I can’t stress how difficult the transition is from a student nurse to a professional nurse.
I even had experience as a CNA, EMT and LPN and nothing could have prepared me for the culture shock that was working on my own taking patients as a registered nurse for the first time.
It is well documented how tumultuous the first year it is for new nursing graduates.
The average nurse turnover rate (how many nurses in a particular unit/department/hospital that seek a new nursing position elsewhere) in an average year was 16% in 2015.
New grads have twice the turnover rate at 30% in the first year as a new nurse graduate and a whopping 57% in their second year as a new grad.
This can be chalked up to a variety of factors including heavy workloads, disillusionment of the profession, crazy hours/schedules, insufficient time spent with patients, or seeking a more challenging work environment.
I was a part of this statistic leaving my first RN position after 9 months to seek a more challenging work environment after nailing down the basic/fundamentals in a general med/surg/ER rotation position. I wanted to work full time ER, the opportunity presented itself.
I felt HORRIBLE leaving after they had invested so much time and training in me. They paid for me to take classes like:
To the nurse who just made their first medication error: I know what you’re feeling.
Your stomach is in your throat. Your eyes are burning with tears. Your heart is racing as you skim back through the MAR over and over again trying to figure out what could have gone wrong.
I know what you’re thinking
I’m a failure. I’m not a good nurse. This isn’t the right profession for me. I could have hurt my patient. What if something bad happens to my patient. What if I get fired. What if I lose my license. What if my reputation is ruined. What if I get yelled at. I should have checked one more time. I’m stupid. I’m worthless. I’m not ready to be a nurse.
Stop. Take a breath.
I remember my very first medication error. I was a new baby RN barely on my sea legs a few weeks after I turned 20.
The medication order: Azithromycin 500 mg IVPB every 24 hours
I gave Azithromycin 500 mg IVPB which is what my MAR prompted me to do when I came on night shift. Little did I know, the patient was transitioned from observation to acute care that afternoon. To do so, the patient was discharged from the observation visit and admitted under an acute visit. Azithromycin was already administered just hours before but the medications administered under the observation visit weren’t visible to me in the new acute chart. As the doctor put in orders (to be continued from the previous chart) it came up as DUE. A seasoned nurse would have looked back at the observation chart to make sure it wasn’t given twice. I was simply doing what my MAR prompted me to do without question. I didn’t ask WHY (rookie mistake in hindsight, but if you don’t know you should be looking for something, how do you know where to look?)
I didn’t even know I made an error at first. The two other nurses I was working with were acting strangely that night. There was a lot of whispering. Around 0400 they presented me with a neatly written and well thought out event report and explained they had written me up for my medication error HOURS after the IV medication had been infused.
I felt betrayed and confused and mortified. I felt like I was going to throw up. Were they talking about me all night? Why didn’t they tell me sooner when they noticed it? Do they think I’m a bad nurse bound to make a mistake? Why were they checking up on me to begin with? Is my patient going to be okay? I need to go see my patient. Does my patient know I’m a failure? Will they ask me to leave the room? Will they ask for a new nurse? How am I going to tell them I overdosed them on their antibiotic?
Rest assured, it all turned out just fine. My patient was fine. I sincerely question the way the medication error was brought to my attention but that’s a story for another day.
I had to tell the doctor. His response was, “Well, that isn’t what I intended but I guess we can’t change it now.” Whew.
I had to review the event thoroughly with my boss. He told me something I’ve repeated to my coworkers and nursing students time and time again.
Everyone. Makes. Medication. Errors. EVERYONE.
If you have never made a medication error, you will and you’ve likely not been in bedside nursing for very long or you’re straight up lying.
One more time for the people in the back, EVERYONE HAS OR WILL MAKE A MEDICATION ERROR.
Welcome to the club! It is almost a rite of passage!
Here’s the kicker you guys, YOU WILL MAKE ANOTHER MEDICATION ERROR.
Yup. That sucks doesn’t it. But that’s life. We are humans. We are not perfect and we will screw up again. The goal is not to make the same mistake twice. I can bet you won’t.
So, to the new nurse (or the old nurse) who just made their first medication error:
You are a good nurse. You are not a failure. You are cut out for nursing. You are learning. You will grow from this.
Stop. Take a deep breath. Take a minute. Take five minutes if you can. Show yourself some grace and read Friday’s blog post on the actual steps to take after a medication error.
I’ve gotten so many comments from readers about what a wonderful nurse I am and how I’m so caring and compassionate but I’m telling you:
I used to be a bad nurse.
Have you ever worked with someone who was grumpy all the time? Someone who was dismissive?
You could tell they hated their job and they were so unhappy. They came off as rude and hurried. Their heart wasn’t in the right place anymore.
