My vent.

[Forever Sunshine, ASN, RN]

I was charge nurse tonight. I had another LPN with me who has been a nurse as long as I have. She was a great help and I am very thankful she was working tonight.

During shift change 3pm-4pm, the unit is indescribable, chaotic, loud, issues with everyone, everything and every place. You really can't even think clearly.

I received a situation of a patient that required additional staff. Two different nurses(one on another unit) were telling me two different things on what to do with this. Her MD was also over on another unit and got on the phone. I was trying to listen to what she was saying and the unit was so chaotic(alarms going off, phones ringing, CNA's complaining) I couldn't think and while discussing this with the doctor she took it as I was arguing with her and twisting her words.

I feel terrible. I didn't mean to react this way and all night I was thinking about this. I was so confused with what was happening with this situation. I was stressed and I know I should have reacted better. I was trying to understand what she was saying while tuning out all the madness around me. I really hope I don't get in trouble for this.

But all night just little stupid interruptions.. staffing issues, call bell alarms, bed alarms that go off every time the patient breathes, CNA's being on break and their residents having to use the bathroom, residents being combative, out of oxygen, phone ringing nonstop, doctors not calling back etc.

When I had to go into the oxygen closet I just let go and cried for a minute. After I got myself together I went back out there and did what I had to do, Awhile later, the doctor explained to me what she wanted to do with the situation above. I documented extremely specific about this patient tonight.

I also did some of the (never ending) paperwork in the med room behind a locked door tonight(Don't worry I could still hear the phone and see everything going on in the zoo). I just needed some quiet.

How do you handle situations like above when things are just exploding around you?

Now I am going to relax with a glass of wine mixed with soda and bag of potato chips(baked) and stalk Cruise Critic of the cruise I'm going on in April(I tried using that to help calm me down at times but it didn't work).

[tyvin, BSN, RN]

Welcome to the jungle! As far as advice it's that with time and experience all things will work out. My one thing when talking to a doc is to make sure I recite all orders so that we're both clear; especially in a hectic environment. All the other stuff sounds like a normal days work.

Only have 1 glass of wine then switch to some nice herbal teas with honey. Light some candles, burn some incense, call a relative you haven't spoken to in a long time. You need to keep your body and mind up to par for the battles yet to come.

[Forever Sunshine, ASN, RN]

Welcome to the jungle! As far as advice it's that with time and experience all things will work out. My one thing when talking to a doc is to make sure I recite all orders so that we're both clear; especially in a hectic environment. All the other stuff sounds like a normal days work.

Only have 1 glass of wine then switch to some nice herbal teas with honey. Light some candles, burn some incense, call a relative you haven't spoken to in a long time. You need to keep your body and mind up to par for the battles yet to come.

I hope it does work out. I felt like I was accomplishing nothing and felt so clueless the whole night.

I feel when I am charge nurse again (if I dont get in trouble for the situation with the doctor.).. I would handle things more differently instead of almost breaking down and saying " i dont know what to do!"

I can't shake it off. I hate arguing with people. I avoid it at all costs. I was trying to make sense of what she was saying and tune out all the noise and chaos around me, and I was under so much pressure.

[pielęgniarka, RN]

I had a rough night at work too:heartbeat:redbeathe:heartbeat as charge nurse and on the cart for the med pass in LTC tonight.... It was like you described, phones ringing left and right no one else answering, call in's for the oncoming shift with no replacement available, commotion all over... a resident fall, no return call from MD, a TMA freaking out, a blown pupil, Chaos, MADNESS! At one point I was talking on one portable phone, asnwering the other one hanging in the hallway while preparing pills, listening to the other phone ringing getting VS, assessing lung sounds, delegating cares, doing blood sugars and drawing insulin all at once until I realized it was ridiculous.

In the middle of that ruckus tonight I finally had to say "Everyone calm down let's just take this one thing at a time." Except much more sternly that you are reading it as! The residents feed off hyper energy and it reflects in their behaviors. At the end of the night I also had all the nurses and nursing assistants do final rounds on eachother's hallways to get a fresh set of eyes on the residents and room orders.

Try not to worry about how the MD took the situation... you did what you could at the time. Sometimes you just have to make sure the residents are in a safe position, tell your other staff members you need to make a call and just leave the floor. Go somewhere else and make the call or take a three minute break to do some deep breathing to center yourself.

I got home made myself some nachos and drank a large glass of water in order to hydrate me for the large glass of Jack I am having next! Enjoy your wind down time, know you are not alone in your situation and keep on keeping on. The LTC folks need GOOD people to work with them.

[Forever Sunshine, ASN, RN]

I had a rough night at work too:heartbeat:redbeathe:heartbeat as charge nurse and on the cart for the med pass in LTC tonight.... It was like you described, phones ringing left and right no one else answering, call in's for the oncoming shift with no replacement available, commotion all over... a resident fall, no return call from MD, a TMA freaking out, a blown pupil, Chaos, MADNESS! At one point I was talking on one portable phone, asnwering the other one hanging in the hallway while preparing pills, listening to the other phone ringing getting VS, assessing lung sounds, delegating cares, doing blood sugars and drawing insulin all at once until I realized it was ridiculous.

In the middle of that ruckus tonight I finally had to say "Everyone calm down let's just take this one thing at a time." Except much more sternly that you are reading it as! The residents feed off hyper energy and it reflects in their behaviors. At the end of the night I also had all the nurses and nursing assistants do final rounds on eachother's hallways to get a fresh set of eyes on the residents and room orders.

Try not to worry about how the MD took the situation... you did what you could at the time. Sometimes you just have to make sure the residents are in a safe position, tell your other staff members you need to make a call and just leave the floor. Go somewhere else and make the call or take a three minute break to do some deep breathing to center yourself.

I got home made myself some nachos and drank a large glass of water in order to hydrate me for the large glass of Jack I am having next! Enjoy your wind down time, know you are not alone in your situation and keep on keeping on. The LTC folks need GOOD people to work with them.

I try to get everything done and make sure the residents are well-cared for. They are the reason I am there. A patient was acting up and was very combative tonight, yelling screaming cursing spitting biting. I gave her something to calm her down and I gave her a hug and said "Listen I just put the babies to bed. You can't be yelling like that or else you are going to wake the babies". The look on her face was precious and I almost started to cry again. That calmed her down for about 10 minutes and then she went right back to her usual self.

[teeniebert, LPN]

Here are a couple of phrases that have saved me several times, your results may vary.

"I'm sorry, could you excuse me for a few minutes?"

"May I call you back in (number) minutes?"

Once these phrases have been deployed (and hopefully accepted), disappear. Use the bathroom, the med room, the laundry closet, whatever's handy. Take several deep breaths--in for 4 seconds through your nose, out for 4 seconds through your mouth. If you're so inclined, go to your happy place. Spend 2 minutes just concentrating on breathing and calming yourself. Then get back to work. The chaos will still be there, but you'll handle it. Really.

[Zookeeper3]

Ok, you had a wine break and a breather, this can be every day in the ER... so take a deep breath. There is nothing wrong, when you have lost total control of the unit, saying... "time out"... "everyone 5 minutes at the nurses station please..." You summarize your priorities and look at the group and say... who can help,who has what?

Calling the gang in stops the chaos, redirects the negative staff and refocuses. You may have to shift personal, switch admit rooms... and for god sakes there is nothing wrong with saying to a doc... "I'm new in charge, this is new to me... what do you need?" if it's not a priority, than politely tell the doc to wait.

Doc's calling in admit orders... doesn't have to be that nurse that has 'em.... although ideal, but pull anyone you can to take the orders.

When you have two competing nurses for your attention, I promise you... just go back to your ABC's.. this will guide you on who needs help most, not who is more vocal or attention getting.

ER charge is a very volitile position and as long as you ACT and don't REACT to staff that are high on adrenaline... you'll be good. You know your issues from that night, changing how you REACT is the hardest part. I wish you well, ER is an incredible place to work after you look past peoples overreactions and can prioritize. You can do this by distancing yourself from the mayhem even if you need a cry to pull it together, it's AOK. just keep it together after.

[HiHoCherry-O]

I know this may sound funny and may not apply to all units (ED specifically) but we turn the lights down at night. I have noticed that when the lights are dimmer, the noise level goes down. When day shift comes on and turns all the lights back up, the noise level also rises.

This of course only addresses one aspect of the chaos going on but if it helps. . .

[Forever Sunshine, ASN, RN]

This isn't ER charge.(Don't get me wrong I can just imagine what you have to deal with) This is LTC charge. The patients are just nutty and you find yourself wanting to rock in a corner singing the ABC's to yourself by the end of the night.

I love the lights idea. It needs to be done during shift change from 7-3 and 3-11.. it really is the most chaotic shift change.

[DCtraumarn]

Nothing is wrong with saying - I need a couple of minutes to think, I will get back to you. Go to a quiet space or take a walk off the unit, get your thoughts together and then call back and/or respond. I do this when I need a moment to think because I need to make a decision. I am an operations administrator for the hospital and easily get over 150 calls/pages during my 12hr shifts.

[Ruby Vee, BSN]

we all have shifts like that, and i doubt there's any one of us who hasn't had a meltdown at some point. welcome to the club! vent away. that's what we're here for.

[netglow, ASN, RN]

Ruby, you are so great at validating people and making things better.