Tag Archives: newnurse

What Nursing School Did Not Teach Me About Nursing, Part 4: Emotional Regulation

Nursing requires emotional regulation in a way that engineering never demanded. If an engineering project experienced delays in my former consumer products and manufacturing career, I could have a lot of anguish, and managers may be upset. Still, such delays generally wouldn’t impact someone’s activities of daily living, quality of life, or health and well-being. There are a lot of passionate reactions when a family member expects to take their loved one home from the hospital but cannot for whatever reason. When there are unexpected treatments, tests, or further monitoring patients must undergo, people get frustrated, particularly when they feel their health issues are unresolved or worsening. The family members or patients express their frustrations with their nurses. I try my best that my patients or families feel heard or understood, but sometimes, a healthcare worker’s efforts are not enough or provide little comfort.

I’ve witnessed codes ending in unexpected deaths, and I still have to be present and care for other patients while surviving family members grieve. I’ve dealt with emotionally unstable, angry, or stressed-out patients and family members. Patients have attempted to hit me or have cussed me out. I don’t take it personally, but I sometimes fear for my safety. I feel like these instances of feeling unsafe have drastically dropped since I started working in the NICU. However, I still float to the PICU or Pediatric units. During my orientation in the Pediatric ward, a 4-year-old patient tried to bite me when another nurse and I tried to change his ostomy bag. Shortly after my cross-training to the Pediatric unit, I had a Pediatric teenage patient attack her sitter. These instances are further reminders of why I chose to work in the NICU over other units. But witnessing these events made me realize that it’s not helpful to react emotionally to dysregulated patients. I’ve seen healthcare workers respond angrily, and it does nothing to help de-escalate situations.

Aside from navigating emotional pitfalls with my patients or their family members, I’ve had to figure out how to deal with specific staff and co-workers. I have had to learn who and how to ask for help or get people to do their jobs so I can do mine to ensure my patients are getting appropriate care. Certified Nurse Assistants (CNAs) typically support registered nurses (RNs) by performing activities of daily living for a patient, taking vital signs, or acting as sitters. RNs are responsible for ensuring the CNAs work is documented and must oversee and support the CNAs work. As a new grad, I’ve had to correct a grumpy CNA about proper hand hygiene or continuously remind a CNA to document their work in the patient’s chart. I like that I don’t have to worry about this in the NICU. In the NICU, we have no CNAs. I appreciate this versus negotiating or constantly confronting an uncooperative CNA to do work or documentation. Don’t get me wrong, just as with any role (Charge nurse, RN, Doctor, etc.), some CNAs are incredible, but some are not. I like having one less variable to deal with during my shifts.

Photo by Karolina Grabowska on Pexels.com

I think it’s good to get a sense of your limitations and your ability to regulate yourself emotionally. I love babies and children, but I chose to work in NICU and not focus on Pediatrics for the genuine concern of being unable to regulate myself emotionally with pediatric patients. Anyone I’ve personally known who’s had a baby in the NICU has had their child leave and carry out healthy lives. My daughter will never be at risk of being in the NICU – she’s way past that stage. However, when I find myself in pediatrics, I see patients there that could be my child – some are there due to some freak accident or unknown illness. One of the most recent times I was in the PICU, a toddler or preschooler was getting intubated on the other side of the unit – I started to tear up as the patient was wailing and crying, “Mama” while their mother held them to prepare for the procedure. I was grateful this wasn’t my patient and tried to distract myself from their cries and their distressed parents by focusing on my patient.

It’s good to see parents involved with their children’s care, but other pediatric patients are there because of abuse by family members and adults. Some of the children’s social situations are sad. I can’t dwell too much on this as I care for my patients, and I try to give the child the best care I can while they’re my patient. I try to develop a trusting relationship with patients (or family members) by promptly communicating with them and responding to their needs. For abused patients, I sometimes tell myself, “This child’s life before they arrived at the hospital may not have been so great, but I can care for them and provide some stability and safety while they’re under my care.”

Complex social problems can also occur with our neonatal patients.
I see my fair share of neonatal patients in our NICU because of maternal drug use – some mothers are remorseful of their actions and are in rehab programs, while others have no desire to quit using. Sometimes it’s hard for the moms to see their inconsolable babies withdrawing and know their baby is struggling because of their drug use during pregnancy. Some babies go home with their families despite drug use, and others do not. Either way, as a nurse, I try to support the caregivers taking the babies home and educate them on how to care for their babies. I’m responsible for the care of my patient while they’re in the hospital, but I also want to support their caregivers and give them confidence in being able to care for their babies (or children) when they leave.