Well…that was me.
I’m sure you’ve heard of burnout. Burnout has recently been recognized as an actual medical diagnosis as burnout syndrome. I wanted to include this chart to clearly differentiate between compassion fatigue and burnout. I was 100% on the burnout side of life.
I want you to ask yourself these questions:
Are you spiritually, emotionally or physically exhausted?
Do you have a positive outlook on your future at your current job?
Do you feel like you see the good in people or give them the benefit of the doubt?
Are you suspicious of your coworkers? Are you afraid they are gossiping about you or have ill intentions?
Is it difficult to concentrate at your work?
Are you as productive as you could be at work?
Do you question your capability to complete your tasks at work?
Do you suffer from chronic headaches or abdominal pain?
Are you sick all the time for no apparent reason?
Do you dread going to work?
THIS. WAS. MY. LIFE.
My documentation wasn’t thorough. I had a negative attitude. I didn’t always show empathy for my patients. I was cited for coming off as rude to other departments and in a hurry and talking too fast. I acted like a know it all.
I was of the mindset “I’ll say it how it is.” One of the new ER nurses told me one day, “You just really have no filter do you?”
I thought everyone hated me. I thought everyone thought I was stupid. I knew I wasn’t good enough. I’m sure everyone was gossiping about me. I was at such a deep dark point in my life that Fall. I wasn’t happy.
I had withdrawn from my coworkers and my friends because I was so sure that they didn’t want to hear about my life or talk to me. I didn’t want to annoy them with my stupidity.
My mind was a battlefield. I was constantly hating myself for the way I looked. I was constantly telling myself I was stupid or I wasn’t good enough. My mind was like a broken record playing this mantra over and over again:
“Why set goals when you can’t achieve them? You’re so dumb. Everyone is watching you. They are gossiping about you. They think you are dumb too. They can tell you’ve gained weight. They can tell your scrubs are tighter. They don’t trust you. They think you’re a bad nurse. They think you talk too much. Stop talking about yourself. No one cares. You look like SHREK. Just go to work and do your job and go home. They don’t like you here. They don’t want to work with you. I feel bad they have to look at me all day.”
My supervisor approached me. She knew I wasn’t operating at my full potential. Other departments were complaining about my negative attitude. My heart broke. I had never gotten a negative review in my life. I’m telling you guys, I had NO idea how bad I was. I spiraled.
In hindsight, I am SO SO thankful that my supervisor came to me. I knew that I wasn’t well but I didn’t know it was effecting my work, my attitude, my work environment, and relationships with my coworkers. I didn’t know how obvious it was to everyone else how miserable I was.
If you knew me during this time, you probably didn’t like me. I’m sorry. I know that my burnout damaged my reputation. I still hear about how far I’ve come and how I used to be very rude. I know I offended people. I know that I wasn’t well liked and I want you to know that I’m sorry and I’m better now. But I also want you to know that this could happen to you too.
I enrolled in therapy in November of 2017. I have been attending ever since to address my deeply rooted body image issues and my need to be perfect. In other words, I am a recovering perfectionist. I am a recovering workaholic. This and my undiagnosed social anxiety put me at an extremely high risk to fall into the burnout trap. I have learned my triggers. I have learned effective coping mechanisms. I know how to recognize burnout in myself. I know how to recognize it in my coworkers and friends.
I want you to know I’m still at the same job and I love it. I want you to know that I was the one putting the pressure on myself. I want you to know that while I was working 60 hour work weeks, I was the one who picked up the hours. I want you to know that if you recognize yourself in this blog post that there is hope.
It was NOT easy. It was hard work. It took time to make progress. Every day was a battle. Every day I was working harder to improve myself as a wife, nurse, and mother. Part of that came in the form of self development. Here are a few things that have played a role in my transformation:
Brene Brown’s The Gift of Imperfection: This book needs to be read by EVERYONE but most importantly it needs to be read by recovering perfectionists. I have read all of Brene’s Books but THIS ONE really hit home and I highly recommend you check it out.
Sarah Knight’s Get your Shit Together: This was a basic introduction for me on working to maintain a work life balance. I remember listening to this on the plane to see my brother in Houston Texas in October of 2017. I was so desperate to feel like I had some part of my life together. Like I said, this book isn’t nearly as “in depth” but it is a basic introduction to getting your life back on the right track.
Here are a few mantras that I recite to myself to cope with day to day work stress that have helped tremendously:
Everyone is welcome.
We are all God’s children.
Will this matter in 5 years?
What is the kind choice?
What is my goal?
You don’t know the whole story.
You don’t know what they are going through behind someone else’s closed doors.
