How to Deal with a Traumatic Situation at Work

How to Deal with a Traumatic Situation at Work

At some point in every nurse’s career, they will experience a traumatic situation such as a hemorrhage, code blue, or even the death of a patient. It is important to know how to deal with the aftermath of this type of event so you can begin the healing process. Failing to take care of yourself or pushing away emotions could lead to burnout and potentially end your nursing career. Here are a few tips on how to process and recover after a traumatic situation at work.

1. Debrief with your coworkers.

During an emergent situation, your perception of the events that took place may be skewed due to adrenaline and anxiety. It is important to take time to debrief with others who were involved in the situation with you, so you can begin to process the situation. As you discuss how everything unfolded and begin to understand everyone’s role in the event, you will be able to process what happened. Be sure to address any questions or concerns you have about how or why things occurred the way they did.

2. Take time off from work.

After experiencing a stressful situation at work, ask yourself how you are feeling about returning to work for your next shift. If you are feeling anxiety or dread, it might be a good idea to take some time off. Talk to your managers about these emotions and see if they can help you to arrange some time off. Having time to process your emotions and refresh yourself will help prevent burnout.

3. Spend time with loved ones.

It is important to spend time with the people you love most after a traumatic event. You may not be able to discuss the details of what happened due to HIPAA, but you can express how you feel emotionally. Your loved ones will be able to comfort you and provide you with the support and space you need to begin healing.

4. Practice self-care.

It is always important to practice self-care, but it becomes absolutely necessary to do so after the emotional and physical stress of a traumatic event. Check in with yourself about the emotions you are feeling and what could help you to process and relieve them. For example, if you are feeling overwhelmed or anxious, try going on a walk or doing a workout you enjoy. If you are feeling physically or mentally exhausted, try getting a massage or taking a nice, warm bath.

5. Seek professional help.

In some cases you may not be able to work through the aftermath of a traumatic event on your own. It is perfectly normal to need additional help from a therapist. Ask your employer if they have reduced cost or even free therapy sessions for employees needing assistance.

It is important to remember that you are not alone and that at some point, every nurse has struggled in the aftermath of a traumatic event. Every day it will get easier and one day you will wake up and feel completely healed.

On the Move: What It’s Like to be a Critical Care Transport Nurse

On the Move: What It’s Like to be a Critical Care Transport Nurse

When patients need to be moved from one location to another, and they’re in critical condition, every second counts. The transport team caring for them during these moves provide crucial care that can sometimes mean the difference between life and death. Today we celebrate them in honor of Critical Care Transport Nurses Day, held annually on February 18th.

Kristen PonichteraKristen Ponichtera, BSN, RN, CFRN, CTRN, CCRN, is a Critical Care/Emergency Nurse at University of North Carolina at Chapel Hill Medical Center. She knows firsthand the importance of being a critical care transport nurse. “As a transport nurse, no two days are the same. The job entails a lot of planning and preparation, as well as constant maintenance of didactic and clinical proficiencies. The ability to perform at a high level at a moment’s notice is a key element of the field because, for majority of the patient population, minutes matter,” Ponichtera explains.

After she spent years working in critical care and emergency medicine, Ponichtera became a critical care transport nurse because she says, “I was ready to expand my scope of practice and test my knowledge and skills to the fullest. Critical care transport nursing was the appropriate step. I then fell in love with the specialty.”

Like every health care position, critical care transport nursing has both challenges as well as rewards. “The biggest challenge of the job, which doubles as the most exciting, is to expect the unexpected. Every patient assumed under your care during transport is remarkably different from the last, and it is the responsibility of the transport nurse to be able to anticipate the needs of each individual patient,” says Ponichtera.

As for the best parts of the job? “The greatest reward of being a transport nurse is being able to give a patient and their family peace of mind by providing care marked by precision and exactitude when they are in their most vulnerable state,” Ponichtera says. “Practicing with autonomy and earning collegial respect is an additional reward in being a transport nurse. Finally, recognizing the impact made each day on the lives of patients and their families adds value to the career.”

If you are interested in looking into becoming a critical care transport nurse, Ponichtera says that “This is one of the greatest jobs in the field of nursing. Confidence coupled with humility are characteristics every transport nurse must possess, as our patients demand the best in care. But we also must recognize there is always more to learn. Luck is where preparation meets opportunity. Getting the right experience, asking the right questions, and never giving up are the ways I was lucky enough to get into this field, and I suggest you do the same.”

