STRESS!!!

ThrowEdNurse, BSN, RN · Mar 31, 2010

I am not brand new to the ER but this happens to me too. I think all ER nurses. Some to varying degrees and precipitated by different events. The very experienced nurses get frazzled too, but it takes waaaay more stress than it does me. Also, they are better at managing the physical manifestations of their stress. Some can just eternalize everything while I become red in the face and incable of creating small talk with coworkers while dashing from room to room to supply room to nures's station to the medication machine. "Good morning! How are you?" I reply with a grumble and a snarl. I am better about getting frazzled than I used to be, though. I always got stress anytime there was a pending order or a new pt I hadn't laid eyes on. I've gotten to where I realize even if I don't have time to do an assessment on a new pt, I can always walk by the room and just glance at the pt, know they're alive and move on to hang the levophed on the critical pt. It's all about time management and knowing about what needs to be done now, in what order, and what can wait. These things come with experience and the ability to shrug off what you can't do now and to not let the little stuff bother you comes with experience too. You'll learn techniques that work for you best in as far as managing orders in a manner that make sense for the pt and you and the needs of the other pts. It's complicated and tricky but there is definitely an ebb and flow to managing every emergency room pt (group of pts) and it's all about putting it together for all your pts and being able to predict what's next and what will happen. In other words, yes it is hard and complicated. It's a huge challenge and one of the major stressors of ER nursing but you can learn to deal with it and you will one day deal with it like the more experienced nurses without breaking sweat. Until then you will break alot of sweat, daily.

Also, if the MD is on you for not preordering labs for his convenience, suggest that he can initiate IV access pts on the pts for you and that may free you up to his job for him.

inteRN · Mar 31, 2010

First, I want to THANK YOU for taking that amount of time out to type that message to me. You are right, and it helps me so much to hear stuff like this from experienced ER nurses I dont work with daily. Sometimes I just wonder if Im on the right track...

greenfiremajick · Mar 31, 2010

I'm a relatively new nurse in the ER, and I have noticed I get really "worked up" and stressed out when I get overwhelmed...its not that I'm not getting enough help from the others, but I guess Im constantly paranoid that they are all gonna blame me for being "slow", getting backed up, or making a mistake. The past couple of days I have been making myself go at a steady pace and I got a little backed up, but I felt like I was covering all the bases with my patients. The ER doc, however, got a little mad because HE got backed up and I didnt go ahead and order the labs on all my patients to speed things up. (Technically I didnt think I could do that but OK)
BUUUUT... If I hurry, my ears get bright red, I get a horrible headache, etc. Just like the face to the left. BUT my stuff is done faster??
I guess my question is what are some things I can do to calm down at work, de-stress, etc (besides deep breathing lol) And the orders thing?? I don't know....
FYI--this is a very small ER. Not a trauma hospital AT ALL...

BREATHE! Seriously....Deep breathing really does help to relax and calm the nerves. Take slow, measured breaths and then resume.

Editorial Team / Moderator · Mar 31, 2010

I've gotten to where I realize even if I don't have time to do an assessment on a new pt, I can always walk by the room and just glance at the pt, know they're alive and move on to hang the levophed on the critical pt.

Exactly. I learned this early on from one of my mentors -- I eyeball the new patient and do a little "sick/not sick" mental sorting.

Larry77, RN · Mar 31, 2010

BREATHE! Seriously....Deep breathing really does help to relax and calm the nerves. Take slow, measured breaths and then resume.

That's what I do. One big deep breath and move on to the next task. I remember feeling the stress when I started in the ED...afraid I was going to kill someone but it got much better. Now for the last year and a half I've been charge and the stress is much worse but still my deep breath helps (and the 1 beer I have when I get home).

luvRNs, BSN, MSN, RN · Mar 31, 2010

As a former ED nurse in a level one trauma center, I agree iwth the deep breathing. There is also one VERY IMPORTANT coping mechanism that hasn't been mentioned yet . It's laughter :jester:

In our ED, the harder the day got, the more we'd do silly things ( or take things out of context) just to laugh. Example: had a wall collapse on a worker at the site of a new Macdonalds and kill a worker two days before he retired. The mood in the rescuscitation was sad and somber and horrible until a tech in the back began to hum "you deserve a break today at Macdonalds"..........

Pain is greatly lessened when you're in it together

PS. Sorry if I offended.... but graveyard humor does help....

MassED, BSN, RN · Apr 2, 2010

I'm a relatively new nurse in the ER, and I have noticed I get really "worked up" and stressed out when I get overwhelmed...its not that I'm not getting enough help from the others, but I guess Im constantly paranoid that they are all gonna blame me for being "slow", getting backed up, or making a mistake. The past couple of days I have been making myself go at a steady pace and I got a little backed up, but I felt like I was covering all the bases with my patients. The ER doc, however, got a little mad because HE got backed up and I didnt go ahead and order the labs on all my patients to speed things up. (Technically I didnt think I could do that but OK)
BUUUUT... If I hurry, my ears get bright red, I get a horrible headache, etc. Just like the face to the left. BUT my stuff is done faster??
I guess my question is what are some things I can do to calm down at work, de-stress, etc (besides deep breathing lol) And the orders thing?? I don't know....
FYI--this is a very small ER. Not a trauma hospital AT ALL...

deep breaths help. I always think of A,B,C first and whatever I can do in one fell swoop - like getting a blanket for one pt, a cup of water for another, etc. I'm always trying to regroup and prioritize - shuffle the deck. I find some days, I'm always a step behind, no matter how hard I try to catch up, but unless there are true emergencies, it doesn't really matter. I look around on those days and see that many other nurses are in the same boat.

back2bRN · Apr 5, 2010

I love the "sick, not sick" quick view.

Know any and all protocols, things you can do before the doc sees the patient, (the ones written down and supported by management that is)!

You say you are new, so yes take a deep breath, not all your patients have emergent needs, learn which ones do and let the others wait. Their lack of planning does not make it emergent.