That Crazy Night Shift

Hello All!

I have recently switched back to night shift (as I previously stated in my other post, into higher acuity the PCU), and I totally loving it oddly enough. It is definitely hard on your body, but I think being on a great unit with great people helps! I have completed my “preceptor days” and am now working on my own in this unit. Classes start tomorrow for extra education and training and there is a lot to learn, but I am definitely excited for the challenge. I feel like just in the last 4 short weeks I have learned and grown so much in my role, but have only touched the tip of the ice berg!

I think that my hardest challenge so far has been switching from computer to paper charting, there is no charting by exception when you have to write your assessment down by hand.

Anyway back to the night shift thing, I gave up my coveted day position and returned to the land of the night, and I can honestly say I am not looking back. It’s been about a month and I truly am ok with working nights, occasionally its more difficult to make plans with the day walkers, and get errands done, but in the overall scheme of things it isn’t so different from the day time its just perpetually dark. Definitely need to make sure to take a Vitamin D supplement as last time I was on night shift I fell into the deficient levels and was told by my doctor that I needed to supplement.

I thought it would be difficult to stay awake and that my system would hate switching back, but I think that my body tends to do slightly better with a night shift schedule as I am SUPER not a morning person (Those 5am wake up calls for me were brutal). Now that I work night shift, I have to plan seeing my family and friends more, but the pay is a bit better so it sort of evens out in the end.

If you have any comments or suggestions on current or ideas for future posts, post them in the comments!

Until next time

~Niki

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Long Overdue

Sooooo Hello everyone,

I have been in a lot of transition, so I apologize for not having posted anything for a couple of months. (Shame on me), but now that things have settled down some, hopefully I am going to get back on track. I’ve been moving around in my job, and taking on new hobbies, which I will address in the lifestyle section of this blog since I know some of you readers are just interested in the nursing part of this.

First things first, I am no longer a new graduate nurse. YAY! I graduated into being in the scary position to do things on my own. I was moved to an NOST (Neuro/Ortho/Surgical/Truama) unit on day shift and stayed there just over a month. We saw all kinds of people, but a lot of them were traumatic falls, voluntary joint replacements, or car accidents. Then I was offered the opportunity to go to PCU (Progressive Care) on night shift, and after about 20 minutes of deliberation decided the night shift was worth that jump, and let me tell you its only been about a week, but I am so much happier and love the unit and people that I am working with! As it has been one of my goals all along to go to higher acuity care, this was definitely the right  move, and the people are amazing.

Part 2, My 1 and only sister and her fiancee are moving to wait for it… JAPAN. Not like up the coast or anything, but half way across the world to Okinawa, Japan. I am excited for her to get to move to a cool new place (and for the excuse of a vacation to Japan 😉 ) I know selfish, but gonna take advantage while shes there. I’m both sad and excited to see her go, but I know it will be good for them and they’re going to have so much fun. She has been thinking about maybe starting a blog for her adventures so if she ever  does get on top of that I will post her link in one of my future posts 🙂

Back to the nursing part of things. I have quite a bit of further education to complete before I am to be on my own in the PCU, drips, medication titration, and EKG classes to name a few. It feels good to feel like I am learning more again and like I am feeling challenged.

Until next time, post what you would like to hear more about in the comments!

 

~Niki

Psych Unit?

Recently my Medical/Oncology unit has felt more like a psychiatric unit. This past week we have had patients screaming, throwing things at nurses and other people, threatening anyone that comes in the room, being verbally abusive not only to their nurses, but to the people that need to be constantly sitting with them. In the past week I can’t even tell you how many times we have had to call security in order to keep not only the patients safe from themselves, but the staff safe as well from the abuse they might take. Part of our jobs as nurses are to protect our patients, but it becomes a difficult task to protect them from themselves when they try to abuse us.

