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

Flip Flopping

No I don’t mean like the shoe… 🙂

Hey all!

So as you may know, I’m a nurse (duh) but I recently switched back to a day shift. Some of you are probably thinking HOORAY! that must be awesome for you, and while I mostly would have to agree with you, there were some initial bumps in the road for me.

The first day of switching back was met with some initial anxiety because I remember how helpless and frazzled I felt those initial 10 weeks I was working day shift as a brand new nurse. However, my first day back I felt it went a lot more smoothly, and I seemed to have a much better grasp of what was going on as a whole with patient care and how the hospital works as a system.

One of the issues I feel that I ran into was after that first day I was completely wiped out. Despite being on a “real people schedule” I was so tired I slept most of the next day and then slept that night! Talk about feeling like a crazy person. After that I seem to have pretty effectively switched back to a day shift cycle. I however have also noticed that I am having more of a constant low grade headache. This I think has more to do with my decreased caffeine intake (1 Fizz stick vs 2, Thank you Arbonne for the awesome caffeine) The caffeine source is great, but my personal choice to have less of an intake I think resulted in a little bit of withdrawal headaches. Oops… my bad.

As with anything that changes in your life, there needs to be a grace period for adjustment, and sometimes that adjustment is just a little more difficult than you anticipated.

Anyone had difficulty with transitioning? I know there are some of you out there that are on a constant rotation. How do you deal? Any tips and tricks for the rest of us?

Please feel free to leave them in the comments 🙂

~Niki

 

PS here is a cup of coffee that I enjoyed in the midmorning 🙂

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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

Difficult Questions

The other night I had an interesting question come from a patient, I had no idea how to answer that question, so I said I would ask someone and get back to the family member.

A little background on what happened. A patient came up from the ED, who had recently been diagnosed with something that would kill her. So she and her family members came up to my floor as we are the oncology unit and deal with a lot of comfort care patients. The patient seemed to be doing quite fine considering her diagnosis, but what one of her family members asked me was what threw me off guard. She looked me square in the eye and asked me how do I make this kind of phone call. I had never been asked that question and I had no response for it. I excused myself and said I would ask some people and get back to her. So I left the room with my head spinning and asked both my clinical coach that night and the charge nurse. They were both seasoned oncology nurses, and both gave me looks that they didn’t know how to answer that question. The charge nurse said that it was probably best to just relay the information, not sugar coat it, and make sure that the sense of urgency was understood should the patient pass quickly as she very well may have.

I was at a bit of a loss for words, and when someone was looking to me for guidance, I was unsure how to proceed. Has anyone had this experience before? Does anyone have some advice on how to proceed in this type of situation?

 

~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

Guilt, Anxiety, and Frustration

I have been struggling quite a bit more on night shifts than I have on my day shifts. While on day shift it was really busy, I always felt like I was connecting well with patients and the work load was always chaotic but manageable. I am not struggling so much with the actual work, but more with my mental state. My anxiety and “hermit tendencies”, as I like to call them, when I go home, have dramatically increased, which doesn’t make anything better.

In the last few days there was also an event at work, that although it was not directly my fault I still feel a great deal of guilt associated with it. I realize that I am being unfairly harsh on myself, but I just can not help but feel like I am totally responsible for that. I don’t want to go into too much detail about it, but initially the medication was hung incorrectly and as I caught the medication error later, but I feel I should have taken other steps to correct the situation. I however had not ever dealt with this situation before, so I followed the lead of my mentor and charge nurse on the proper protocol for this particular situation.

That being said I of course take responsibility for my own actions and realize that I should have listened to my nursing intuition for this particular situation, and notified the MD as well.  The PFO or pre formatted order was set up in such a way that it appeared that we should be able to titrate it according to the order set, but then the medication error element of it should have shot up little red flags to notify the MD, which my sleep deprived little brain failed to see as red flag warnings.

There are a couple of elements that I think factored into this particular situation that made it less than ideal, which is why I am still beating myself up about it. One being the craziness of the shift (those full moons I didn’t believe in before I sure believe in now). I was unable to even think about sitting down to chart until 1am, and this particular evening I was unable to even make it to my lunch/break period until 5am, which is 10 hours later and 3 hours later than I normally go. All of which are fine for me, it just goes to show how insane that particular shift was.

After having had a tough couple of weeks, I am trying to remain optimistic, but I am just afraid most of the time to go back to work now because of the acuity of the patients that have been on the unit so far. It is not a nice feeling to go to work and feel like you’re going to have a panic attack or something before you even start your shift. I am also frustrated by the fact that I feel like the acuity of the unit has gotten to be high lately. Each of the patients are not necessarily medically sicker, but they require more interventions and attention so other elements of my care feels like it is slipping. I also feel that there are a lot of admissions that all need to be done at once, and all of that paperwork takes time.

There are a couple of things I have decided I am going to try as a result.

  1. Probably the most difficult for me as I am working nights and tend to want to eat junk, is to try and eat healthier meals. I don’t mean like all of a sudden I am vegetarian or anything, but try to eat more vegetables and less junk/processed foods.
  2.  Another issue that I was being great with on days but am sucking with on nights is exercising regularly. I keep telling myself that it can wait and I am tired now, but realistically that is when I should be getting up and out. I know motivation when I’m tired is such a challenge so I am going to try and just get outside and walk even if its only 10 minutes, thats better than 0 minutes :).
  3. I am also going to try mixing up my schedule as that was a suggestion from another fellow nurse that I had not previously thought to do.
  4. I am also going to continue to ask for feedback from others to see what worked for them and what hasn’t. All suggestions are welcome as there is no way to know what works until after you have tried.
  5. I have also started baking again, something I love to do, but I have let it fall to the side as I have been tired.

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Hopefully some of these changes will allow me to feel more like myself again. I know it is unrealistic to try and implement these all at once, but I feel if I set a goal to try at least 1 per day that should help. Has anyone else had a struggle like this, or is still struggling? What did you do to help you move through it?

Let me know in the comments 🙂

~Niki