Surviving a Bad Day

Jul 03, 2019

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You’re not helping anyone by being a martyr. When you neglect to care for yourself in basic ways, you are not only letting yourself down, but you are also letting your team down. Your colleagues and your patients need you to be at your best, and that means taking care of yourself.

Andrea Useem

Bad days happen in all professions, but in the high-stress world of acute and critical care when patients and families are often experiencing their worst moments, they can be much more intense. Three compassionate nurses have made it their mission to help colleagues prepare for and get through the tough times and thrive in their practice. Magally Rolen, RN, Texas Health Harris Methodist Fort Worth Hospital; Anna Rodriguez, endoscopy nurse, University of Utah Hospital, Salt Lake City; and Andrea Useem, RN, CN III, Virginia Hospital Center, Washington, D.C. area, recently presented at NTI 2019 in Orlando about how to survive a bad day.

What made you decide to speak about surviving a bad day?

Andrea: I think the decision to leave the bedside — or nursing itself — is often the result of an accumulation of bad days. What if we could intervene early in that progression? If we have skills to manage those days and learn from them, I believe we could extend the amount of time we can thrive as bedside nurses.

Magally: Bad days make you stronger and wiser if you approach them the right way, and they help you find out who your allies are. I call them my “character- and team-building days.”

Do you think nurses having a bad day also affects patients?

Andrea: How can it not? So much of our job as nurses is relational, meaning we are bringing our whole selves to help care for the patient. If we are drained, exhausted or angry, for sure we will have less energy to give our patients.

Anna: You’ve probably heard the phrase “put on your own oxygen mask first.” When your physical, mental and emotional energy is depleted, your patients can totally tell. Plus, evidence directly correlates nurse burnout to patient outcomes. Taking care of yourself is part of being the best nurse you can be.

Some nurses tell us that they’re too busy to take a real break or they feel guilty asking another nurse to watch their patients. What advice would you have for them?

Anna: Sometimes you just have to pick a point in your shift to hit pause and step away, knowing that nursing is a 24/7 job, and there’s never a “good” time. I ask a nurse to watch my patients and offer to return the favor during their break.

Andrea: You’re not helping anyone by being a martyr. When you neglect to care for yourself in basic ways, you are not only letting yourself down, but you are also letting your team down. Your colleagues and your patients need you to be at your best, and that means taking care of yourself.

What can nurses do to ensure they don’t bring a bad day home with them?

Magally: Take a deep breath and maintain a positive mindset. As soon as you clock out, think about the good things in your life, such as your family, pets or your upcoming vacation. Play relaxing or upbeat music. Call a friend and tell them how you feel — sometimes we need to debrief our feelings to feel better. I also like to listen to inspirational speeches while I’m driving to uplift my spirits and build my motivation.

Can you tell us more about your bad day checklist and burnout book?

Andrea: As a new grad, when I needed to master a new skill like setting up an arterial line, I would create an index card that I could carry around in my pocket. I decided to make an index card with advice to myself about how to survive a bad day. That became my bad day checklist.

Anna: My burnout book is a small notebook that I keep in my locker at work; I started it during my second year as a nurse. It’s the place where I write down funny work stories, patient thank you notes or co-worker compliments. When I’m having a bad day, I’ll flip through that notebook and reconnect with my why.

You say that a series of bad days can lead to burnout. How can nurses ensure that one bad day remains an isolated incident?

Andrea: To me, this is a psychological question. When I have a bad day, I “pile on” with negative thoughts. For example, if I’m having a bad day, I tend to think ahead and imagine that my shift tomorrow or next week will also be bad. So I start dreading those future shifts, and that dread becomes yet another burden in my already bad day. One important step is reminding myself: “This is a bad day, period. It will end, and other days will be different.” I’m lucky to have a job where the good days outnumber the bad.

How can a nurse support a colleague who is having a bad day?

Magally: At my unit, when we know one of our co-workers is struggling, we team up, come up with a plan, divide the duties and conquer the shift. As a military wife, I have learned we should never leave a co-worker behind when they are having a bad day. A helping hand is always welcome, especially when you’re obviously sinking.

So asking for help is key. What are some signs that suggest it’s time to reach out to others?

Magally: Clear signs and symptoms that a nurse is in desperate need for help are: if you have not taken a break and are getting hungry/ angry — “hangry” — you can’t remember the last time you went to the bathroom or drank water, your co-workers keep asking you if you need help (sometimes others can tell you need help before you realize you need it) or you are way behind on charting. None of us wants to bother busy co-workers, but we need to admit there are times when we can’t do everything ourselves.

Anna: Part of being a patient advocate is recognizing when their care is being compromised or delayed because of other tasks that are taking priority. I start asking for help as soon as I know my patient’s care is being negatively impacted.

Andrea: When I was a fresh new grad, I was sometimes afraid to ask for fear of being seen as needy or incompetent. Now I am better at trusting that inner voice, the one that knows I need help in order to give our patients the care they deserve. Asking for help at work is not asking a personal favor; it’s just what it means to be part of a team.

Because balance is such an important part of surviving bad days, what do you like to do outside of work?

Andrea: I like doing things with my sons that we all enjoy, whether that means watching reality TV together or skiing or teaching them to drive. My husband got me into running, and my dream is to one day run the JFK 50, a 50-mile ultramarathon in Maryland.

Magally: My loved ones and I spend a lot of time at our family ranch, where we have a vineyard and apiary. I also garden and tend to our backyard chickens and home vineyard, exercise, volunteer and play with our dogs.

Anna: I enjoy yoga, walks with my husband and dog, and interacting with other nurses through social media. I also love planning my next trip or vacation. Most of my traveling lately revolves around attending nurse conferences to speak about nurse burnout and resiliency.