Productive Days I learned that a HUGE part of my problems were trying to find a work life balance. I would come home on my 1-2 days off during the week and just sleep. I was so exhausted I never felt fully accomplished at home or at work. I started putting together the beginnings of my “productive day” that I refer to often on this blog. Read more on that here:
Seeking professional help: I also highly recommend counseling. I LOVE going to see my therapist. She is so kind. I’ve been so fortunate that I have never paid a bill for one therapy session due to some AWESOME insurance. I have come so far, I rarely talk about my anxiety or my body issues anymore when we have sessions but it still feels so good to have a third party listen in and offer perspective.
So what is my goal with this post? I know that as you are reading you are thinking of someone. Maybe it is a coworker, a supervisor, a friend, a daughter or husband. Do you know someone in your life that is burnt out? Is their toxic behavior effecting your life or work environment? THEY. MIGHT. NOT. KNOW. Just like me.
It may be time to have an honest conversation with them or refer them to your company’s employee assistance program. It may be time to send them this blog post and see if it helps them recognize these feelings within themselves.
I was so upset with my supervisor when she first came to me. She was describing me in a way I wouldn’t have recognized. I was mortified. But that conversation changed my life in so many ways. I will always be grateful for her honesty and her professionalism. Maybe you need to be that person for someone.
I’m so glad to meet you. SINCERELY. I firmly believe I am meeting a group of lifelong friends today. I look forward to becoming your mentor and colleague.
I hope when you’re struggling you hear my voice in the back of your head reminding you to use your nursing judgement.
I hope when I have to give you some negative feedback you can understand it is only because I want the best for you and your patients. It’s better to learn as the student than to learn as the nurse.
I hope you are patient with me. There are so many of you and just one of me. I want to give you all of the knowledge I can. Please know I’m trying.
I hope you are patient with yourself. I wasn’t strong like this when I started out, none of us were. You’ll struggle. Embrace it. Most of all learn from it. Give yourself the time to grow into the nurse you want to be. It doesn’t happen overnight.
I hope you give it your best effort. I know sometimes it feels like you’re “working for free” but I challenge you to challenge yourself when you aren’t feeling challenged. Ask for a heftier patient assignment. Volunteer to assist with an admission.
I hope you are forgiving of your classmates. Nursing school is such a stressful time for everyone. Emotions run high and you never know who is at their breaking point. Please be forgiving of them. Please understand what they are going through.
I hope you think of me every time a beta blocker makes you LOL or when you give Lovenox, low molecular weight heparin, in the love handles. (my former students should understand that joke)
I hope you remember what this feels like when you’re nervous and new and green. I hope you are patient with nursing students when it is your turn to be the expert.
I hope you can build your confidence. I hope that when you have a bad day or when someone makes you feel small or someone makes you feel like you aren’t cut out for nursing you won’t believe them. I hope you know you are made for more and that you are enough.
I hope you are learning to understand and not learning to pass the test. There will come a day when you catch something everyone else missed or you save someone’s life with the information you’re working so hard to understand.
More than anything, I hope you appreciate the struggle. One day you’ll look back at how far you’ve come. I hope you can appreciate how much you’ve grown. I hope you can draw strength from your weaknesses. I hope you can remember how scary this all feels right now and be proud of the nurse you’ve become.
How many times do we hear that phrase “above and beyond?”
ALL. THE. TIME.
I hear it in award speeches, I hear it in those cheesy AIDET classes we have to take, I even hear it in interviews.
“Describe a time you went ‘above and beyond’ the call of duty for your patient?”
What is your above and beyond?
My dad died from lung cancer on June 2nd 2019. He had a long 129 days from diagnosis until his death. He spent most of his time in and out of hospitals.
My dad was a pretty gruff guy. He wasn’t one to show much appreciation or affection. He really avoided the doctor at all costs prior to those final months.
His first hospital stay was following a failed attempt to remove a 4 inch tumor from his right lung. It didn’t work. They sewed him back up.
His second hospital stay was following a fracture of his C2 vertebrae. He was leaning back in his recliner. He spent a week in the hospital.
His third and fourth hospital stays were a week long each. We thought he had radiation pneumonitis. He didn’t. He was dying. We didn’t know yet.
Throughout the hospital stays, my parents had picked out their favorite nurses.
Lauren was my dad’s nurse when he broke his neck. Dad was on the medical oncology floor which was a really busy floor. Lauren’s phone was constantly ringing. I knew she had her hands full. Yet all I heard about was how smart Lauren was. I was so excited to meet her because I’d heard such high praises.
I spent two days with my dad in the hospital. I met Lauren. Don’t get me wrong, Lauren was a fine nurse but she didn’t have the superpowers my mom and dad had described. In their eyes, she was “above and beyond.” My mom went as far as to write a letter to make sure she was recognized for her efforts.
Do you know what Lauren did?
