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".

[SWM2009]

While I work in a facility where management occasionally works the cart when they absolutely can't find coverage for a shift, I find this article completely unrealistic. What utopia healthcare facilities do these authors work at?

[chacha82, ADN, BSN]

Agreed. The first four hours of the shift are the most chaotic where I work. No one in management would ever pick up a patient load for the first four. In fact, I've never seen them on the floor.

I'm ok with that. They do their thing, I do mine. The suggestion they would cover someone so they could sleep is not realistic at all.

[Tomascz, ASN, RN]

Oddly enough, assertiveness training was not offered at my nursing school. They did offer us a couple free sessions with some reputable Psychologists, but nobody ever took them up on it that I know of.

As far as I can tell, most schools don't bother with psych screening prospective nurses (for suitability) nor do they teach aspiring nurses any real world survival skills. The occasional "communications" seminar, after you've worked in the field and developed a good case of Rhino-hide, or a nervous tic, is too little to late.

It's just my opinion, but nursing being what it is, there are enough people working in the field that are pathologically dysfunctional, particularly in management, that your chances of working with a crew that's more than 70% functional, emotionally, is slim to none.

That's not to say that there aren't a lot of us that can make it through the day and do our jobs well under occasionally grueling circumstances (they aren't all bad days, for petes sake). It does go without saying that a twisted sense of humor and a tiny streak of sadism may stand you in good stead on occasion.

And no, it's not going to get better soon. Look at it this way; at least you're not a*s deep in blood in the middle of the Crimean war.

[BethBoynton]

Thanks for your comments. I am idealistic and believe the real world can be better for us in healthcare and in general and work towards that goal. Saying "No" can be a good option and in fact lead to new ideas and solutions. It would not, IMHO be appropriate to say "No" all the time and leaders will need to have clear expectations and great communication skills if this becomes Nurse Amanda's response!

[BethBoynton]

Yes, keep some hope alive. I think there is a fine line between blame and accountability. Blaming has a judgment attached, I think like she is bad somehow and that isn't my intention. Amanda should be accountable and so should her organization. This way there is room for both to learn!

[BethBoynton]

Emotional intelligence isn't a made up term. In fact, it all about self and other and in the big picture calls upon all of us to be more accountable and better listeners. Managers who are putting all the responsibility on staff are not doing their part as leaders to advocate for resources. I would challenge such a manager to be assertive FOR staff (part of EQ) and to validate staff's concerns and set limits in a healthy way (also part of EQ). Ultimately, EQ has the potential to level the playing field and help nurses with the issues you describe. One book I'd recommend for learning more is Daniel Goleman's "EQ: Why it can matter more than IQ".

[BethBoynton]

Feedback can be tough to take in at times and that's ok. Many of you have said the scenario is unrealistic and I hear you. I've worked for years in toxic cultures and believe in something much better. I am calling for a higher standard for staff nurses, managers, and senior leaders. I am challenging the status quo and advocating for cultures and systems where everyone is respectful. I don't think it is unrealistic, just ideal and a lot of hard work. Also, while I appreciate feedback, I don't appreciate some of the rude remarks.

[Altra, BSN, RN]

Emotional intelligence, or the lack of it, is not the reason that Nurse Amanda's manager is extremely unlikely to offer to cover 4 hours of a shift on a Sunday morning.

I believe you are attempting to describe the role of what is currently buzz-termed "EQ" in assertive, effective communication skills. But tangentially connecting it to solving staffing shortages by having the manager/director work staff shifts ... is not particularly helpful.

[jena5111, ASN, RN]

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.

I have only been a nurse for four months on a cardiac-med/surg unit, and I see the staffing situation for what it is--perpetually challenging. I receive a text on nearly every day off asking if I can work for double or even triple overtime. Sometimes I say yes, but more often I say no.

In my pre-nursing career, I worked for years as a manager in charge of hiring, training, staffing, and scheduling for a large department of shift workers. It is a tough gig and I empathize with the situation on my unit.

But as a new nurse, I treasure my days off as a "recharging" time. The extra money isn't worth it. I worked four 12-hour shifts this week (three in a row plus an extra) and I'm currently exhausted. I woke up this afternoon to a text from my manager asking me to work again tonight. Note to self: turn off text ringtone when day-sleeping.

It's honestly not my personal obligation to fill in for CHRONIC under-staffing. And...my manager who texts me on my days off is leaving for another (non-management, outpatient) job in two weeks. So that kind of tells me what I need to know.

I am grateful for my job, and for the chance my hiring unit has given me as a new grad RN in a competitive job market. I'm digging my heels in and not leaving anytime soon. But boundaries need to exist between my job and my non-working life. Taking on too many extra shifts just doesn't work for me right now.

[Ruby Vee, BSN]

Emotional intelligence, or the lack of it, is not the reason that Nurse Amanda's manager is extremely unlikely to offer to cover 4 hours of a shift on a Sunday morning.

I believe you are attempting to describe the role of what is currently buzz-termed "EQ" in assertive, effective communication skills. But tangentially connecting it to solving staffing shortages by having the manager/director work staff shifts ... is not particularly helpful.

If the OP's goal was to educate bedside nurses on the role of EQ in improving our lot, perhaps a more realistic scenario would have been helpful. The scenario used was so unrealistic as to render the entire post laughable rather than to provide useful nuggets for reflection. It only served to remind us that the nurses who write about topics such as this are so disconnected from the actual job of working the bedside as to have no idea how to help us problem solve.

The problem as defined seems to be that Amanda says "yes" to overtime without bothering to think about her own needs first, and then is exhausted both mentally and physically. Perhaps the more emotionally intelligent answer would have been to have Amanda think ahead about the family event she wishes to attend this weekend and negotiate with her manager for the time off rather than just working the overtime. A manager who is desperate to cover Monday's night shift may be willing to give Amanda time off on the weekend, knowing that she still has five days to find coverage for that weekend shift. Or perhaps Amanda could have negotiated with co-workers to cover that weekend shift in exchange for another date down the line. The OP's decision to "solve the problem" by having the manager work four hours so Amanda can "sleep in" is so far off the mark that the rest of the article seems silly.

Perhaps the original poster needs to spend some time in the trenches before seeking to advise those of us who work the bedside. Or at least make the effort to define and solve the problems in a way that is meaningful and makes sense.

[LittleOldLadyWho, ADN, BSN, LPN, RN]

Just another example of management not being aware of the real world happenings on the floor.

[pebbles, BSN, RN]

Emotional intelligence is not a replacement for inadequate support from management or HR.