1. Stay calm. Remember it’s only 12 hours.
2. Think of it like triage; Plan around the most critical cases, and take into account the nurses who will be able to handle it safely.
3. Set up a cheat sheet. Separate the critical cases/ admissions coming/ open beds/transfers/downgrades/upgrades/telemetry/tasks: code cart, Pyxis or Omnicell count, glucometer check/supervisor’s name &beeper #
4. Be fair with the assignment - Avoid engaging in favoritism. Remember how it feels when you’re on the wrong receiving end (it sucks). You want them to have a good day, do what you can to start it off with good morale. If you’ve got a per diem, registry nurse, or float nurse, any of which have never worked on your unit before; avoid giving them the biggest train wreck patient, just because they’re “not one of your own nurses.” Think of how terrifying it was when you’ve had to float to a foreign unit, and got trapped with the worst cases, all because the cliquey nurses wanted to palm them off. It’s not nice, or the best idea; consider patient safety - the nurse will also likely need your help all day, given they’re in a new environment, or perhaps not used to cases like that. Distinguish this from favoritism. It’s not preferential treatment - It’s nurse safety, and it’s patient safety. Be fair with breaks. (Check if everyone is actually taking their break. Chaos prevents breaks and sometimes it’s forgotten).
5. Have a quickie staff meeting - Include the nursing assistants, let them know the plan for the day; i.e., which patients are the most unstable, which are likely jumpers, confused, restrained. Communication is the key to prevention.
6.Make your own rounds, several times a day. Ensure your colleagues know you’re there to support them, and help where you can.
7. Be mindful of the nurses/nursing assistants who say “I’m okay” and may actually need more help than the ones complaining a lot. Offer assistance with IV’s, turning and cleaning patients, answer call bells, assist with admissions, discharges and transfers. Ensure each nurse & nursing assistant receives some sort of assist, even if it’s to give them a few minutes break from a frustrating patient or family.
8. If the unit census is high, and you need to assign yourself to patients, try to take the ones that are low maintenance (or at least the ones whom start out they way). This isn’t the time to prove you can handle your own unstable patients and be in charge. Your time is better utilized managing the flow of the unit, and being free to assist all the other nurses.
9. Listen to everyone’s concerns, always consider things from their perspective, and do what you can to help their day run a little better, but don’t take on the unit’s problems, or gossipy cliques - it’s far too stressful, and likely won’t be solved in just one day. Let them be. There will always be someone who instigates foolishness, someone who finds fault in everyone, someone who is always annoyed, someone who doesn’t do their work, someone who battles everyone, someone who tries to one-up everyone, someone who hides in the supply closet.
10. If you feel the staffing is insufficient, speak up to the nursing supervisor. If you’re a unionized hospital, fill out the paperwork that reports the staff’s concerns with patient safety. Don’t be afraid to stand up for you and your colleagues. You’re the patient’s as well as the nurse’s advocate.
10.25. Never let anyone bully you into doing things “their way,”or manipulating you into changing an assignment to suit them. It’s impossible to please everyone, the best you can do is to be fair to everyone.
4 out of 5 ;) Nice to meet you 👋
I think it’s kind of wonderful that you’re looking for ways to help your friend during this immensely stressful time - genuine support is invaluable. It’s hard to articulate why it’s so overwhelming, and I’m not sure I have any better ideas than what she may already be doing, (but I can try).
Perhaps what makes it so frustrating is the combination of stressors; the surprise of competitiveness in a profession you wouldn’t expect it would exist in, analytical and critical thinking, exams which confound even the strongest of students, grades that seem to go out the window, facing the unpredictable during lab, or clinicals - where they feel consistently ineffectual, and the understanding of the vulnerability of human lives they will be responsible for. And, perhaps, a daily battle with confidence (usually not ending well).
- What may help your friend is isolating a strength. Why’s this important? In the thousand things she may think she is doing wrong every day, amid all the criticisms; it’s important to recognize what’s surfacing as a strength, unique to her. Examples; the ability to connect with patients, or maybe a photographic memory - pharmacology knowledge where they can just spit out the medications, class, side effects without looking it up, good documentation, etc. Students spend so much time thinking about, and working on what they are failing at, it’s imperative to also remember the things that they actually do well, particularly when times are tough.
- Also, integrate outside experience - previous learning and work experiences are all valuable, no matter how unrelated they may seem. It’s the discipline and focus learned that helps guide study and practice.
- Does she have a network of support at school? Is she able to communicate her frustrations and needs to her professors? Sometimes this is difficult, particularly for introverted students. There always seems to be swarms of students around the instructors, it’s hard to catch them without an entourage. Perhaps she can make an appointment with one of them to talk through how she’s doing.
- A reflective journal is something that works for some students - an outlet for articulating thought, in lieu of actually talking to people. (It is also pretty interesting to look back on this along the journey).
Additionally here is a recent post on surviving nursing school;
If I am truly honest, I probably cannot pinpoint what makes nursing school so overwhelming, all I know is when I was there, I felt incompetent 95% of the time, but it was the occasional surfacing of the 5% spark of understanding, & hope that I could maybe do this, as well as an unrelenting discipline that prevented me from quitting.
Every so often, I am asked by non-nursing friends why the pinning ceremony is considered more important than the actual degree graduation ceremony - they both are important - the achievement of a degree, and overcoming obstacles to get there, for all students in any program (not just nursing) is a beautiful moment, intensely satisfying and important for reasons that are relevant to each person and area of study.
Perhaps in nursing it is because it’s an intimate gathering; the journey of tears, physical and emotional strain have resulted in us actually becoming a nurse - at that point we’ve realized a once thought impossible dream, and much like the graduating oath of a doctor, we’ve taken a pledge to honor and care for each patient, no matter their walk in life. Perhaps just focusing on that as a goal is what may help your friend through.
If your friend would like to talk through her fears a little more, I may not have the answers, but I can provide a little understanding - she can write to me here privately.
Thank you for writing,