Lauren listened. She sat down, she talked to dad, and she actually listened. More than that, before she responded, she thought.
Dad always commented on that. He said he could “see her wheels turning.”
When the strongest pain medications weren’t touching his pain, she listened. She sat down, talked to dad, and she actually listened.
When he had concerns about his new feeding tube, she listened.
Lauren worked on a busy floor. Lauren wasn’t always on time with her medications and assessments. She was already preforgiven because Dad knew whens she got to him, she would listen.
That’s it guys. That’s the BIG SECRET to getting all those fancy nursing recognition awards: LISTENING.
I have bent over backwards and sideways four ways to Sunday for patients.
I have bought people the giant packs of depends, I’ve paid for people’s taxi’s, I gave a patient a ride home or to their hotel on several occasions. I have literally saved lives. I went and bought a family member of a dying resident cheese curds after work and brought them back to her. I went in on my day off to be with an old man with no family so he wouldn’t die alone.
All of these grand gestures may get me into heaven one day but do I listen to my patients?
Do I make sure they feel like more than just a task I need to complete?
Do I see beyond the tubes and wires and remember they are a human?
Do I sit down on their bed and look them in the eye?
Am I listening to respond or am I listening to understand?
In a world of screens and monitors and technology I challenge you to disconnect and reconnect.
In closing, my fellow nursing friends, I challenge you to rethink your above and beyond.
Have you seen these posts running around Facebook? These fear mongering posts about “DON’T KISS MY BABY!!” And then pictures of severely ill children in the pediatric ICU?
These posts drive me nuts.
This is not one of those posts.
RSV is a virus. It stands for respiratory syncytial virus. Most kids do really well with it and don’t need to be hospitalized. There are a few kids who need extra support like breathing treatments or steroids. There are a few more kids who unfortunately cannot tolerate RSV at all and it can become deadly. These kids are usually immunocompromised to begin with or have reactive airway disease already as a child or a preemie baby.
The older you get the more tolerant you are to RSV. In fact, a myth is that adults and older children don’t get RSV. That’s not true. We do get RSV but it’s just a cold for us. OR we’ve already been exposed as a kid and we are tolerant to the virus. We can still pass it on to others though.
RSV IS a virus. There is not a cure or treatment for it. We only treat the symptoms or “symptomatic and supportive care.” If they need rehydration we give fluids. If they need oxygen we give oxygen.
The only reason we really test kids for RSV is to rule out bacterial causes of fever and illness. For example, if we just assume a fever is caused by RSV we could be missing a urinary tract infection or strep throat which ARE treatable with antibiotics. Also, it helps us identify those kids who might need extra help fighting the virus.
Here’s what gets my goat. Influenza is also a virus. Kids can also get influenza. Influenza can be just as dangerous to babies. Influenza can put kids in the ICU too. Influenza kills people. BUT YOU CAN VACCINATE AGAINST INFLUENZA!! And the same people who are all like “DON’T KISS MY BABY!” Some probably didn’t get their flu shot either.
Here’s also what drives me bananas. RSV does not live on the lips and faces of well meaning relatives. Weirdo Great Aunt Becky isn’t trying to give your kid RSV when she kisses your baby.
The baby is more likely to get RSV and all other viruses from the shopping cart you didn’t clean off.
The baby is more likely to get RSV from childcare or their toddler cousin.
The baby is more likely to get RSV from going in public.
The baby is more likely to get RSV from the doctors office.
The baby is more likely to get RSV from YOU NOT WASHING YOUR HANDS and kissing YOUR OWN BABY!
But they are also equally as likely to get any other virus from anywhere else viruses live.
Also – I don’t want to brush past that. Do you think great Aunt Becky is the only one with RSV living on her lips just waiting to give your newborn the kiss of death? NO! Do you kiss your newborn? Like everyday? Like multiple times a day? YES YOU DO! More likely to catch something from you. Just being honest.
So get your flu shot. Wash you hands. Stay home during flu season. Quit passing the baby around the room at winter get togethers. Don’t let them suck on the shopping cart. Wash your hands some more. Expect your kid to get an insane amount of viruses and runny noses and coughs between November and May. Take kids to get their flu shot. Immunize your kids.
If your kid gets RSV, don’t panic. MOST KIDS DO JUST FINE without hospitalization. My son has tested positive for RSV twice and influenza twice. He did fine at home all four times and proceeded to give it to our entire family.
And to Great Aunt Becky – don’t kiss babies. Not only because you could potentially give them a virus but also because THATS WEIRD TO KISS OTHER PEOPLES BABIES. Full stop.
One of my FAVORITE parts of being a clinical instructor is participating in exit interviews as the associate degree of nursing students graduate – nurses who are just about to graduate and take RN boards. They come in and are interviewed by several instructors to practice interviewing for a real job.
