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Given how much time we spend at work, it’s almost inevitable that we end up divulging secrets here and there about ourselves and others to our coworkers. Some info can be innocent, while some can border on risqué. We’ve all had those days where we couldn’t wait for a quick break to share the unit’s latest gossip or complain with a coworker about management’s latest flub. But whether or not you realize it, these seemingly harmless conversations can come at a hefty price. Here are five breakroom discussions to avoid like the plague! Don a garland of garlic and proceed with caution through this list.

1. “I’ve had enough!”
Never discuss your work problems at work—it may come back to bite you. If you’re having workplace troubles and it’s something your boss or an administrator can help you with, go directly to him or her. If you have a problem that can’t be solved by your boss and you need to get it off your chest, pull a trusted coworker into an empty room that’s far away from others, close the door and speak in hushed tones. Don’t go into the breakroom and vent unless everyone else is having the same problem. Above all, remember to be careful! What you say to a coworker easily can be twisted into something terrible by the time it reaches your boss.

2. “Did you hear about…?”
Gossip! We all love to hear it, but we don’t want it to be about us. Never start rumors that are unfounded or hurtful. As juicy as it may be, it can be harmful to your career. Keep your words positive and try not to repeat rumors or gossip. We’re all working toward the same goal: getting patients well and ready for discharge. The focus should be on their care, not our coworkers’ personal lives.

3. “I know whose side I’m on!”
We all have opinions about how things should be run, so discussions about politics often can lead to anger and resentment. And if you think politics is only about the government, remember that our employers also have political characteristics; there are leaders, lobbyists, policy makers and supporters in every facility. Be very careful how you speak about the leaders of your facility. If you need to vent, become informed and go to the policy makers themselves with possible solutions, or find a safe person to discuss the matter with. Never vent to a coworker.

4. “Maybe we should pray…my way.”
My mother always said, “Never talk about religion in public.” I grew up in a religious household, so I never understood her reasoning until I went off to work. Everyone has their own beliefs. Never try to force someone to go to your church or bully them into becoming a believer. If you’re approached by someone with questions, by all means give them the answers, but never force the issue. As Thomas Jefferson penned in an 1802 letter, there should be a “wall of separation between church and state.”

5. “You won’t believe what I did last night” and other R-rated conversations.
Personal stories of a certain nature should be kept to a minimum at work. It’s perfectly fine to discuss vacations, family and even heartaches, but when conversations turn from G-rated to X-rated, walk away. You know the stories: “I was so drunk” or “You won’t believe what I did in bed!” Many nurses find the crazy antics of their coworkers fascinating, but management doesn’t need to know how drunk you were or how crazy you got last night—they could decide that you may not be the type of person they want working for their company. Whether we like it or not, we represent our facilities and profession everywhere we go, so keep your work conversations G-rated and your personal life personal.

If you ever get the chance to visit your breakroom, keep your conversations friendly. Remember, don’t share anything at work unless it’s something you don’t mind everyone knowing—you never know who’s listening behind the breakroom door!

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There is a tradition in some countries concerning the dead: When a person dies, the windows are opened to allow the spirit to vacate. What happens when windows aren’t open? Are the spirits trapped? I don’t know if all nurses are superstitious, but I’ve come to believe that some spirits never consider leaving this earth or are confused as to whether or not they have actually died.

In our facility, we have a few employees who’ve chosen to stay on even after death. Our long-term care and rehab unit cared for many former employees until their passing. While some of them departed to greener pastures far above the clouds, some have decided that they would maintain their place in our facility even after death.

There are numerous unexplainable happenings on our unit each week:

A nurse in a 1960s starched white uniform, complete with cap and white shoes, appears when a patient is on the verge of death or struggling to stay alive. We feel that she is summoning us to check on our patients. There is also a maintenance man in the facility’s green uniform who visits the rooms that he occupied until his passing.

