Nurse Amanda's Terrible, Horrible Day & the Case for Emotional Intelligence

BethBoynton

Can We Help Amanda Survive Her Nursing Career? Or her Day?

By Beth Hawkes and Beth Boynton

Amanda is desperately trying to get through her shift today without running into the bathroom and crying.

Her patient in 4141 is calling again for pain medicine. A fresh post-op is coming from the OR. Mr. Mendez in 4146 is in the hall, arms folded, staring her down and impatiently waiting for his discharge instructions.

It's Amanda's 4th straight day of 12 hour shifts. Dr. Surgeon yelled at her for not calling him sooner about his patient and in turn, Amanda was curt with the new grad she is precepting. Amanda apologized right away, but she could see the hurt in her preceptee's eyes.

Amanda's manager politely but firmly refused to give her the weekend off even though Amanda filled in for two sick calls this week. Her husband is going to be pissed because they are supposed to go to a family party Saturday night. She'll probably make it, but she'll be exhausted and thinking only about her alarm going off at 0500 Sunday morning.

After the weekend she has 2 days off. She just needs to make it until then!

Does any of this sound familiar? What would you do? Is there anything you can do? Our colleague Beth Boynton is always talking about the importance of emotional intelligence and communication, but how can that wishy washy stuff help Amanda now and in the future?

I decided to ask her some questions and she if she has any ideas!

Beth H: How can EQ help when Amanda when boss refuses to give her time off?

Beth B: When clinicians have high EQ they are more aware of their own feelings, and respect and manage them in healthy ways. They set healthy limits, respect each other's needs, wants, and limits, negotiate compromise, share ideas and concerns, listen to and give constructive feedback, and are able to ask for, offer, or refuse to help based on how they are doing at any given moment. They're able to recognize social cues, apologize when appropriate, manage conflict, work in teams, lead and follow respectfully and effectively!

If both Amanda and her manager developed a little more EQ they might have a conversation like this:

Amanda: I'm exhausted and going to my family's party is important to me. I feel like I went above and beyond to work extra shifts during the week and deserve to have the weekend off.

Manager: You look exhausted. I understand that the party is important to you. Thank you for helping out this week. Unfortunately, there is no one to replace you and your weekend commitment is an part of your full-time position.

Amanda: I understand. Still, I'm worried that working this many consecutive 12 hour shifts is dangerous. Even if I don't go to the party, I'll be even more tired by Sunday. I'm not sure I'll be able to work safely.

Manager: You're right. We both should have thought about that. What if I work from 7a-11a on Sunday so you can sleep in? Later in the week I'll look at our overall staffing and sick call patterns.

Amanda: That would be great. I'll get to bed early tonight and go to the party for a couple of hours. In the future I'll be more careful about filling in for sick calls.

This is the kind of conversation that honors individual and organizational needs while shedding light on underlying problems such as staffing.

Beth H: At times the workload is unsafe. Can you help with that?

Beth B: Absolutely! Knowing when our workload feels is unsafe or we're becoming too stressed is part of developing EQ. While managers become better listeners frontline nurses will develop self-awareness and the confidence to say, "I'll need someone to get Mr. Jones' new orders clarified and medicate him for pain if I'm going to take a new admission". A manager might respond with acceptance of this idea or offer another solution, "You're already in the middle of managing Mr. Jones' pain and have a rapore with him. You finish that and I'll the new admit started for you".This combination of speaking up and listening is critical for safe staffing and cultures.

Beth H: How do I tell if my EQ is high or low?

Learn more about EQ and you will learn more about yourself. There is a new measurement tool called the EQi assessment tool created by Melinda Fouts, PhD.

Beth H: Tell us about medical improv

Beth B: Medical improv is a fun way to learn EQ and other interpersonal skills! Once you learn a few principles there are many games that can be framed for specific learning goals.

Learn more about the innovative crowdsource project to bring improv to healthcare organizations by googling "Improvoscopy: Serious Play for Safe Care".

MPKH, BSN, RN · Apr 22, 2016

Emotional intelligence is important, but the above scenarios will only happen in the ideal world. Won't happen in the real world.

My manager will not offer to step in so that a staff member can "sleep in". You don't work your scheduled shifts? You might not have a job to come to. Sick calls are not floor staff's problem--if someone is mandated then that is a different thing than picking up to cover a sick call. If staff is mandated, my manager will adjust the schedule so that the staff in question will get appropriate time off. If it is a pick up, no dice.

Ditto that with manager helping with admissions. My manager would tell us to figure it out, use our resources, use our teams, etc.

Maybe what nurse Amanda needs is to learn to say no, and to ask for help from her fellow co workers.

chacha82, ADN, BSN · Apr 23, 2016

Don't agree to four in a row unless you are an experienced traveler or have the stamina for it. I agree with above, no management is going to take over so you can sleep. Lay eyes on your post op and stabilize them. If you have a tech, delegate the vitals. Then pain meds if they are available, then discharge.