“Although small, the transport nurse community is always willing to lend a hand to those looking to break into the field,” says Ponichtera. “Seek us out and we will be happy to assist our fellow nurses in any way we can.”

10 Big “Do’s” and “Don’ts” of Interviewing

10 Big “Do’s” and “Don’ts” of Interviewing

Interviewing has a basic set of standards that should be foundations for every interview and permeate every aspect of the interviewing process. From your preparation to your final contact with HR or a hiring manager, you should adhere to these “do” and “don’t” principles.

5 Do’s

Be Honest

Character is one of the most important aspects any employee can have. No matter how good a liar you might be or how much you may stretch the truth, you give off cues that you are not telling the truth or the whole truth. If a potential employer gets the feeling that you are not being completely honest, it will be a huge red flag.

Hold Yourself Well

Posture says a lot about your personality and your attitude. Hold a professional posture that exudes professionalism, self-confidence, and a positive attitude. Don’t get too casual with how you sit or the language you use. Make solid eye contact and be actively engaged in listening.

Dress Professionally

If you are not sure how to dress, do some research. If you aren’t sure if you are over- or underdressed, err on the side of being overdressed. Never do the opposite. Most organizations post a general dress code. Be professional. You might have to invest in a nice business suit that fits you well. Don’t walk in looking unprofessional because of your clothes. Be sure you are well groomed and that your clothing looks professional.

Admit Weaknesses

As mentioned previously, we all have weaknesses. Acting as though you don’t is essentially lying or having a huge ego, neither of which is good during an interview. Remember that a weakness doesn’t mean you’re completely failing in a particular area—it just means that you are not as fluent in that area as in others. Weaknesses can be overcome, but character issues most likely won’t be.

Communicate Well With Human Resources

Human resources has a direct relationship with hiring personnel. If you are not professional in your interactions with HR or prove difficult to work with, that information will surely be communicated to the hiring team. Oftentimes an HR representative will sit in on the interview as well. Any interaction with someone involved in the hiring process should be taken seriously and handled professionally.

5 Don’ts

Fake It Till You Make It

To a certain extent you need to be able to back up everything you say during an interview. Sure, you could argue that you won’t lose a position after obtaining it if you can’t back up everything that was said during an interview. There is a level of cheating yourself you do with that mentality. To say you have something that you don’t actually possess shows a lack of integrity. This is why plagiarism is frowned on and so harshly punished. If you didn’t actually do the work for your degree, you are lying about your credentials and don’t possess the skills that your degree implies you do have. You are lying through the means of a degree because you can’t actually back up what that degree symbolizes or entails. To those who actually put in the work and possess the skills, that attitude is highly offensive. Make sure you can back up what you say.

Exaggerate

We all know people who dramatize every story to make themselves look as innocent as a dove and someone else as evil as Satan himself. Don’t be that person—don’t exaggerate a situation to make yourself look flawless. Don’t demean other people. This is not a healthy sign of a professional. Be clear, objective, and truthful. Talk more about actions and less about personalities. Oftentimes things can come across as gossip. Employers will not knowingly want to bring that into the workplace.

Bring Ego

This “don’t” could really wrap up a few others more generally. Bring your personality to the interview in a professional way, not your ego. Let the interviewers get a feel for who you are and what your likes and dislikes are. But don’t bring ego. People are almost automatically turned off by people with a “big head.” Ego could practically look like an overconfidence in oneself—a failure to admit any real weakness, never being able to admit you’re wrong, or that you think more highly of yourself than you do of others.

Be Irresponsible

There are so many things to say in this section. Be sure to take anything you need with you. Have an extra sheet of paper and a writing utensil to take notes. Show up at least 15 minutes early but don’t arrive at the interview more than 15 minutes early. If you are unfamiliar with how to get to the interview or how bad traffic might be, get there with plenty of time to spare. But if you are 20 or 30 minutes early, don’t let them know you are there. Wait until it’s between 10 to 15 minutes before the scheduled time and then show up to your appointment spot.

Take extra copies of your resume or any other documents, such as a letter of recommendation. If you carry a folder or writing utensil, be sure that they are in good condition as well. Make good eye contact and be sure to greet everyone in the room who is interviewing you.

Forget to Follow Up

Follow-up is an important aspect of an interview. It gives you one last opportunity to influence the interview panel or those making the hiring decision. During a follow-up, by phone or email, be as professional as possible. Thank them for the opportunity to interview for the position. Express how you think you’d be a great fit for the role. Let them know that you will wait to hear back regarding their decision. Don’t make them feel as if they need to respond to your email or that you are expecting a response from them. That is not appropriate for a follow-up. If you want a response to something, do it through HR.