In the evening, lights and water faucets turn on and off by themselves until a staff member yells, “Cut it out!” On other units, monitors can be heard in empty rooms, and a white vapor in the shape of a skirt floats around corners in a hallway outside of patients’ rooms.

Some of these visitors keep patients awake, while some keep vigil. Nurses have also reported entering well-lit rooms only to have the lights go out, or discovering that unlocked doors suddenly won’t open. One nurse reported finding a quadriplegic patient turned, with pillows tucked behind him, without anyone being in or near the room.

Weird, huh? Not so strange if you can blame it on a spirit who didn’t have an open window to vacate through. So the next time you hear a bump in the night at your facility, it may be a past/passed employee forgetting to punch out on his or her final day of life. At least…that’s what I believe.

Happy Halloween!

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Every nurse has gone home at the end of a shift and had the thought: Another day without a moment to think about food or the bathroom! We sacrifice our personal needs for the needs of others each and every day. We’re the first to admit it. We put ourselves last when caring for our patients. Sooner or later, enough is enough.

Here are five big things that can eat up your time during a shift—and what you can do about it to stay on an even keel.

1. Budget cuts. Healthcare facilities may have fewer support staff due to budget cuts and people less willing to do menial jobs. Finding people who want to do direct patient care is difficult, which leaves nurses doing more. Many nurses work short-staffed and are expected to perform jobs that would normally be completed by a nursing assistant or housekeeping. Toileting a patient when your own bladder is full can be an experience in self-discipline. Many times nurses chuckle over the need for personal Foley catheters and caffeine drips as they run from patient to patient.

Solution: Try to do tasks in groups. Pass fresh water to all of your patients prior to passing medications. Once meal trays are passed, eat and use the restroom; most patients are busy eating and requests are few. You can restock gloves and necessary medical supplies when patients are at physical therapy, having procedures, sleeping or visiting with family.

2. Hourly rounds. This has become a common policy in many healthcare settings. Nurses are expected to enter a patient’s room hourly and ask the patient if she has needs or wants. The nurse is expected to fulfill each request and then move on to the next patient. Doing hourly patient checks is supposed to allow the nurse to have more free time and prevent patient falls, unless the nurse has a large patient assignment. No policy is foolproof.

Solution: Ask the CNA to round on your patients so you can document, take a break or run an errand. If a patient needs medication, the CNA can relay the message to you once you’re available. Nurses continue to have less time for meals and breaks with or without hourly rounding. If you get a break and leave the unit, keep your ear out for those dreaded overhead pages. Remember your patients come first!

3. Administering medications. In the hospital setting, the days when one person administered medications to the entire unit are gone. Each nurse is responsible for her patients’ medications. Entering a patient’s room with a cup full of pills and hearing him say his pain medication isn’t working, he needs a drink or needs to use the bathroom can cause a nurse to get behind.

Solution: Ask your patient what medications work for him at home and notify the attending physician for medication changes (within reason, of course—we’ve all had patients who exaggerate what they take at home). Try to be sensitive to the needs of your patients, but don’t let them manipulate you. Try repositioning the patient or use heat or ice therapies. When your patient needs to use the restroom during medication times, ask if it’s critical; if not, call your CNA and move on to your next patient.

4. Cleaning up after coworkers. Following a nurse who leaves food trays from various meals along with wet towels and linens can be frustrating. It’s hard to clean up after someone else. Nurses are supposed to keep patients’ rooms clean and clutter-free. There are times when garbage cans are overflowing and housekeeping can’t be found. Cleaning your patients’ room can make you late in completing necessary tasks, which may include your break.

Solution: Take a linen cart and bin with you when you begin your rounds on your patients, and replace clean linens and remove dirty linens at the same time. Straighten beds and tidy bedside tables. This time with your patient can give you a chance to do patient assessments on alertness, orientation, recent memory and shortness of breath without your patient ever knowing it. Bring an empty push cart on your next rounding and remove trays and anything else that’s been left in the room. Garbage cans? Wait for the patient to call for the bathroom. You can empty the trash after placing your patient on the toilet.