I declined to be a preceptor last week. I'm sure I will get dinged for it later, but it is one way to keep my sanity. I pick up extra so at least I do that.

jme2018, LPN, EMT-P · Apr 23, 2016

This....this b.s......this is what's wrong with healthcare today. Emotional intelligence? What kind of made up junk is this? What about holding employees - line staff and ADMIN accountable for the issues that are going on in healthcare? The schedule where I recently worked was done month to month, and, during a particularly difficult staffing time, I stupidly volunteered extra shifts, which ended up being 100 hours in that pay period (I'm a .5 btw, and these are 10 hr shifts). I'll give you three guesses what happened when the next month's schedule came out - I was scheduled 3 out of 4 weekends (supposed to be every other), 70 hours in a row the first pay period, 60 hours the 2nd pay period, and my xmas was changed from xmas eve to Xmas day when I had just worked thanksgiving and was already scheduled for new years (the nov/dec holidays were scheduled prior), and no-one bothered to ask if any of this was o. One of the weekends was supposed to be my weekend off, and I had a family christmas that weekend, and plans Xmas day. When I called the scheduler out on this, her response was "oh, 'the boss' said she would talk to you about it and to go ahead and just schedule it. I assumed she talked to you and that it was ok." Of course, the 'boss' never, ever, did talk to me about it, and the scheduler made a couple changes for me, but that was literally the last time I offered to pick up extra shifts. I just think this whole scenario that was played out above belongs in the land of unicorns and rainbow brite, not in the real-world of healthcare. Made up terms like emotional intelligence are dangerous because it puts all the responsibility on the employee. Yes, I should've known better, I wanted to "help my unit and co-workers", and in the above scenario, the employee should know her limitations, but it's also up to the supervisor to take responsibility to fix the problem rather than put a bandaid on it by saying, "I'll work a couple hours so you can sleep in". How about the boss saying, "I'll take your weekend so you can recharge your batteries"? The only thing offering to let employee sleep in does is give the boss an opportunity to come across as some kind of hero to her boss, without really having to put a whole lot of effort into it. Healthcare is a mess and it's only going to get worse.

OCNRN63, RN · Apr 23, 2016

This scenario shifts ll the blame on "Amanda." "Yes, it was my fault that I tried to help out my unit by covering sick calls. I'll try to remember to say "No" more often."

In all the times I've worked when we were running around with our hair on fire, I can count on one hand the managers who rolled up their sleeves and pitched in.

Well, one can always hope.

Ruby Vee, BSN · Apr 23, 2016

The above scenario is, I'm sure, what happens in the ideal world and what ivory tower nurses are certain can happen in the real world. Unfortunately, it's pretty unrealistic -- so much as to send my coworkers into spasms of laughter associated with crying and possibly peeing. Excuse me while I go find a nice, soft cloth to clean the coffee off my screen.

blondy2061h, MSN, RN · Apr 23, 2016

It would be amazing if I could find my boss to have that conversation with, much less get her to come in Sunday to cover part of my shift so I could sleep in. Her weekend starts Friday and ends Monday.

calivianya, BSN, RN · Apr 23, 2016

Where do we find the people that write these articles?

I would be willing to bet most of my bank account they don't work bedside, and probably haven't for years if they ever did at all. I have never had a manager cover any shifts for me, or any part of any shift. This sort of fairytale post is ridiculous.

In fact, my nurse manager was only a bedside nurse for a couple of years before she became a manager, and she was a nurse when there was still paper charting at my job. She freely admits she has no idea how to do any documentation or administer any medications in the computer. She talked in a staff meeting about how she didn't know how to turn an IV pump off once when she tried to help and the patient in the room looked at her like she was nuts.

She would be worse than useless trying to help the bedside out, and honestly, she'd probably be dangerous. One time she came in a little early and took the trash out of the rooms for us. I think that's the extent of the help she's qualified to give.

Rexie · Apr 23, 2016

My jaw dropped when I read that the manager offered to pick up the first 4 hours of a shift. Most managers on most floors that I work will occasionally answer a call light. Occasionally. And then come find me to fix the problem. There was one manager who actually shut off an IV pump and flushed the line after an antibiotic was finished. I've never seen it before or since.

It all sounds good in print but it is so far from the real world that we live in.

pixierose, BSN, RN · Apr 23, 2016

Reading this from a nursing student's perspective, I gotta say: "c'mon now, honestly?" This is the type of innovative, unrealistic "advice" I have to look forward to in the years to come to apply to my future career?

Even I can see the BS.

Luckily, I'm realistic.

First piece of advice gained: don't read these type of articles.

LadysSolo · Apr 24, 2016

At the hospital where I used to work, the day they got rid of all the LPNs, they sent management out to "assist." The RN who was in HR was assigned to my floor. I asked her to take a temp on a patient, and put another one on the bedpan. She DIDN'T KNOW HOW to take a temp, and said she didn't know where to get a bedpan?!?!?! So management take a shift?!?!? REALLY!!??? On what planet?????? :speechless: