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.
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  2. Visit SarahRN2013 profile page

    About SarahRN2013, BSN, RN

    Joined: Jul '12; Posts: 31; Likes: 26
    Specialty: 4 year(s) of experience

    6 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.
  5. by   pmabraham
    Quote from SarahRN2013
    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?
    1. I pray a lot, before, during, and after the shift.
    2. I try to do reality checks with my patients -- even when it's not so busy, such as I am passing meds now, and will come back ______ (to empty your hat, get you a snack, and other low priority items) within x to y minutes (I try to be broad on the y; and if depending on how the patient's reacting to the initial part, may even let out when I'll be back just stating something like after the med pass.
    3. When there are issues that need to be brought up to other parties that are not "right now" type of events when I'm in the middle of x "right now" events, I write a quick note on my brain sheet making a box to remind me it is a task. Then as time permits, I review and do the task and check it or otherwise pass it onto the next shfit.
    4. When possible, I do try to get to the patients that have valid issues with whom I could not deal with first, second, etc. and just sit with them for a moment holding their hand (or whatever works).
  6. by   bugya90
    Quote from 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.
    I've been told I always look calm during a shift. I've been in Med Surg a few months. I'm definitely not calm, I just have a good poker face. My mind is constantly racing and sorting through all of the tasks/issues. There are days my charting doesn't get done until the end of the shift and that's ok, as long as it gets done at some point that's all that matters. I have a good report sheet that I write things down on and cross off as I chart them (hourly rounds, careplan, etc).
    After a crazy shift I typically am so exhausted I just go home and crash but if you're to wired to sleep then a little exercise or reflection type practice may help.
  7. by   caffeinatednurse
    I have a close relationship with one of my coworkers. We process the night together during our walk from the elevator to the parking garage. After that, I do some more processing on the way home, have a snack, and crash. I used to stay up, worry, and have a harder time falling asleep (sometimes I still do). Mostly, I just try to do the very best that I can, chart as much as I can, and move on.

    On my days off, I give myself permission to take care of myself - sleep in, watch my favorite shows, see my friends and family, and think about anything but work.
  8. by   caffeinatednurse
    I should also say, it gets easier with time and practice.

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