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A guide for the new nurse: 5 things to do when everything goes to Hades

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Everybody has bad days at work. Sometimes, though, nurses have Amazingly Bad Days—the sort of days that are best described with the silhouette of a nurse howling in front of a full moon. It really doesn’t matter what causes those days: The spike could come out of the bag of blood you’re about to transfuse (happened to a coworker) or you could get six competing, contradictory orders from three services, all on the same patient (happened to a coworker), or you could get the sort of patient who, by rights, ought to be in the ICU and who thus takes up all your time and energy while the rest of your patients fall down in the bathroom or get their antibiotics late (happened to me). When things start to go down the tubes, there are things you can to do keep your shift from being a complete mess.

1. Prioritize. Remember that bit from nursing school about airway/breathing/circulation? It works on the job, too. If you have a really critical patient, be sure she has an open airway and can breathe on her own before you do anything else. For the ambulatory or semi-ambulatory patient, the priorities will be a bit different: Call ’em safety/pain/toileting. Make sure your noncritical folks are safe (this includes positioning and restraint checks!) and comfortable, and aren’t lying in poop or wet, and then take care of the things further down your priority list.

2. Ask for help. Be specific. Experienced nurses will often jump in and take a hand in a crisis because they know what needs to be done. If nobody’s hopping in, though, it’s time to ask—your coworkers, your charge nurse, the respiratory therapist, whoever can help you. Delegate. Ask a person to cover specific rooms while you deal with a crisis, or ask someone to round on particular patients for you.

3. Do not panic. Every shift ends eventually. You can only do what you can do. Sometimes things just plain have to slide if your hair is on fire. If a medication scheduled for the end of your shift has to be given by the oncoming nurse while you deal with a code or rapid respiratory team response, so be it. It’s a 24-hour job, and sometimes, if things are really and truly awful, you have to ask for help from the folks who relieve you.

4. Staying late once in a while won’t kill you. Now, if you’ve got crises galore every single day and are staying for two hours after the end of your shift more often than not, it’s time to take a good hard look at both your work environment and your time management. If, though, you’re usually out on time (because we all know how important it is to Management that you not clock overtime!), you can stay late occasionally without getting into trouble.

(I should make it clear that I am neither advocating habitually shoving routine tasks off on the next shift, thus abusing them, nor leaving in the middle of a situation in order to keep your superiors happy. Knowing when to say when and when to stick around is a balancing act that varies from unit to unit and from facility to facility.)

5. Speak up. This is the most important one. If you’re not getting the support or answers you need from the doctors with whom you work, don’t be afraid to make a fuss, call repeatedly or even page the rapid response team. The facility where I work is full of patients who have three or even four different specialties on their cases. Sometimes, that means that the patient will circle the drain with ever-increasing rapidity while the docs pass the buck back and forth, from service to service, in an attempt to get somebody else to make a tough decision or three. Our nursing director made it abundantly clear when we instituted response team pages that they could be used when an individual nurse felt like things were getting out of control and couldn’t get answers from the physicians.

We’re good at yelling when we need something at my facility, but nobody’s afraid to hit the page button if need be.

Remember: You’re the ultimate gatekeeper for your patient’s treatment, safety and well-being. Don’t be afraid to be loud and in charge; you’ve got somebody who’s pretty helpless who’s depending on you. At worst, you’ll get a reputation for being pushy and stubborn—and pushy and stubborn are not necessarily bad things for a nurse to be. At best, you’ll pull victory out of a day that would’ve otherwise gone down the tubes completely, resulting in somebody getting sicker or getting hurt. That’s not a bad end to a day at all.

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2 Responses to A guide for the new nurse: 5 things to do when everything goes to Hades

  1. debbie

    had this type of day yesterday…all heck broke loose at the lat minute….

  2. r

    I got a laugh out of #4; my hubby stayed late (off the clock), regularly – my gripe: if you’re gonna work, get paid for it as often as possible; if not, finish the notes & leave cuz “you’re not the only one who can care for those patients.” (His supv. once called him a ‘hummingbird on crack’) Working late frequently is bad for the nurse – not enough down time; bad for the patient – tired caregiver.

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