Stress & Time Crunches/Having THOSE Days..!

[CiaMia, BSN, MSN, DNP, RN, APRN, NP]

Okay y'all. I'm going to start typing and see what happens (haha). Looking for some feedback/advice/ways to deal.

I'm a relatively new grad, started in med/surg/tele in March, been off orientation since May. 6 months out. There are some days I feel like I'm doing okay, and some days I feel like I'm going to walk in next shift to be called into [unit-manager]'s office and get a thorough talking to. I find it really hard to gauge where I'm at, and don't get a lot of feedback - and tend to be sensitive/anxious/hard on myself at baseline.

Sunday I had one of those shifts that make you not want to come back. I had 3 discharges/1 AMA within 45 minutes of each other (which was like... ugh), an admission in the middle (of course), and my sickest patient went for a scan which determined that he needed to have a drain placed. I got SO MUCH ridiculousness from the on-call team trying to coordinate. I'm talking multiple calls in the space of minutes while there's a provider on the other line; then running around like a crazy trying to get his anticoagulation reversed and all that that entails while caring for a full assignment. Then I had to take him downstairs since there was a transfusion running. I didn't get to tape report (which we usually do) and had to give verbal, and my brain was SO fried and I just felt like I was leaving a whole mess for the oncoming RN to deal with. I tried to make sure I had documented on everything but I left feeling SO frazzled and miserable.

Today I was cancelled at 3pm for low census and really struggled to get everything tied up and handed over... granted, there were extenuating circumstances (struggling with a PCP's office to finalize/reconcile discharge orders that were messed up delaying a discharge; a family changing their minds about waiting for the patient to have a bowel movement to send for culture before they left and instead asking for a lab sheet to bring one in -- which I had offered 4 hours prior and been told no, we'll wait...), but again, I just felt like I was leaving a whole mess of crap. On top of which, I got stressed and my charge nurse (takes no assignment) could tell and when I asked if she could hang an antibiotic kinda snapped at me and said YOU JUST NEED TO TELL ME. So now I feel like crap, and like SHE'S going to go to [nurse-manager] and complain. Sigh.

So my question is, how do you deal with these days? What are your coping strategies for when these situations are either beyond your control and you have to reconcile that, or in dealing with them better?

I mean, my meds are out on time barring extenuating circumstances. I do my assessments and usually am able to document as I go or at the very least am caught up by the afternoon. I really don't find myself staying an hour and a half after my shift just to get caught up... but my head feels so jumbled and pulled in a million different directions in these moments and that's when I feel the stress...! I know it's possible that there are things I miss/forget, but I've caught things too and I know it happens. I would never see it as a negative reflection on whoever it was, but rather a reflection of the situation. I'm harder on myself though.

For balance, a few positives to give some perspective heh:

- I had a patient's family specifically ask for my full name and spelling so they could send a thank you to me/note to our unit manager for everything I had done for them.

- The SNs on our unit right now specifically ask to be with me and have told me how much I've helped them/how much they've learned with me.

- The unit clerk told me this morning that she felt so bad for me on Sunday but that I had been SO NICE through the whole thing (even though in myself at the time I didn't "feel" like I was necessarily being nice haha).

Thoughts/advice/feeback?? Please!!

[CiaMia, BSN, MSN, DNP, RN, APRN, NP]

One more thing to add...

I am motivated. I genuinely, genuinely want to do a good job. I want my coworkers to trust me, and I want chargeRN to know I ABSOLUTELY will ask for help when I need it. I for the most part love my job and am so privileged to be where I'm at. Even if there are issues to address, I would take it as a learning experience.

'Kay, that's all - lol!

[HouTx, BSN, MSN, EdD]

Peaks and valleys.... although it is difficult to find perspective when you're in the middle of all that turmoil, your Sunday shift isn't the norm, right? We all have had those horrible shifts where it seems like the nightmare just won't end. But somehow, it does end & we totter out the door and head home. "Those" shifts are unusual but for me, they served a purpose. I used them as a benchmark whenever things started to go South.... my internal voice going "well, whatever happens, it will never be as bad as the time everyone got food poisoning and had to leave in the middle of the shift - leaving me with 6 ICU patients and one CNA" (actually happened).

From my perspective (older than dirt), it was clear that your Charge Nurse should have been keeping an eye on things and pitching in to help when it appeared that you were going under. The primary justification for a staffing model with a Charge Nurse who doesn't take an assignment is - to ensure that s/he can step in and provide quick and appropriate assistance for anyone who needs it. So - this was her failure, not yours. From your description, it sounded like you did very well.... everyone survived into the next shift (including you).

So what now? Well, you've got a great "war story" for the lunch table & scaring new grads. You also have a very clear understanding of what it feels like to be drowning without anyone offering to help you. As a result, you're probably much better attuned to what's going on around you & more likely to offer to help if you see someone else in that same situation. You're going to make a SUPERB Charge Nurse.