As nurses we are trained to deal with escalation to an extent, but when there are several of this type of patient on the unit at the same time, it makes it extremely difficult for us as nurses to deliver effective care to all of the patients equally. We do our best, but of course those that are more stable and less acute patients are sometimes left more to their own devices than we as nurses would like. It frustrates us as nurses to no end, and shows how lacking our healthcare system is in dealing with the psychiatric patient. One of the most acutely psych patients was realistically just on our unit awaiting placement. Which means there was no where for him to go because either the places for him to go are completely full, or they are not accepting that type of patient.

Has anyone had to deal with a patient that was just absolutely crazy? How did you deal? Do you have any recommendations or comments to share with us? Good or bad are always welcomed, we can learn from others bad experiences.

 

~Niki

My Favorite Shoes

This post is going to be a little less emotionally charged, but I wanted to talk about my favorite shoes and why they are my favorites.

I wear Dansko clogs. Yeah yeah I know they cost an arm and a leg, but they absolutely save my back after a long day of standing. Initially in nursing school I had one of the sexiest white pairs of Danskos. They put quite a bit of pressure on top of my foot, but the sales clerk assured me that they would stretch over time. They made my back feel so much better than another pair of shoes I decided it would be worth it to stick it out and see how they stretched out. My white pair unfortunately never stretched out to the point of being comfortable. I decided on a whim to buy a black pair on ebay that had been lightly used just to test to see if there was a difference. I saw an IMMEDIATE difference. The shoes although a size smaller than the white ones I purchased fit much better over the top of my foot and stretched to my foot rather than being stiff and painful like my white pair.

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Courtesy of the Dansko website. I did not take this photo, this is just a representation of the shoes I purchased.

Once I graduated nursing school I decided to buy myself a new pair, so I could start my nursing career with a fresh feeling. When I went to try the shoes on, I tried a pair and told the sales woman they felt a little snug, she told me to try a different pair in the same size as they can vary slightly from pair to pair and boy am I glad that I did! This pair fits perfectly and have stretched to fit the shape of my foot beautifully. They give me the support I need throughout my shift so my back doesn’t hurt and although my feet are sore at the end of my shift, they are not as sore as when I would wear other shoes. All in all for me they are worth the investment, just make sure you get a pair that initially fit correctly.

Sorry for such a long post about shoes, but as a professional that spends up to 12 hours on her feet, shoes are rather important 🙂

~Niki

Limit Setting

Something that has been both a struggle for me in my personal and professional life is setting limits with people. I have a very hard time saying no, especially when it is someone who is in pain or is in the hospital. 99% of people are in the hospital because they need to be, not because they want to be, but every once in a while there is a patient that is there because they want to be and are seeking medications or other services they could not otherwise obtain.

Saying no is a skill I am still learning, but setting limits is something that I needed to learn early on in nursing. I remember the first time that I needed to set limits with a patient I failed miserably. Fortunately my instructor was with my so she was able to give me some pointers, but I remember feeling like such a doofus that I was unable to steer the conversation the way I wanted to and that I allowed the patient to walk all over me. I had never had to assert myself before so this was totally new and foreign to me.

Now I am better at setting limits with my patients, but I still have a long way to go before I feel comfortable doing it. I still struggle with it every time I have a patient that is difficult, but I am getting better at it.

How do you guys handle setting limits with difficult patients? Or any patients for that matter? Was this something you struggled with? Let me know in the comments below.

 

~Niki

Dealing with Difficult Patients

The other night I had a particularly difficult patient. On top of being in acute alcohol withdrawal, this individual also had an extensive psychiatric history and history of previous substance abuse. This is a winning combination that leads to a busy night. First this patient had been getting better during the day, and for the beginning portion of my shift, this patient was fine. Then as the night progressed and my other patients drifted off to sleep, the patient began to escalate. Everyone that is a fall risk in the hospital has a bed alarm on so that we as nurses know that patient is getting out of bed and can run in there to prevent any harm or falls to the patient. This patient was setting off the bed alarm at an increasing rate. I was giving this patient Valium 10mg every hour as that was how his PRN (as needed) order was ordered. The patient was not responding to Valium, and I even tried giving a dose of Ativan, which had a temporary fix for about an hour before the patient was climbing out of bed again.