Anything you can do to help increase your chances of getting a new job should be taken seriously. Implementing these ten foundational “do” and “don’t” principles will help set you apart from other candidates.

What a Knockout: Working as a Perianesthesia Nurse

What a Knockout: Working as a Perianesthesia Nurse

When patients need surgery or any other procedures that require anesthesia, they need a good health care team working with them to ensure their safety. Perianesthesia nurses are a crucial part of this team. And in honor of PeriAnesthesia Nurse Awareness Week, Regina Hoefner-Notz, MS, RN, CPAN, CPN, answers our questions about working as a perianesthesia nurse.

Hoefner-Notz is the Clinical Manager for Phase I & II PACUs (Post-Anesthesia Care Units) at Children’s Hospital Colorado as well as the Vice President/President-Elect for the American Society of PeriAnesthesia Nurses (ASPAN). An edited version of the interview follows.

Regina Hoefner-NotzAs a perianesthesia nurse, what does the job entail on a daily basis?

Perianesthesia nursing encompasses all the care an individual might need around (Peri from the Greek for “around”) the administration of anesthesia—hence the practice name perianesthesia. Most people think in terms of recovery rooms and surgery, but this practice has evolved into so much more.

Nurses in perianesthesia guide and care for individuals through some of the most traumatic times of their lives. Surgery and procedures are nerve-racking for everyone. Anytime a patient receives anesthesia, there are nurses who prepare them, educate them and their family members, vigilantly assess and intervene as they recover from anesthesia, as well as continuing to prepare them for returning home safely. These nurses are specially educated and knowledgeable about many aspects of care, and various surgeries and procedures.

When I discuss this with nurses with whom I work, I acknowledge that they accomplish in 1-2 hours what it may take other nurses an entire shift to figure out. Perianesthesia nurses deal with multiple patients throughout a shift, each requiring care compassion and spot-on assessments.

I have the great fortune of managing our Phase I and II postanesthesia care areas. These nurses specialize in the immediate needs of their patients as well as collaborate with our anesthesia colleagues to determine when a patient is well enough and safe enough to leave the hospital after his surgery or procedure.

Why did you choose this field of nursing?

I was searching for a new nursing venue after 20 years in pediatric critical care. I had heard of the PACU as a great place to work and, in 2000, I took the leap to try this practice area. It has been one of the best career decisions I have ever made. After orienting and learning new skills, I remember thinking, “This is why I went into nursing, to see the whole picture.” It is extremely gratifying to be able to see a patient and family come into a hospital, successfully have surgery, reunite with loved ones, and be comfortable enough to go home to continue their recuperation in familiar surroundings. I love it!

What are the biggest challenges of your job? 

My challenges are a little different right now as a nursing manager and leader. I want every nurse to see this as an amazing practice area and to reach their greatest potentials through education and participation. I try to encourage ongoing professional education and involvement. It has been extremely rewarding to see nurses reach professional places they never thought possible, knowing I have a small hand in some of that. Other challenges evolve around the changing face of health care and trying to determine how we continue to give exceptional care to our patients, while always being mindful and good stewards of our financial resources.

What are the greatest rewards?

I have been a pediatric nurse for 37 years. The greatest reward of this job is to see families breathe that sigh of relief as we reunite children with their parents after surgery. The reward is seeing a child well cared for, and not as afraid as they might have been if they had not been in a pediatric hospital with perianesthesia nurses providing very specific care for them. My practice area combines two great loves—perianesthesia nursing and pediatrics.

What would you say to someone considering this type of nursing work?

This is an incredible practice area with something for everyone. Some nurses want to be front and center, always part of the action, and there is a place for them in PACU. Some nurses want to educate patients and spend meaningful time making sure everyone knows what to expect and what to do—there is a place for them in the pre-op areas and Phase II discharging areas. Some nurses want a little bit of everything, and they can do that too. Perianesthesia nursing can be found in hospital settings, surgery centers, outpatient centers, GI clinics, dental clinics, and anywhere there is a need for anesthesia and excellent nursing care.

Is there anything I haven’t asked you about being a perianesthesia nurse that is important for people to know?

Perianesthesia nursing is so privileged to have a professional organization exclusively dedicated to this practice area. ASPAN is the organization whose core purpose is to “Advance and promote the unique specialty of perianesthesia nursing.” ASPAN sets standards of care by promoting evidence-based practice for all nurses practicing in this area. This organization encourages networking, as well as professional growth and development, for all its members and I am a perfect example of someone who has been able to expand my professional horizons by being actively engaged in ASPAN. I would encourage every nurse to seek out his or her specialty organization and get involved.