It is so fun to see students that I’ve had in clinicals and known throughout their time in the nursing program check off their final task on their checklist on their way to graduation. We are holding a pinning ceremony for them on Thursday which is also one of my favorite parts the semester and then I’ll start in January with a new group of students!
Throughout the interviews this week, a few things really stuck out to me and I wanted to share them with any new grads or really any nurse who is job seeking. I’m going to do a series of tough interview questions that nurses are usually asked in interviews. Today I’m focusing on that culture question.
The Culture Question
Culture is defined as the customs, arts, social institutions, and achievements of a particular nation, people, or other social group.
We live in rural northeast Iowa – I mean RURAL northeast Iowa. In 2017, the major city/town I work in had a total of 93.8% WHITE alone residents. Most of the population we work with APPEAR to have the same culture as I do as a white woman. I cannot honestly think of a black man or woman who works in our facility. My students have very few opportunities to work with students of “other cultures”… or so they think.
Usually the question comes up in interviews about how the nurse would provide trans culturally congruent care across the life span in a variety of healthcare settings. So many of my students said “I’ve never worked with anyone of a different culture.”
WRONG. Pediatric patients are their own culture. Elderly patients are their own culture. Childbearing women are their own culture. Farmers are their own culture. The list goes on and on. We may appear to be the same, we are not. Just because we are white, does not mean we belong to the same culture.
I have a friend who grew up with a single mom and has no idea who her dad is. I have a friend who was adopted. I have a friend who is a twin. I have a friend who is a vegetarian. I have a friend who is a Jehovah’s Witness. I have a friend who has a deaf mom. I have a friend with autism. I have a friend who grew up in the military and moved frequently. I have a friend who has survived childhood cancer.
Each of us bring our own unique set of experiences and values to the table. We may appear the same, but we do not all belong to the same culture.
Can you imagine the difference in my Thanksgivings?
I have my family – I am the youngest of 5, both of my parents came from families of 5 or 6 children, we can’t possibly fit our entire family in one building. It is loud and we drink alcohol and graze all day and the boys end up in the garage smoking.
On Craig’s side of Thanksgiving, we can fit his entire mom’s side at one kitchen table. He has a Great Grandpa, a Grandpa and Grandma, and both parents. I don’t even have a full set of parents and my two grandparents that I knew passed away before I graduated high school.
But Craig is white and I am white so some might assume we belong to the same culture or set of beliefs.
I would not approach caring for an elderly demented patient the same way I would care for a woman who just had a baby. I wouldn’t even care for a woman who had her 7th baby and a woman who just has had her first baby the same way.
How to Answer the Interview Question
The safe answer to this question is first acknowledging that we all bring our own set of beliefs and culture to the table regardless of what we look like or where we grew up.
The best way to make sure you are honoring your patient’s beliefs and wishes is to get to know them. That way you can identify any language barriers, educational barriers, maybe they are under a huge amount of stress etc. This can help you coordinate resources and make sure you’re providing effective teaching. You can also identify any barriers they may have for caring for themselves and for maintaining compliance with medications and self care.
What if I haven’t taken care of someone with a different culture than mine?
Re-read what you’ve just read – you HAVE taken care of someone of a different culture!
Talk about having to float to a different department and caring for a subculture of patients you aren’t used to such as caring for OB moms.
Talk about having to tailor your care/conversations to dementia patients by playing along in their world.
Talk about the important role the chaplain has played in your facility and how incorporating the patient’s cultural beliefs in the dying process is not only important for the patient but also for the family.
Talk about how you will always respect the patient’s wishes and beliefs even though you may not share those same values.
Make sure you sound politically correct
I’ve had a couple students say “the patient was Spanish.” Well that’s not exactly the proper terminology. While I don’t claim to be the most politically correct person in the room, “Spanish” is a language and does not always properly explain the patient’s ethnicity.
Not only that, but they may all speak Spanish but have their own accent or way they speak the language – just like we have a northern accent, a southern accent, a British accent, and English accent etc.
For example, the patient may speak Spanish but is actually from Guatemala which would make them Guatemalan. Or they may speak Spanish but be from Mexico making them a Mexican. They may speak Spanish but be from Honduras.
Now you may not know all of the right ways to pronounce every culture, but if you know that you want to talk about a patient interaction with a childbearing Somalian woman, when you are rehearsing your answers for the interview make sure you look up the proper way to describe their ethnicity.
AND OF COURSE…
The proper way to summarize and conclude any interview question is with “And that is how I provide culturally congruent care” or “And that is how I blah blah blah” so the interviewers know you are DONE with your response. “and so yeah” is not a proper conclusion.