12 hours worth of this is enough to make anyone lose their mind, but as nurses we need to keep our cool and treat each patient with the respect and courtesy everyone deserves. There are a couple of ways that I have found that work for me when I do this.

  1. Remembering what the patient is here for and that patient safety comes first. I will be the first to admit after the 203 time the bed alarm rang I was tempted to just turn it off. But this of COURSE would be dangerous for the patient, and neglectful of me, so of course I did not do this, but just taking the extra moment either before running into the room to steady the patient, or after settling them back in to remind yourself that they don’t know any better and are there because they need your help is a good way to keep yourself sane.
  2. Speaking with your coworkers about it. Just allowing a little bit of your frustration to leak out and have someone who understands validate your frustration can help relieve some of it.
  3. Speaking up and knowing when to ask for help. We are nurses. We are strong. We are patient. We are also human and have our limits, so knowing when to ask for help is crucial. On my particular unit we all work as a team, so my fellow nurses would occasionally run in there as needed when I was running behind or with another patient. I of course reciprocate as needed when my patient load is not as crazy, and someone else has a difficult patient.
  4. After work activities. Make sure that your shift doesn’t totally get to you! I know this probably sounds ridiculous with the above story I just told, but have a glass of wine or cocktail with friends and just vent it out. Especially with some nursing buddies, they can relate and maybe even give you advice about how they deal with it. I included a picture enjoying some time out with friends. Or just do whatever you enjoy doing to blow off some steam.

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This is just one example of a difficult patient and they come in many different forms. What’s the most difficult patient you have ever had? Leave it in the comments

~Niki

Sleeping and Nights

I have finally been able to switch over to night shift! YAY! This is a win for me, as I tend to be more of a night owl than a morning person. But there are a lot of people that have a hard time adjusting to nights. This post is going to be about what works for me to be functional on non work days, and everyone is different so I please keep that in mind when reading this article.

I am already naturally a night person so some of these things are much easier to me. To begin, I have skewed my schedule so that I am up until 0200-0300, and sleep until 1100-1200, typically 0300-1100. This sets me up to stay up to 0730 the next morning when I need to work.

Setting an alarm the next day after your last night shift and getting up to go for a walk or go do something active definitely helps you get over that feeling of being hit by a freight train.

I always wake up parched and with a mild headache, the getting up and moving helps with the headache, and a good glass of water and rehydrating all day helps with the parched feeling. However the parched feeling is not exclusive to nights for me, I am never drinking enough water when I am working, which is a personal issue and potentially the topic of another post ;). I enjoy my hot yoga, going for long walks outside, and some gym time. I get bored easily so I try to keep things varied, so I don’t burn out on one thing.

One thing I have also realized for me is caffeine. Oddly enough contrary to probably what almost every other nurse out there is going to say, I need to stay away from caffeine. It makes my sleep cycles really strange and too much of it actually exacerbates any anxiety I might have. So I have been weaning myself off of my caffeine, although it’s slow going, I definitely enjoy a cup of coffee every now and again (hey, don’t forget to feed the soul and do things that make you happy 🙂 ).

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I am so tired by the time I get home and go to bed I don’t really need black out curtains, but a lot of people benefit from them. I used a throw blanket (which worked just as nicely) for a while, but then I find that for me it is extra difficult to get out of bed after having slept for my 4-6 hours, so I have left them behind for a brighter future (pun intended 😉 ).

I usually pass out and am sleeping for a solid 4 hours before I wake up, but if I have had a particularly trying or emotional night and am having trouble getting to or falling asleep, I have melatonin. I rarely use it, but it is rather reassuring to know that I have it should I ever need it. It is over the counter, but I spoke with my doctor about dosing before beginning to take it, so I would never recommend to take supplements without knowledge about what you’re doing.

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Any other tips and tricks out there about working nights and sleeping during the day? I know I am still testing different things out to see what is going to work best for me, so this is a preliminary list of what works for me :).

 

~Niki