Looking Back: What Retired Nurses Want You to Know

Looking Back: What Retired Nurses Want You to Know

Whenever we finish an experience, we tend to look back on it for many reasons. For example, we may look back after graduating from college to remember what classes we liked or friends we made. We revisit childhood in our minds to think of the really good times we had and what it was like growing up. And, when we retire, we will probably think back to what we learned, loved, and liked about our careers.

At Friendship Village Tempe, a retirement community in Arizona, there are forty-five retired nurses. They took some time to tell us what they would love for everyone—from new nurses to experienced ones—to know.

“Everyone today must acquire knowledge regarding their own health in order to make wise decisions.”
—Mary Lou Adler, RN, BSN

“Being a nurse uses all the knowledge and skills that you have. Deciding to be a nurse means you have not decided anything yet, because there are so many opportunities in the field.”
—Nancy Dolphin, PhD, BSN

“Problem solving skills can be transferred from bedside care to international leadership in addressing and advocating for health and human rights.”
—Joan A. Newth, RN, BSN

“Nurses can be advocates for family and friends when they are hospitalized to ensure safe, appropriate, compassionate, and ethical care.”
—Rosemary Kessler, RN, BSN, MED

“Since Florence Nightingale established the foundation for nursing, our profession has continued and continues to evolve as an art and a science.”
—Joan A. Newth, RN, BSN

“The number one thing that I would want you to know is that laughter is the best medicine. The number two thing is—that laughter is the best medicine!”
—Marilyn Lehwalder, RN, BSN

The following are from retired nurses who preferred to be anonymous:

“It will never get well if you pick it.”

“Marry a doctor.”

“Old nurses never die, they just lose their—patients—patience.”

What advice would you share with your nursing colleagues? Let us know in the comments!

PICC Line Placement in the NICU

PICC Line Placement in the NICU

I have been placing percutaneous intravenous central catheters (PICCs) in neonatal patients for almost 25 years, and I admit taking apart the process seems a bit daunting. One of the most important factors for successful insertion is good planning.

The first thing I do is identify the patient. Any neonate who is less than 1,250 grams, requiring antibiotics or total parental nutrition for more than 5 days is an obvious candidate. An infant over 1,000 grams requiring frequent blood draws could be considered for a larger PICC as the unit I work in uses the line for blood drawing as well as fluids and antibiotics. The patient should not have active bacteremia or fungemia.

Once I identify the patient, I review the current fluid status and recent complete blood count. A platelet count over 50,000 and normal hematocrit are preferable, and if out of acceptable range, it’s best to take time to correct these before attempting the procedure.

After I have identified the patient and assessed the individual factors, I will put in several prep orders. These orders include an intravenous (IV) 20 ml/kg 0.9 Normal Saline bolus, 1 mcg/kg fentanyl, and 0.1mg/kg versed given via IV. The bolus is to be completed immediately prior to procedure, the sedation and analgesia just before the start. I almost always follow this pre-procedure protocol, especially if this is not the first PICC attempt on the patient. Blood vessels in neonates tend to be especially friable and, in my experience, a normal hematocrit, fluid bolus, and appropriate pre-medication minimize that obstacle.

Next, I examine the patient’s vessels and look for the biggest vessel that is suitable for a PICC. I start with extremities as a PICC dressing is maintained easiest on an extremity. Recently, I have preferentially used the right saphenous if it’s suitable. The main reason I have been doing this is that there is more leeway on the placement of the tip of the line than in an upper extremity. Upper extremity lines have a smaller acceptable target area, a higher incidence of line migration; the observation of the tip placement on X-ray is very sensitive to the patient’s arm position when the X-ray is taken. Also, a lower extremity line will often remain in a central position through patient growth.

The procedure of PICC placement is well documented. The few variations I use when I place a PICC include: my own positioning and I cut the catheter to the exact length.

One important pearl I would give to the novice PICC inserter is to practice your IV insertion skills. Proficiency in IV insertion will not guarantee that a PICC insertion will be easier, but without the IV skills, insertion of PICCs in neonates will be less successful.

Like any other procedure, PICC line placement requires patience and practice. The methodology I use has been refined over the 25 years I have been doing this in the NICU. If you are interested and would like to discuss it, please do feel free to email me at Christine.omalley2@uchospitals.edu.


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