Many times in your nursey career, your seemingly awesome shift will turn crazy in a moment. The mark of a good nurse is staying calm in the midst of chaos.
This is when your prioritization skills need to be on point. You should think, “what is the most important and time sensitive thing at this specific moment?” There are many things that can seem like emergencies that need to be done RIGHT NOW, but should actually be moved further down the list due to more pressing issues.
For example, when a nurse gets an order to transfuse blood, one may think that they need to drop everything and go do that immediately because blood = new and scary. However, think about the reason they’re getting blood. Is it because of acute blood loss or symptomatic anemia? Or are they chronically anemic and their H/H has slowly dropped over the last few days and now we’re finally transfusing because it’s barely below normal? Acute situations means you do need to drop everything. Chronic, proactive situations/orders means you can get a few important things done first. If you get an order for a unit of PRBC’s for a chronically anemic and asymptomatic patient and it’s mid-med pass and you’ve got 2 patients left with insulin due with their trays in front of them, I’d finish those two meds really quick before ordering your blood.
Calm delegation is the second step in keeping calming during a crazy storm. After you identify what needs to be done, identify what you can delegate safely. And when you go delegate these things, convey to the person you’re delegating to that it is time sensitive. You may be so calm that they have no idea you’re internally freaking out.
During all of this, it is important to have the mentality that you can handle anything. Even if you think you can’t.. that totally does not matter. What’s important is that you convey to your patients and coworkers that no matter what happens, you have got this. Confidence, confidence, confidence. It goes such a long way in the midst of chaos.
So, let’s review with an example..
You are giving meds to your second patient. He starts to puke. You look into your computer chart and see an order for 2 units PRBC’s on your first patient. You see you have an order for Zofran on your puking patient. On your way to go get Zofran from the Pyxis, a family member calls and wants an update on your third patient. A doctor is rounding and starts asking questions about your 4th patient. And while the doctor is asking questions, your 5th patient is on their call bell, having to go to the bathroom, and wants a pain pill for a mild headache. OH! And the family member of your 6th patient says they are really, really lethargic and breathing really weird all of a sudden.
Now that you’re SOB from reading that, in what order do you do everything?
First, take a deep nursey breath.
Second, put your Nurse Face on because you can handle this.
Talk to the doctor whilst walking to the Pyxis and get Zofran.
Have whoever answered the phone with the family member take a message – you’ll call in 30 minutes.
Delegate to the nurse who just discharged 3 patients, is all caught up, and is flipping through her phone in the nurse’s station, to give the Zofran you just pulled. Tell her the patient is currently puking.
Delegate to your tech checking her email to get a set of vitals on your 6th patient, and make sure to tell that tech that this needs to be done like, now, because the patient is having changes. When she’s done, tell her to take your 5th patient to the bathroom. Have her tell the 5th patient you’ll be there in 10 minutes with a pain pill.
Go check on your 6th patient who just got a fresh set of vitals. Call the doc, if needed. While you’re waiting for the doc, fill out your blood request form, and grab the pain pill out of the Pyxis. Wait to send the blood request down until you hear from the doc about your 6th patient before sending it down. You want to make sure there aren’t any STAT orders you need to complete because once you send for the blood.. it’s on it’s way, and you’ll only have 30 minutes to hang it (and you have to be in the room with them for the first 15 minutes).
If everything is good with your 6th patient, send down your blood request form and while they’re working on sending the blood, go give your pain pill. (Bonus! You know they have 3 other meds due in 15 minutes so you snag those as well.) If your blood isn’t here by the time you get done with that, call the family member back and check to see if the Zofran worked on your second patient.
BOOM. You’ve put out 6 fires. And it’s only been 28 minutes.