As an ER nurse, one of my most valuable skills is my ability to go with the flow and be flexible. I found this meme on Facebook and I felt it in my BONES people!
As an ER nurse, I say bring ’em on down!
I feel like this is a skill that is overlooked. ER nurses have the ability to adapt and change their course of action as patient conditions get more critical or census gets higher. Whatever comes our way, we will make it work.
Often times, I hear other nurses say, “I could never work in ER because I don’t know what comes in next!” That’s what I love about it. Navigating my way through a full lobby of sick patients, all of our beds full, and the ambulance bringing in a critical patient tests my critical thinking, triage skills and flexibility. I’m confident in knowing I can make just about anything work and I can handle it.
This is a learned skill and if you’re used to working in a pretty steady and even paced environment, chaos comes with a lot of fear leaving many nurses at their witts end screaming “I CAN’T TAKE THIS ANYMORE!” But YOU CAN!
The next time you feel like you can’t handle anything else and the patient load gets piled on thick, critically think! Here are a few tips I have:
First of all, is this safe? Is this a safe patient load? Don’t get this confused with “I don’t want to take another patient” but really think about it: is it safe for me to take another patient? Can I give all of my patients the attention they need?
Second of all, you’re never alone. Know your team’s strengths and weaknesses and use them to your advantage.
Delegate. Delegate. Delegate. If you are swamped you should NOT be completing TASKS. Tasks include getting vitals, starting an IV, helping someone to the restroom, fetching things, etc. You focus on assessments and documentation – things you cannot delegate.
Believe in yourself. Shake off the mindset of “I’m drowning” and jump into “I’m handling this like a BOSS!” The power of positive thinking is incredible.
What resources do I have? Could I request a float nurse? Is someone on call that can come in? Is another department slow? Could someone come in early? Could this admission wait?
Don’t let anyone go unseen. Triage people in your lobby. Get in and get a set of vitals on your new admission. Lay eyes on your patient as soon as you are able to get a good baseline assessment. If you don’t and things go south while you’re away, well, that’s bad.
Hang up the phone! So many times I’m getting pulled out of a patient’s room for a phone call or spending my time on hold. No one ever tells you how much of nursing is just waiting on the other end of a parked call. Either ask someone to hold for you, ask them to take a message, ask to call them back, or just transfer it to someone who can help them. So many times we get calls from people wondering “Should I come in?” or “Can I take this medication for a headache?”or “I was seen there earlier and have a question..” While I would love to take these calls in my downtime, I have to take care of the people who are here and under MY care right now.
Ask for help. Recognize signs that you are behind or that you’re not doing well. If you’re distracted and unable to focus on your medication pass, you need to ask for help. If you’re catching yourself almost making a mistake because your mind is so overwhelmed, you need to ask for help. If you feel your patient load is unsafe, you. need. to. ask. for. help.
Make a list of things that need to be done and prioritize – back to AIRWAY BREATHING AND CIRCULATION. Treat PAIN. Make a schedule. When you enter a room think to yourself: I can allow 15 minutes to complete this med pass. I have to be out of the room by 4:45 – even consider setting a silent alarm on your watch if time management is becoming a problem for you.
Often times when I feel overwhelmed and I feel like I have so much to do but once I actually sit down and think about what needs to be done, I’m doing just fine. Give yourself a reality check. Take a deep breath. And press on. A good way to consider this is, “If I had someone to delegate to, what needs to be done right this second.” Usually, I can’t think of much.
Finally, when the department is bogged down, LET YOUR PATIENTS KNOW. I have a few different scripts I like to use to explain delays:
“We have a critical patient who just came in” or “We are experiencing an unusually high ER census at the moment and we are doing our best to take care of critical patients.”
“I don’t want you to feel like I’m not paying attention to you. I will be back as soon as I can be but in the meantime I brought you a glass of water and a warm blanket. If you have any questions or concerns, the best way to get a hold of me is to push this call light button because I may be tied up for a bit before I can come back in here. Please let me know if you need anything at all – especially if you start to feel worse.”
People are usually very understanding if they know there is a delay and how to reach you if they need you. Tell them where the bathroom is. Thank them for their patience. Get them a warm blanket. Offer a glass of water. Give them a time estimate if you can.
This is a great example of when I love my iWatch. I will tell the patient: “I’m going to set an alarm on my watch to come check on you in 15 minutes to see how you’re doing” or “The pain medication should be kicking in in about 20 minutes. I’m going to try and be back in here at 2:20 to see how you’re doing.” and then set an alarm. This has helped me keep up on my documentation as well.
That’s all folks! I’d love to hear some other time management tips from the nurses reading this! Leave a comment below or on my Facebook!
