Returning to Work After a Stressful Shift

[SilverBells, BSN]

This last week, I had a very rough shift in which basically anything that could go wrong, did go wrong.  

For instance, the following happened all in one day:

-Patient had unwitnessed fall and sustained an injury.  We did everything right when we found her by not moving her when she expressed pain and calling 911 immediately.  However, the problem lies in why the fall happened in the first place as it was unwitnessed and the patient is always confused.  Daughter has a history of being vindictive.   

-Another patient was sent in to the hospital  for abnormal lab values.  This was after a week of trying to figure out why he was declining, and so finally, I got an order from the doctor to send him in. 

-Another declining patient was enrolled in hospice after a week of family going back and forth of what they wanted to do.  

There were many other issues that day, including stressful staffing issues, call-ins, and medication order concerns, but these were the few that stuck out to me and the ones that, even a couple days later, are causing me stress and worry.  The fall with injury is bothering me the most.  

Anyway, I'm having a bit of anxiety of returning to work after all these issues and am wondering how other people deal with returning to work after shifts that have gone very badly.  I can't help but feel that these issues reflect poorly on me, even though I handled them correctly when they occurred and got the patients the care they needed.   My concern is that all of the significant issues that happened that day happened on my unit, while the other unit remained rather quiet, with few concerns.   Maybe I'm overthinking things, but am not looking forward to returning to work again.  

 

[Daisy4RN]

More than likely none of issues you describe were your fault. If you truly think that may be the case I would do a root cause analysis (so to speak) and see if you still feel that way. People do/will fall but were all possible precautions taken, if not assess what can be done better next time. Did you notify the MD about the concerns about the declining pt in a timely manner, if not you will next time. This is how you go back to work! You see if there are ways to improve, or realize you did all you could have. Things happen and that doesn't necessarily mean it was your fault. If any of it was just learn from the mistake and move forward. Patients in rehab/snf are usually very sick/high acuity so some will most likely decline (depending on diagnosis/prognosis etc), there is not always something you can do. Hope your next shift goes better, we have all had bad ones!

[CheesePotato, BSN, RN]

OOf, have I been there with the bad days.  It be like that sometimes.

So, here's what I am noticing about your post--you handled a bunch of issues and then when you came home....what did you do?

And what I'm looking for here is self-care.  Self-care may sound "new age" or whatever label you want to give it, but it is how we thrive.  You know the saying: You can't pour from an empty cup.  So how do you fill your (not literal) cup?

For some, journaling works.  For others, they go and talk to a counselor.  And there is nothing wrong with that.  Still others, like myself, ruminate and work through them to learn from experiences and then let it go while violently eating cheetos. <--don't do this. Others work out or watch a movie.

My point is this: Take care of yourself.

Now, as for how it reflects on you....sometimes bad things just happen despite our best efforts.  No matter what, try to learn from it and take something away from it.  In this way you turn a negative experience into something that promotes growth.  Let the rest roll.  

Hang in there.  Be kind to yourself.

~~CP~~

 

[TheMoonisMyLantern, ADN, LPN, RN]

Most of the time when I have a really bad shift, the next shift I work is much better so it usually balances out. BUT sometimes I have an entire week that is bad, and I just try to ride it out. 

[Davey Do]

13 hours ago, SilverBells said:

wondering how other people deal with returning to work after shifts that have gone very badly. 

I weighed the need to return to work against the desire to avoid it.

Being something of  hedonist, liking to sleep in a warm bed with a roof over my head, usually outweighed the avoidance factor.

[Davey Do]

17 minutes ago, Davey Do said:

I weighed the need to return to work against the desire to avoid it.

Sometimes. Sometimes facing adversity not only tempers our mettle, but also allows magical and life-changing events to occur.

Case in point: June 5, 2006 was a terrible 12 hour shift where I had to deal with acting out patients, abusive family members, and rogue staff. I considered calling off the next shift.

Had I called off, I may have never met my future medical nurse wife Belinda who was pulled to geriatric psych.

When I shared my almost called off that shift with Belinda, she too had also considered calling off.

My mantras when going into work were: "Expect the unexpected. This shift may be the best, or the worst, shift of your career."

 

[turtlesRcool]

Interestingly, of the three things you list, I only see one as "going wrong."  Having a fall is always a stressful thing.  I had one two days ago when a patient was detoxing.  Fortunately, she admitted to turning off the bed alarm herself, so no reprimand to me, but it's a lot of documentation and worry about injury.

The other two issues sound like something going right.  A patient whose lab values were abnormal was transferred to a higher level of care to try to figure out what the problem is.  That's how the system is supposed to work, and you were part of getting him the care he needs. The patient going on hospice is also a natural progression.  It's sad to see a patient nearing the end of life, but it's also a good thing to be able to focus on comfort for the patient, and for the family to be onboard with that.  Definitely not easy, but when a patient is declining, I sometimes feel like I can finally REALLY care for him/her once the decision has been made for comfort measures, and we can dispense with the uncomfortable tests and interventions that weren't doing any good anyway.

This isn't to say that work wasn't stressful, or that it's wrong to feel the way you feel.  But when I get into the headspace that things are going wrong, I can sometimes turn it around by focusing on what's going right in the situation.  Sometimes what's right is just that we've changed the goals of care or we've implemented a different level of intervention.  I try not to worry about the things I can't control (such as an elderly patient's decline), and focus on the things I can control (how I interact with those patients). It doesn't always work, but it helps.

I hope your shifts are getting better!