How to keep your cool walking into a $h!tshow shift: 5 ProTips

How to keep your cool walking into a $h!tshow shift: 5 ProTips

You know the shifts I mean. The second you step onto your unit, you can tell that this -ish is bananas. Call lights going off like crazy, heart monitors alarming, phone lines ringing, nurses and CNAs scrambling.
Or worse.

You see no one. They're all tied up in rooms doing god-knows-what instead of sitting ready to give you calm, thorough report. It's upon seeing this that I invariably want to turn on my heels and walk out before anyone has the opportunity to see me.

But love for my profession and fear of joblessness and poverty work in tandem to keep me moving forward to the report room instead of running for the elevator.

So how do I keep my cool? The obvious answer is a daily SSRI and a PRN beta blocker before work, but that isn't very helpful to my readers at large. Here are some non-pharmaceutical ways to brace yourself as you walk into what can only be described as a shitshow.

  1. Do bedside report. Some people claim it's time-consuming and they get roped into doing a bunch of shit that delays the off going nurse from getting to leave. The vast majority of the time this has been untrue, though this is anecdotal evidence. Bedside report achieves a few key things:

    a. ensures the previous nurse isn't gonna walk out while you inherit a patient who is covered in poop and ripped out their IV an hour ago. Hold each other accountable and walk in and show each other that things are under control.

    b. If you do bedside report, review major things like lines, drains, pumps, wounds, etc, you've already got a good chunk of your assessment done. Boom.

    c. Complete quick, easy, yet annoying tasks that turn to into disruptive call lights later. Introduce yourself, boost your patient,  assess pain, help them to the bathroom and see how they move, etc. Then you know you're starting your shift with the itty bitty tasks done.

    I always address the patient at the end of bedside report by saying "I am going to go meet my other patients and make a plan for the night. Is there anything that you need immediately before I do so?"

    Do your "easiest" patient first and end with the more time-consuming ones, so that if you do a few extra tasks in the last patient's room after report, the off-going nurse can jet.

  2. Mend fences at the start of the shift. If I hear that a patient or family member had a rough time getting along with staff that day, or if something negative happened,  I resist the urge to avoid that room in fear and I face the problem proactively. Since I work nights, I say things like "I hear today was rough on you. My plan for you to have a good night is _______." It also never hurts to ask them what their priorities are moving forward and what would make them feel better (about the conflict or event).

    Some people can't be schmoozed, and jerks do exist among patient populations, but I have experienced positive changes in some patients' demeanors when I take this approach. I think it works often enough that it's worth the times it doesn't. And of course, use your judgment - don't apologize for things you didn't do, but do empathize with your patient. Build trust by showing them you're on their side.

  3.  Have your superhero toolbelt on when you clock in. Your list of necessary tools is going to vary depending on where you work. For me, I have a list of things I have on me at all times during my shift.
    Here's a list:
    *Stethoscope    *black/red pen/highlighter/sharpie  *pen light *mini-safety scissors
    *small stack of alcohol pads  *5-10 IV hub caps   *med sheets/report sheet
    *a few  saline flushes in my cargo pocket *fancy hospital-issue iPhone

    Save yourself time and steps by not having to run all over the unit looking for things you need to complete unexpected tasks during the busiest hours of the shift.  I keep the same items in the same pockets each shift because I can whip something out without digging. I'm a regular Nursing Batwoman.

  4. Show up a few minutes early to assess the situation. I'm literally talking just a few minutes. Some employers won't let you clock in early to look through charts and orders, but I cut my losses and do it anyway.

    My personal experience is that the money that I lose in the 10 extra minutes per shift is worth it for me to feel more prepared and less anxious when I step out to take my patient assignment.

    If I only have a few minutes, I'll check the previous nurses' assessment for each of my patients and the existing orders.

    If I feel generous or there's a fun group of nurses on shift, I'll show up a little earlier. I'll do the same as above, and add on the admission note and the latest doctor or social work note for the plan of care.

  5. Form alliances at the start of the shift. No, I'm not talking Survivor-style, though some shifts feel like it. I mean, find your best allies for the shift.
    If you're in a pod with another nurse and you both have patients that need to be turned, team up. If you have a nursing assistant or patient care tech, touch base with them to prioritize cares.

    While we can't count on sticking to our plans, we can at least amplify our spirit of teamwork and make sure no one feels like they're walking into the shitshow alone.

    What are your go-to tips for braving the storm? I want to hear your thoughts.
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    Happy Nursing, folks!


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