5. Documentation. Last, but most important, is patient documentation. Documentation is easier due to electronic medical records. Well, that’s what the IT companies would like us to believe. Documentation continues to keep us from doing the things we’d like to do, like go home on time. There’s no way to cut corners when we document on our patients. Documentation is a legal document that can be used in a court of law. Do your best and don’t rush.

Solution: Work on documentation when your patients are sleeping or visiting with friends and family. Mealtime—yours’ and your patients’—can also be used as a time for documentation. Remember, if you work while you eat and don’t take a “real” dinner break, you should be paid for your time. If it’s a busy shift, keep notes on your patients’ changes and do your documentation after your shift ends. Punch out after you finish documenting, not before you start.

Nurses will never have time to put themselves first until they punch out at the end of the shift. Reward yourself frequently during your free time and continue to do your best for yourself and your patients. Create balance in everything you do.

What are your solutions for staying “on top of it”?

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It’s hard to say where telling people your age is a bigger issue: Hollywood or nursing! Trying to be taken seriously as a fresh-faced new grad can be just as aggravating as being passed over because you’re over 45—even though you have twice the experience necessary for the job! Here’s some advice on how to battle the age bias at every phase of your career.

AGE RANGE: 21–26
If you’re fresh out of nursing school, continue your education. If you have your AAS in nursing and have passed your NCLEX, take a few courses that can be used toward your BSN or a course through your local Board of Cooperative Educational Services (BOCES), which can give you skills in phlebotomy or IV access. Many hospitals have IV access teams, and knowing how to draw blood or access an IV may help you get your foot in the door and get that job quickly. Additional training shows that you have a vested interest in your profession and tells potential employers that you aren’t ready to quit learning.

Dress code
When you get that all-important interview, dress as though you’re going to meet with the president of the company. This may sound like tough love, but unfortunately it can make a huge difference. Keep piercings to the ears only; remove all facial piercings. Cover any exposed tattoos.

Men:
Get a haircut.
Men should wear clean and pressed shirts and ties with dress pants.
Be clean-shaven or at least keep your beard meticulously groomed.

Women:
Wear a dress that’s not too short or too tight, and wear pantyhose, even if you hate it!
Keep the color of your attire basic, nothing flashy.
Polish your shoes or buy a new pair. No sneakers, flip-flops or uncomfortable shoes.
Keep jewelry to a minimum.

AGE RANGE: 35–44
When over the age of 35, be sure to stick with age-appropriate clothing and hairstyles. Tidying up your look in certain cases doesn’t hurt, either. If you have mousy colored or graying hair, color it a soft hue that’s a shade lighter than the natural hair color of your youth; harsh hair color can age you.

Check out current fashions and refresh your wardrobe with a few new items. Go to your local makeup counter at a major department store. Get a facial. Keep your look soft and, again, age-appropriate. If you’ve been thinking about losing a few pounds, it’s time to start. Eat healthfully, drink plenty of water (it brightens your eyes!) and get enough sleep. It’ll all show up on your face!

AGE RANGE: 45 and up
If you’ve been a nurse for a very long time or are just starting a new career after the age of 40, it may be difficult to find a nursing job or even change your field. Use your life experiences to enhance your resume. Did you care for an ailing family member, or a child with a chronic disease? Sharing this information could land you your first job.

Don’t get desperate and apply for jobs that aren’t realistic. You have to remember that the job you could do in your 20s and 30s may not be the job you can do in your 50s and 60s. A good rule of thumb: Look at your potential job as one you may have until you’re 65 or beyond. Try to stay away from nursing jobs that require a lot of heavy lifting or repetitive work.

Keep up your nursing skills. Try taking a few certification courses that will enhance your resume and make you more marketable.