I wanted to do a post explaining how nurses hours work. I try to make sure I have this conversation with my nursing students before I set them free into the nursing world because it can be difficult to understand.
A lot of nurses work in FTEs. Each 0.1 FTE is 4 hours. For example I work a 0.9 FTE that means I work 36 hours in one week or 72 hours in one pay period. (9×4=36)
If I was a 1.0 FTE I would work 40 hours in one week.
If I were to be part time I would usually only work a 0.6 FTE and I would only work 24 hours per week or 2 – 12 hour shifts.
Usually positions that work below a 0.75 FTE (depending on the organization) are not eligible for full time benefits or they have to pay more for their benefits that they receive. Sometimes when you are new, your only option is to wait until a full time FTE opens up to get all of the hours you want and take a lesser FTE like a 0.6 to get your foot in the door.
I personally enjoy working my three days a week and then having the other four off. If you were to group all of your days together, for example, if you work Monday, Tuesday, Wednesday, Friday, Saturday, Sunday you would have the next week off because you worked all of your 72 hours in one week which is what I’m doing this week.
As I’m trekking through a long week of work – here’s a glimpse into my work schedule:
Monday – 12 hours – day shift
Tuesday – 12 hours – day shift
Wednesday, Friday, Saturday, Sunday – 12 hours – overnights – that’s working the next 6/7 days – a 72 hour work week.
It also gives you an opportunity to pick up major overtime in your scheduled week off. I’m averaging 48 hours a week for December with my overtime.
Various organizations have incentives to pick up extra hours. Sometimes you can earn $3-$4 an hour extra just for picking up a shift but you can earn time and a half every hour worked over 80 hours.
There are also weekend package options which is where you work 4/5 or 5/6 weekends – Friday, Saturday, and Sunday, they are eligible for full time benefits, and then earn either time and a half or a dollar amount more per hour depending on the organization.
We do self scheduling where I work and I love it. A blank schedule goes out, all nurses take the time to fill in which hours/days you’d like to work, and then it gets tweaked by our supervisor. I would say I get 90% of the shifts I write down or sign up for. There isn’t much overlap because we are all on different weekend rotations.
You would think this would be a difficult way to schedule nurses but it actually works out great. Many of our nurses WANT overnights and many WANT day shift. Personally, I’m a flip flopper. I don’t like to work only days or only nights so I usually end up working Monday and Tuesday day shift and Thursday night overnights with my every third weekend rotation.
We call it “hell week” at work because if you work all of your shifts in a pay period in one week you get the next week off completely without taking PTO which is great!
It’s also nice because I can still take a week off of work for a vacation without having to use my paid time off. I just schedule myself accordingly but that may also mean I work the “hell week.”
I’m sharing this with you just to give you some more information on how nurses “crazy hours” actually aren’t that crazy and they definitely have their perks!
In conclusion, to my nursing friends, I want you to consider and ask a few questions before you take a new job with new hours:
Do they consider seniority when making the schedule?
How many weekends will I work?
Is there an opportunity to decrease FTEs to part time?
On average, how long does it take to get the shifts/schedules I want? (for example, does it take several years of night shift to get seniority to move to day shift?)
How many FTEs do I have to work to gain full time benefits?
What works best with my family’s schedules?
How long am I willing to work the shift I don’t want to work to get to the shift I want to work?
That’s all I have for today folks! I hope this is helpful!
P.S. I also wanted to touch on what it means to be PRN – PRN means AS NEEDED. Many nurses, when transitioning to a new job stay PRN at their old job which means they can still pick up hours and they are still an employee of the hospital. You can have a full time job and work PRN somewhere and pick up hours!
In honor of Emergency Nurses week which lands October 6th-12th, here are 10 reasons why I love being an ER nurse!
1. Shifts go by FAST
(For the most part). When we are super busy it feels like time flies! I work 12 hour shifts and I love it – I either work 7 am to 7 pm or 7pm to 7am! I love both shifts equally and I flip flop shifts a lot – often in the same week! People call me crazy but we do self scheduling in our emergency department and I sign up for the rotating shifts! I have to work 3 – 12 hour shifts a week – I wouldn’t want it any other way!
2. Emergency nursing is all about TEAMWORK!
Each day I work, my team consists of a doctor, another nurse, and an assortment of EMTs and paramedics. We coordinate with ancillary departments such as lab, radiology, social services, and EMS. Every team member plays a vital role in the care of our patient and it is well known that we can’t do our job without the other team member(s). We all hold a mutual respect for each other’s role.
My coworkers/team members are amazing. They make my job so much fun. They also understand what it is like to work in an emergency setting: the frequent flyers, the rude patients, the safety concerns, the disrespect, the heartbreak, the trauma, the things you can’t unsee, THEY GET IT. I can lean on them for support in a way I can’t lean on my husband or my friends.
