess because we are so short staffed this is why im going from long days to nights and back again. All i can do is monitor the situation.

In a few weeks time again I will be doing two 12 hour day shifts and then a night shift the day after. I said could that be altered but unfortunately it can not be changed due to short staffing. I did try.

I do not know why i gave the mom the wrong labels and it does trouble me. Do i allow myself to become distracted easily? Do i internalise chaos and let it affect me? Do i need to say no to parents asking for me to fetch x, y and z and say "please can you ask someone else, im in the middle of something". Is it over tiredness, exhaustion causing brain fog, loss of clarity of mind.

Im.in the UK, we don't have traveller nurses. We have agency and bank nurses, it depends who we can get and more to the point if they turn up or turn up late can cause further problems.

I have spoken to the union that I am part of, and have been told to use the hospital escalation policy. As far as I am aware if we are very short staffed we should complete an incident report stating the risks. I should have filled one out. That night shift was scary.

I have summarised the events of that night shift to the manager. On a positive note all babies were feed, all medications including intravenous medications given as prescribed. I thoroughly checked everything. I specifically remember telling people go through your medication charts..i don't want any mistakes. I want nothing missed. I do not want any drama. And then at the last hour i trip up and im so annoyed with myself.

Im doing an assertiveness study day but what else can i do other than monitor my shifts and monitor my own fatigue levels. I do strilongly believe fatigue has played a big role here along with assertiveness and emotional strength/resilience in the face of chaos.

I am an intelligent person, how can I get through this. Mistakes make me feel worthless and inadequate and I berate myself. Every mistake is a kickdown that I have to take.

Im pretty sure HR, management and Risk know how bad our unit is. How can we be perfect and make no mistakes in these conditions.

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I have had 5 patients, once i had 6 patients until a nurse came on to an afternoon shift to provide relief. Now some of these babies are rooming in with mom but still its 5 babies with a lot of tasks to do. On one shift one of the nurses had to take one baby for an ultrasound and another for MRI. She disappeared for hours. It was just me and a senior nurse and i was really drowning at one point. It was feed after feed after feed after feed. And im standing there thinking "im going to collapse any minute now"

But apparantly that's neonatal nursing for you.

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Specializes in NICU, PICU, PACU.

No, actually it isn't. We have staffing ratios here. Step down kids can be 4:1, NICU level any where from 3:1 to 1:1.

My only suggestion is to map

out your whole shift hour by hour for each patient. Do the easiest and quickest kids first, leave more complex ones for last. Draw up/pour all your feeds at once and label them with patient labels, get all your meds and put them at the babies bedside (unless they need mixed or refrigerated), get any labels for moms at the beginning of the shift and place them at

tge bedside. Check charts before you start.

If a parent asks you for something all you need to say is, I will get to it just as soon as I finish what I am doing right now, with a smile. Don't let something interrupt you mid task unless it is an emergency. Labels are not an emergency.

Sorry you are going thru this.

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Im being totally honest. Im on holiday at the moment and i havent exactly been having the time of my life really. Far from it. The thought of going back to work doesnt exactly have me leaping off the roof in joy. Work conditions still seem bad although we are supposed to be getting some new people in soon. How soon i dont know.

Making mistakes really makes me feel lower than low. I wish i could back in time and correct it, spotted my own mistake. I know i was burnt out and over tired with my shifts and the effect of short staffing and working twice as hard for many shifts. I was on a day shift the day before and that was bad too.

I even suspect others have made mistakes too. Something will give in this situation and it will be the nurses cognitive ability that will go down the pan. With me it was a basic mistake but still a mistake that i really didnt need. I couldnt even get through my shift in one piece. Something had to trip me up like the devil lurking in the background. That is how it feels.

If I hadnt of gone on holiday I probably would have been found collapsed under a pile of coats in the changing room. Ive tried to explain all this to my manager. I dont know what else to say but exhaustion and fatigue does nobody any favours.

I dont know about staffing ratios but there doesnt seem to be enough staff at the moment. It seems to be in crisis mode at the moment, requests for help nearly every shift.

I sincerely hope to God it changes when I come back

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Hi All,

Got to go to a meeting regarding these mistakes ive made. Ive wrote out a very long statement in regards to my concerns on the staffing crisis on the unit which is ongoing, my shift patterns and rotations and feeling burnt out and tired.

However speaking to the ward manager it seems that whatever i say doesnt seen to be registering with her because all i keep getting is yeah but you gave the wrong labels. Yeah bjt you gave the wrong labels.

Im not an idiot. Now she is asking if im dyslexic or have dyspraxia which my understanding is a cognitive neurological brain processing signalling problem. Ok....

I happen to have a degree in English. I can drive a car and operate a computer. Nobody has ever said i have dyslexia or dyspraxia. I have wrote academic assignments too.

Im pretty outraged at this moment in time.

6 people have left the unit so far because its crap

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