Returning to Work After a Stressful Shift

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!

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~~

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. 

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!