We all know each other’s weaknesses and strengths. We are all invested in the care of the patient and want the best outcome. Being a member of the emergency healthcare team is such a privilege and I do not take it for granted.
3. You never know what is coming through the door!
When I ask nurses why they wouldn’t want to work in the emergency department, this is the #1 answer: I don’t know what will come through the door next.
THAT’S WHAT I LOVE! I LOVE knowing that things can change any second. I love the challenge of managing several critical patients showing up at the same time. I love the rush. I love the unknown. More than that, as I’ve become a stronger nurse, I love knowing that I can HANDLE anything that comes through the door.
This may sound arrogant but…..
You have to be confident in your skills – what if I said “I don’t think I can handle anything that comes in.” That isn’t reassuring.
I am NEVER alone – refer back to reason I love ER nursing #2 – I have an amazing team.
4. You get to work with every population!
I work in a general critical access hospital – this means that it is a small hospital. We have 25 beds between med-surg floor and OB. The ER has 10 beds. We average seeing about 25 patients a day. I work with every type of patient of every age of every background. We have quite the diversity of patients – more than you’d expect in the rural midwest. Each population brings its’ own unique problems and considerations so my day NEVER looks the same!
5. I LOVE starting IVs.
Seriously though, I LOVE starting IVs. If I ever work in a bigger hospital, I think I would apply to be on the IV team! I start an average of 0-10 IV’s a day. The ER nurses and paramedics serve as a resource to the rest of the hospital for difficult IV starts. There is nothing more rewarding than being able gain IV access on the first stick of a difficult patient – all the way from newborn babies to the elderly.
6. You get to work with EVERY body system and learn how one affects the other!
From the relationship between magnesium and potassium, to the interactions of ace inhibitors and why it can have a cough as a side effect, I’m such a NERD when it comes to how medications effect the body and how each body system effects the other. If we aren’t sure how compazine works, why does it cure a migraine? Does this medication act as an anticoagulant or a anti platelet? Why is toradol more effective than narcotics when treating kidney stones? Why is a beta blocker given for a STEMI instead of a calcium channel blocker? Just when you think you have a handle on it, a new medication or disease process comes along!
7. You get to know frequent flyers!
Frequent flyers is sometimes used as a derogatory term in emergency departments. For me – I love my “repeat customers.” I get to know them, their health history, their chronic problems, their families and I feel like I can take the best care of them! I “sign up” to take them right away – they are relieved when they see me and I take pride in knowing that I am the best nurse to care for them!
8. You get to see some cool stuff.
This one is obvious. Every time I tell someone I’m an ER nurse their first response is usually “I bet you see some cool stuff.” Yes, I do. Sometimes I’m laughing all the way home, sometimes crying. Some days I spend all day learning and some days the cases are pretty predictable. I have to be really careful how I word this answer. Obviously I don’t WANT people to get hurt and have really cool injuries but it happens and sometimes I come across a really interesting case – traumas, medical mysteries, deep deep lacerations, incision and drainage of cysts, gun shot wounds, etc.
9. I get to develop my multitasking skills everyday!
I LOVE this part. My mind automatically multitasks and develops to do lists and can go a mile a minute – I didn’t start off like this but my management and multitasking skills get stronger every time we have a crazy busy day with truly critical patients and only 10 beds and an ambulance coming in and going out and an IV start in CT and a GI bleed who needs blood hung and a helicopter landing and a suicidal patient requiring one on one care and that little tot just threw up in the lobby and med surg is ready for report and I haven’t peed in 8 hours and forget a lunch break – I LOVE days like that.
10. I’m a resource to other departments.
I love starting pediatric IVs. I did not used to. I used to beg the paramedics to step in for me or send someone else with more experience down to start baby or kiddie IVs until one day a good friend of mine said “you won’t learn if you don’t try.” I spent the next year taking EVERY possible IV start and pediatric IV start available. I studied it, I watched other experienced medics, I would assist whenever I could, and now I’m a resource. I’m a relief to others who are scared like I used to be. Am I perfect? NO. I don’t get nearly enough exposure but by taking every opportunity to learn I have built my confidence and I’m now a resource to my coworkers and other departments. This is an example of how I reach to be the best nurse I can be for my patients. I also try to offer as much experience as I can to other departments. If we have a critical patient, I’ll ask med – surg to send down a “newbie nurse” and I’ll walk through treating the patient step by step so they are more prepared and understand how to handle critical situations such as hanging drips, giving RSI medications, or working through a code. Be the mentor you wish you had.
That’s all folks! Thank an ER nurse this week! I’ve also seen that it is PEDIATRIC NURSES WEEK! ❤️❤️ so show them all the love you can too!