And a last word of advice: If you’re 40 years old or older and have proof of age discrimination, contact the Equal Employment Opportunity Commission.

AT ANY AGE
When you go to an interview, never mention your age or verbally compare yourself to the age of the staff. Your experience and what you have to offer your new employer is all that matters. Dress to impress, but don’t overdo it, and don’t wear heavy perfume or cologne. Once you have that job, keep your attire age- and size-appropriate. When choosing work apparel, always remember that you’re a professional.

Whatever age you may be, stay positive! While some people get the job of their dreams on the first interview, there are some who must interview multiple times. Think of interviewing as your job. Be prepared for your interview, do your homework and stay optimistic. Sensing an age bias can frustrate anyone. Don’t let other people’s opinions bother you!

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Once you graduate from nursing school and start your first job, it doesn’t take long for you to realize that the days of “perfect” SIMS lab patients are gone—and you’re not prepared for it.

Unfortunately, dealing with volatile patients (not to mention families), stressed-out coworkers and hot-headed doctors are things that most nurses are left to confront for the first time all on their own and without much prep. So what can you do to stay safe?

Know Your Environment
Nurses who work in the emergency department and psychiatric units have an increased risk of exposure to violence. Med-surg and outpatient clinic nurses can also experience violence in the workplace. Short staffing and the reduced use of patient restraints in healthcare facilities also put nurses at risk. The potential for violence can occur any time a nurse interacts with a patient or the patient’s family. A nurse can be attacked while caring for a demented patient or one suffering with delirium from medication or recreational drug use, psychiatric disorders or hospital psychosis.

If you’re a new nurse, especially in psych, remember that each patient diagnosis and each medication can have multiple reactions that can cause a patient to lash out at those who are caring for them. Some healthcare facilities offer training courses that teach nurses how to defuse and manage volatile situations and patients. If you work in one of these specialties, then run, don’t walk, if one is offered in your facility.

Exercise Your Rights
Hospitals and healthcare facilities should have policies to protect their staff. Educate yourself on those policies and follow protocols when dealing with any violence. Most nurses have been verbally or physically attacked by a patient at some point in their career. When such an incident escalates to an uncontrollable level, never try to control a patient alone. Hospital security needs to intervene. Security officers are trained professionals and can protect you from any and all abuse. Memorize the codes and phone numbers for security within your facility.

Supervisors should be notified, and be sure to document all patient interactions and reactions in an incident report. In some states, nurses can contact local police, file reports and press charges if involved in a patient attack. Always seek medical care after a patient attack; even the smallest injury can become a future problem.

Use Your Smarts
Hospitals and healthcare facilities are public places. Never enter an unsecured area alone—the potential for an attack is too great. Nurses and healthcare providers need to feel secure and safe in the facilities where they work. Always stay alert and know where phones are located within your facility. If in doubt, buddy up when you leave the building or enter the parking garage.

Never give a patient your personal information. Keep your phone number and email address private. If a patient needs to contact you, use the facility’s phone number and email address. Keep your private life separate from your professional life.

Know the Signs of Horizontal Violence
Horizontal violence, or bullying, can make the working environment unbearable. Nurses may encounter bullying from superiors, coworkers and the patients they care for. How do you keep moving forward in an environment that could be potentially toxic? Document each infraction against you. Confront the perpetrator; sometimes he or she will back down. Stay positive in the midst of your struggle. Show respect if the horizontal violence is coming from a superior, and again—document, document, document! Once you have enough documentation and/or you feel that you need to take further measures, go up the ladder of command and voice your concerns.

Sadly, some nurses leave the profession, vowing never to return, while some manage to endure hating each and every moment of their workday. Nurses work in stressful environments where patients’ lives are their priority; add horizontal violence and you have a recipe for emotional disaster.