I’ve never had a job that demanded so much of me every day. Nursing can be mentally, physically, and emotionally draining. Until I became a nurse, I don’t think I realized the impact nursing has on a person holistically. I like helping people, I like that I can do that as my job, and I want to be able to do that for a long time. I always heard about the nursing shortage but never really considered that what was contributing to that was nursing burnout and nurses leaving the profession until I started pursuing nursing as a second career. It’s essential to be aware of the typical challenges nurses face to determine how you will guard yourself and strategies for longevity in the profession. I hope this series of posts helps provide insight into what it’s like as a novice nurse and some of the things I do to keep myself connected to the things I love about Nursing. Good luck! If any other nurses out there have other advice to share, I’d love to hear it!

Staying Organized: Brains and Checklists

On my first day in Nursing Fundamentals Clinical, my instructor shared a typical schedule to follow when we’re on the floor and the expected flow of the day. My instructor explained how the nurse has to keep organized to ensure the nurse properly assesses each patient, gives medications on time, takes vital signs as needed, provides education, addresses orders, and documents care. One of my classmates asked how a nurse keeps track of everything, and my instructor responded, “Oh, I use my brain.”

My classmates looked at one another, perplexed. I wondered, “How will I hold all that information and remember everything I have to do in my brain?!?” Only later, with some further explanation from my instructor, did we realize the “brain” on which she was relying to stay organized is a document and not an organ in her body.

A nurse’s “brain” is a document that helps a nurse stay organized and allows the nurse to take notes for shift handoffs, doctor’s reports, or assessments. A nurse can also use a brain to track: treatment or surgery, when to give medications or perform additional tasks, inputs, and outputs, progression of care, or the completion of orders. Of course, the nurse documents care within a patient’s chart. However, a nurse’s “brain” serves as a mini notepad or planner for the nurse between charting.

In nursing school, I was exposed to and used various types of brains. There are numerous templates for brains available, and some are even free. During nursing school, I liked trying the brains offered by nursing.com. (With a subscription, the website provides a brainsheet database of 33 different brains, some focused on specialties like ICU, Peds, or L&D). Often, units in hospitals print specific brains for staff to use. However, it is the nurse’s preference that determines the brain a nurse uses. For instance, my preceptor never uses the unit’s pre-printed brains and writes out her brain every time she shifts. While nurses are not required to use a brain, I don’t believe I’ve ever met a nurse who doesn’t use one.

After attempting to use multiple brains, I decided to design my own. Some brains don’t have enough space, are not organized the way I want, or do not capture the information I need. As a new grad nurse, I find it difficult to track the completion of required charting or documentation unless I note it in my brain. No generic brain template is going to capture the documentation unique to my unit.

As I imagined what I wanted to include in the brain I was designing for myself, I read the book “The Checklist Manifesto: How to Get Things Right” by Atul Gawande. My husband received it as a gift, and he recommended the book to me. He thought it would interest me since the author was a surgeon exploring ways to make surgeries safer. The author worked with the World Health Organization (WHO) to develop a checklist to use for surgeries, to prevent errors (and ultimately, injuries or deaths due to preventable mistakes). It was a quick and fascinating read. He explored how other industries such as construction or airlines use checklists. As in surgery, errors in those industries can be fatal. At its worst, errors in construction or flying planes can be catastrophic and result in mass casualties. Yet, such errors are rare compared to mistakes in surgery. The book discusses how he and others developed a worldwide surgical checklist for WHO and what resulted. The author also shares when checklists are inappropriate and offers tips on developing them, even down to what font one should use. I enjoyed reading the book – it was a nice break from studying or reviewing nursing-related topics, yet I felt it was helpful to me as a nurse.

Considering what I learned from Atul Gawande, I placed a documentation checklist onto my brain template. Since I’ve set the documentation checklist in my brain, I’ve been more efficient in my charting. I can ensure I’ve completed the charting documentation for each patient without spending extra time combing through various sections of a patient’s chart to verify completion multiple times. My preceptor does not have to stay over later to complete missing documentation for our patients as she did earlier during my orientation and training. My checklist lets me know what I’ve done and what’s still missing during my shift. I know I’ve become more proficient at time management since starting orientation, but having the checklist helps me keep organized and manage my time. Plus, as a checklist gal, it feels satisfying when I cross off all the boxes in my checklist by the end of the shift.

The documentation checklist I added to my nursing brain

Are there checklists you use day to day that help you in your personal life or your work? Or, are there brains you’ve used that you like? I’d love to hear and learn what works for others!