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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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

 

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

Transitioning to a New Hospital

One of my biggest fears when beginning a new job was that I had to go to a hospital system I had never been to before. There were several reasons I was nervous about this transition. Some of the biggest ones included being in a new place, with new people, and a new EMR (electronic medical record).

One of the actions that helped me over come some of my nerves on my first day was driving past the hospital a couple of days before my first day. Knowing where to drive and where to park made me feel like I at least knew where I was going on my first day.

I was also fortunate enough to know another girl who was was walking in to the hospital on her first day on the same unit as I was. We walked out of the parking structure together, but then quickly realized we both had no idea where we were going, we had a general idea, but that was about it. Thankfully there was a security guard that happened to be walking by just as we walked out of the structure and pointed us in the right direction. We made it to the unit without further incident 😉 .

The unit was warm and welcoming and everyone on the unit was prepared to help us with our transition. This also immediately alleviated a lot of the worry I was having about being “the new kid” on the unit.

What I had the most trouble with was with the EMR. I had used a couple of different EMRs prior to this experience, but this one was different than the others, and one I was completely unfamiliar with. Realistically it took me about 3 solid weeks before I was comfortable charting my assessment completely on my patients, and I am STILL not comfortable with everything in the system. That and there is a combination of paper and electronic charting and that is something I am still not completely comfortable with and it confuses me at times. The other nurses I am working with have assured me several times that learning that whole system is something that takes time and I will become more comfortable with it as time goes on. I certainly hope thats the case, but for the time being it still feels crazy.

There are many reasons I was nervous, but those were some of the main reasons I wanted to hit on. Does anyone have anything that made them nervous or anxious on their first day? Leave it in the comments 🙂

 

~Niki

Dealing with Stress

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Stress is a large part of what nursing is. In nursing school I struggled a lot with managing my own stress, because this was a level of stress I had not had to endure before.

Stress can come from many different aspects of the job

  1. The job itself
  2. The long hours
  3. Being in unfamiliar territory
  4. The patients or their families
  5. Co-workers
  6. Life outside of work
  7. Your own expectations of yourself

It could be one, some, all, or aspects of our lives that are not listed here that cause our stress, and it manifests differently in everyone. Personally it manifests as being grouchy, lashing out at people, and when left untended (which did happen in nursing school 😦 ) can turn in to anxiety and depression.

When I am the most stressed, I am the least equipped to deal with my anxiety and it can get the best of me, BUT on a more positive note now that I have expressed the reality of stress, there is still a lot that you can do about it! Personally when I moved, I uprooted my life to move to a new place, with no one I previously knew from a cozy little city where everything had been familiar and comfortable for so long that the transition was a difficult one.  After some time, I was not sleeping enough, I was eating junk, and I was not exercising regularly.

Initially when people were telling me to make sure I took care of myself, I kind of blew them off thinking…psh everyone says to eat right, sleep enough, and exercise, I’ll be fine it’s whatever… Later realizing that those things are KEY to keeping yourself feeling good and managing your stress.

I CAN NOT STRESS ENOUGH HOW MUCH OF A DIFFERENCE THIS MAKES!!

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Some fresh tomatoes from the garden 🙂

Once I began sleeping more than a few broken hours a night, eating more balanced meals, and taking the time to exercise (even if that means just going for a walk around your neighborhood), I felt I was able to manage my stress and start to feel like myself again and like I had control over my life (I mean to the degree we can have control over life, we can’t control every thing 😉 ). The exercises that worked best for me happened to be jogs and walks outside, because the fresh air tends to do me good, and hot yoga because I had so much anxiety, the inward reflection and focus on my breathing helped calm me down, in addition to improving strength and flexibility (something I am sure we would all like!).

What are some things you like to do for stress relief and management? Leave tips or tricks in the comments!

 

~Niki