The Bad Shift

[Rexie]

I've had a string of bad shifts, usually due to poor staffing but also due to difficult patients. Not patients that were especially sick but difficult personalities. Patients who have prn pain meds ordered every 2 hours, patients who want to be waited on hand and foot, patients who threaten to go to management if their every 2 hour prn narcotic is half an hour late because you were tied up with another patient. And unfortunately, you know whose side management will take. Damn those patient satisfaction scores. Add to that staffing cuts where there is no secretary to answer the phone, no CNA available to toilet the little old lady with her little old bladder who needs to be toileted every half hour or so. Family members who are advocating for their loved one maybe a little bit too aggressively.

Do you have any tips for pulling yourself together when you feel like you're spinning from being pulled in too many directions at once?

And how do you recover from a bad shift or a series of bad shifts? I've had a few days where, although everyone was still ok at the end of the shift, I felt like a complete and utter failure, exhausted and demoralized. Lately, there are days where I just do not want to go back. I'm hoping it's just a phase our facility is going through because I don't want to leave. But it may get to the point where I have to start thinking about my next move. I would rather find a way to cope better with the chaos. Any tips or words of wisdom?

[GE90]

thats why i do peds

never liked adult patients and never will

[NightNerd, MSN, RN]

Aw! Our unit has been going through something similar. I'm sorry you're stuck in that awful cycle.

Make sure you schedule regular time off so you have that to look forward to every so often. Give yourself time and permission to do what you enjoy after each stretch of work; housework and such stuff really can wait! If your coworkers and managers are supportive, maybe talk to them about what you feel could have gone smoother during a shift; they can either reassure you that you did the best you possibly could have, or give you ideas for next time you face the impossible. And, if there's something in particular that you know would make your job easier, it never hurts to bring it to someone's attention (in a constructive way, of course).

As someone who is about to move in to my next job, I can say that for the right job, the above ideas will generally get you through those really awful stretches. For me, I just don't get excited about my current position anymore, even when a shift goes well. You'll know when it's not worth it to put yourself through the hard shifts to get to the good ones in your current job. It sounds like you really like where you are and are just having a hell of a bad spell right now. Good luck!

[nutella, MSN, RN]

Look at the assignment "mix" .

Sometimes it is just part of the game that everybody has "terrible" shifts but often enough, it is due to poor assignments. For example - if there is one nurse who is always moaning, groaning and raising h*** when she gets "difficult" assignments, the charge nurse is less likely to give her those patients. Because they do not want to deal with this behavior and the aftermath. That can lead to an uneven mix for everybody else.

Of if one or two people are "well liked" by the assignment nurse, it is more likely that they get the "easier" assignment and stuff gets dumped onto nurses who do not speak up or are new.

When I did assignments I would keep track of the patients that are "heavy" in terms of tasks to complete and do my best to even out everybody's assignment. But I can say that this is not what everybody does. Often enough, I had horrible shifts only to find out that I got "dumped on" .

Or I got the CNA assigned that was notoriously known to be unavailable or hiding in a room - that will ruin your whole day.

Other than that I can only say that there are good and bad days in nursing and you just go through that.

[calivianya, BSN, RN]

You might just have to leave. Even the same type of unit can be very different across different facilities.

These are both ICU, so this is probably a bad example - but my PRN job is more aggressive about taking foleys out early and taking out central lines to prevent CLABSIs. The net result of this is constantly restarting bad PIVs and having to get up and toilet everyone. We have CNAs, but they can't be everywhere and toileting everyone themselves, so I do quite a bit of toileting my own patients. I swear to God every time I come in I have to restart at least one peripheral. They are better staffed, but it's 10X more aggravating getting up and toileting all the time and having to constantly stick people for new IVs.

My full time job has a tendency to leave foleys in forever for accurate I&O measurements, and the same thing with central lines - they pretty much only get pulled on ICU discharge, if even then. However, my full time job is way shorter staffed and we don't have CNAs. The thing is, I would rather work with 3 ICU patients with foleys and central lines with no CNA help than I would with 2 ICU patients who both have to be toileted and have peripherals. Stuff like having to toilet people all the time is a BIG deal, IMO, because it's such a time waster. Even having CNAs doesn't help because they are nowhere to be found most of the time. I would personally rather not have to deal with CNAs.

I haven't got the patience to work somewhere I'd have to toilet someone every 30 minutes. I work the minimum number of shifts to stay with my PRN employer and that's it. If that was my full time job, I'd be out of there. I haven't got it in me to work somewhere that I couldn't just stick a foley in for patients with urinary problems, like the little old lady example. We have too much else to do. That LOL with the urinary problems is eating up at least 50% of your shift, and if she can get up and walk, I very seriously doubt she's your sickest patient. It's just not fair to the sick patients to get our time eaten up by the healthy ones.