No one needs to feel threatened at work, nurses included. If, after an attack, you find yourself having physical or emotional difficulties, seek professional help. Most facilities have outside counseling resources available to employees. Don’t try to go it alone. We all need support from our friends, coworkers and loved ones. If the situation seems impossible and the violence has escalated to a level that causes injury, you have to report it. No one ever should have to feel that their life—emotional or physical—is in danger because of someone else’s actions.

Don’t do a double too often. You can be a team player, but learn to say no. We all love the extra cash, but doing too many doubles can cause burnout. Also, an extra shift or two can put a strain on your personal life, so check in with your relationships outside of work before agreeing to work a double shift. Don’t work doubles before going on vacation, even if you need the money; you will not enjoy your time off. And listen to your body—it will tell you when you’re doing too much.

So how do you survive a double shift? Here are some tips.

Stay Fueled
You’ll need food to keep you energized through a double.

• Run, don’t walk, to get something to eat! Hopefully you get asked to work a double before the cafeteria closes. If you work in an area with delivery, order enough food for two meals and a snack.
• Eat healthfully. You don’t want to feel weighed down by heavy, greasy foods or get a sugar rush and then suffer the subsequent crash that comes right afterward.
• Limit your caffeine consumption. Really! It’ll only contribute to the jitters and acid reflux.
• Stay away from foods that are known to enhance sleep. These include turkey, bananas, oats, peanuts, milk and carbohydrates. Stick with a high-protein meal or snack to keep your brain stimulated.
• Spread out your meals by grazing. It’s never wise to inhale your meals when you’re working long shifts. Your body needs continuous fuel, so save the large, heavy meals for when you get home.

Stay Productive
You can’t sleep while you’re moving! Here’s a list of ways to stay busy on a double:

• Get ahead. Restock med carts, put linens in your patients’ rooms for the next shift, catch up on required education, check your emails or do some research on your patients’ diagnoses.
• Be thorough. Read through your patients’ charts, check labs, check orders and make sure they are completed.
• Catch up on your documentation. Now is the time to write detailed notes on each of your patients. Clean storerooms and common areas (we know how dirty a unit can get!).
• Offer to help your coworkers. They will probably love you for it!
• Give extra TLC to your patients. With your extra time, you can really connect with your patients. Do all the things that may not get done during a busy eight-hour shift: washing hair, giving a thorough shower or bath, taking a longer stroll in the hallway or just sitting and talking with your patient.
• Check in with patients’ families. If they’re milling around, spend some time getting to know and understand the family dynamics of your patients.
• Don’t forget your hourly rounding. If this is your hospital policy, keep rounding! Let the patients know you’re staying for them. They’ll generally take pity on you.

Stay Safe

• Be honest if you’re not on your “A” game! If you’re yawning, your eyes are watering or you’re rubbing your eyes more than usual, you need to sleep for the sake of your health and that of your patients. Set the alarm on your cell for a quick 15- to 30-minute nap in the break room or in an empty patient room while a coworker watches over your patients. A nap can help to increase productivity and alertness, especially if you didn’t sleep well prior to your double shift. Never assist or do a procedure when you’re tired!
• Don’t drive if you’re sleepy. You may have heard this before, but I’m reiterating it here: Driving on little or no sleep is like driving drunk! Accidents can happen when you’re exhausted. Experts say that if you’re blinking more than 10 blinks per minute, you’re probably too tired to drive. Other signs of being too tired to drive are yawning, nodding off, watering eyes or if you can’t remember whether you completed routine tasks. If you’re too sleepy to drive, ask family members to pick you up. You can also take a cab or bus. Or consider taking a nap before attempting to drive home, especially if you live more than a few minutes away. Listen to your body’s signals! The life you save could be your own.

Getting cocky, or worse yet sloppy, can quickly earn you your walking papers. Here are five ways a nursing student can get expelled.

1. Ignoring the rules.
At the beginning of your first clinical, you’ll be given a student handbook. Read it! Highlight those rules and policies that you may have difficulty with and begin to work on your weaknesses. Don’t forget that school policies are for everyone; your behavior is not an exception to the rules.

Breaking with HIPAA is another reason for expulsion; never discuss a patient’s information outside of the clinical setting. Also, never report to clinical under the influence of alcohol, a controlled substance or narcotics. The possession of alcohol or illegal drugs at a clinical site can also get you expelled. Most facilities have smoking bans, so don’t even think about lighting up in nonsmoking areas.

Keep your cell phone in your car or book bag. Most programs forbid cell phone use during clinical. And never take pictures of your patients or their procedures. You can be expelled and possibly prosecuted if Mr. Jones’s laparoscopic cholecystectomy ends up on YouTube without his, the hospital’s and/or school’s permission. Did you know that a felony conviction of any kind may be cause to deny nursing licensure?

2. Not completing assignments or cheating.
You may be given a syllabus at the beginning of your classes. Follow it. Most nursing programs allow a student to hand in late assignments, with the professor’s approval, until the end of the marking period or semester. If you begin to struggle in a class, ask for help.

Never refuse to hand in an assignment because you didn’t understand it. Your professors would rather see you in their office asking for help when you begin to struggle than when the assignment is past due. Go to your professor during his or her open office hours or send an email asking for a time that you can sit down and go over homework assignments that are giving you trouble. Too many missing assignments can bring your grade point average down, and all nursing programs have GPA requirements.

NEVER cheat or plagiarize. All programs have rules about plagiarism and cheating and will enforce them if a student is caught cheating doing either. Many schools have computer programs that check for plagiarism, so cite everything.

3. Skipping classes or clinical.
The U.S. Department of Education has a 10 percent excused absence rule in programs that use a clock hour program. Maximum excused absences are based on the nursing program’s clocked hours, so if your program has 780 clock hours for the duration of the program, you can only be excused 78 hours; any more than that and you can be expelled.

If you have an emergency that keeps you from attending classes, call the program director or your professors and let them know what you’re going through. Some programs allow for extensions when you’re facing difficulties. Think of school like a job: A no-show/no-call is subject to losing a job and getting kicked out of school. If you’re expelled or wish to leave in the middle or end of your training/schooling, most programs require you to pay back any financial aid that you received.

4. Lack of preparation.
Make sure you’ve taken CPR and have all immunizations and health forms completed prior to attending your first clinical. If the facility where you’re doing your clinical requires you to receive the flu vaccine, you’d better get one. If you’re allergic, get a note from your physician.

If your program insists on you wearing the school uniform to preclinical, clinical and/or classes, then wear it. Don’t show up to clinical without your uniform or with a dirty uniform. You are representing the school and the nursing profession, so be professional.

I know of one nursing student who got sent home because he wore the wrong color socks! Some programs are that strict. Bottom line: Not being prepared more than once could cause you to get the boot.

5. Going rogue.
Doing a procedure on a living, breathing patient without your nursing professor observing you, and/or harassing or causing harm to a patient or another student is a serious no-no.
It’s okay to practice procedures in the SIMS lab, but don’t try it at the hospital on a human subject without the professor’s approval or observation.

You’re working under your professor’s nursing license, so do no harm! If you try a procedure on your own and someone gets injured, you are liable—and so are the school and your professor. There are also rules about harassment and physical abuse to another person while in the clinical setting. Any conduct during clinical, on campus or in the clinical setting that threatens or endangers the health, safety or welfare of a person can get you expelled. Never carry a firearm to clinical. Hard to imagine anyone would get that one wrong — but if it’s written in a student handbook, you have to guess someone did it at least once. We’re not making this up, folks!

No one wants to be a nursing school dropout. Getting familiar with and following the rules outlined in your school’s student handbook is the best bet. This small measure of common sense will have you walking down the aisle on graduation day with flying colors. Good luck!

Editor’s note: For programs that don’t follow/no longer follow the clock hour system, many schools allow up to three unexcused absences. Beyond that, a student can be expelled.