Is there really such a thing as a normal day on the OB unit? Highly doubtful. Unpredictability and uncertainty loom from the beginning of your shift to the end. But what if you could achieve some control over your day and try to decrease both your personal stress level and the stress of those in your immediate environment? While keeping your day 100% stress-free may not be possible, at least lowering the stress level for yourself and others is achievable and can help you to maintain stellar composure through the most grueling of patient scenarios.
Listen to these random comments made from OB nurses during the early hours of a recent 12-hour shift. Can you relate?
- “Are you kidding? I’m not taking that patient, I already have two labor patients!”
- “We need to make new patient assignments because the ED is now sending two more patients, and one is in active labor without any prenatal care.”
- “The patient in room 218 is having ‘lates’ and Dr. A is wanting to move her to the OR.”
- “I just found out the ‘no prenatal care’ patient is twins.”
Does this chaos cause your blood pressure and anxiety level to rise?
In today’s fast-paced landscape of high-technology birthing units, these scenarios are all too familiar to those in obstetric nursing. OB units, like EDs, never know what will walk through the door next. A day starting with ten patients can easily double in a few hours. Patient assignments and ever-increasing acuity and census levels can bring stress and dysfunction to even the best of units. And unfortunately, the nurses all too often feel the brunt of the impact.
Let’s take a deep breath, count to three, and begin to address a few actions to de-escalate.
1) Do not start your day with a high level of frustration over your assignment.
Voice concerns early. Discussing assignments together at the start of your shift provides a comfortable and acceptable forum for everyone to communicate their thoughts. Perhaps you have had several difficult patient scenarios in the past several days. This would be the perfect opportunity to voice your concern and request consideration for a different assignment. Informing your charge nurse of your recent scenarios can help her to achieve equitable assignments. This is an example of where co-worker consideration matters. Fairness of assignments is a big deal. Workloads for vaginal deliveries do not match workloads for C-sections, and tasks for high-risk patients do not match those for low-risk patients. Everyone needs to take their turn in sharing fair and equitable distribution of the hard stuff. Be respectful of your co-workers, step up to help when you are aware they have a heavy assignment, and go out of your way to make sure your unit has a team approach to patient safety.
2) Respect that the charge RN will have the final delegation authority.
The charge nurse is working hard to understand the “big picture” of the unit’s census and acuity as well as the complexities of the day’s tasks. They also must consider the level of experience and competence of all RNs on the unit.
Entry-level competence demands special consideration. Younger RNs with minimal experience will burn out sooner when assignments are particularly burdensome on a regular basis; moreover, these sorts of assignments are likely beyond their scope of ability. Burnout leads to turnover, and losing young nurses is not advantageous to staffing quotas or staff stress level. The staff nurse needs to appreciate the role of the charge nurse and not stew over assignments.
3) Be adaptable.
Understand that your assignment may need to change throughout the day. While continuity of care is important, nurses need to recognize census change is inevitable. Consolidation or redistribution of resources is vital to patient safety, and full compliance with optimal perinatal staffing guidelines may not always be possible. Commitment to your patient will help you get through your day and remove you from extraneous staff drama. Witnessing whining, complaining, and arguing distracts even the best of nurses and escalates anyone’s blood pressure. Stay focused on the task at hand and consciously avoid negative and harmful behaviors. Much has been written on the amazing benefits of mindfulness and meditation. Both can catalyze positive change and improved outlook. If you find yourself drowning in a toxic environment, step back, take a deep breath, relax, and try to redirect your focus with positivity. Focus to keep everyone’s best interest at heart. Consideration of your peers is not only respectful, but shows integrity and professionalism.
4) Get to know your patient.
Strong nurse-patient relationships are known to promote nurse satisfaction and decrease stress. Remind yourself how lucky you are to have a job that helps others with a life-changing and a life-lasting event. Childbirth has been slated as an event that is so monumentally powerful that memories that surround the birth experience remain intact for a lifetime. People interviewed in late life still recall specific details of the delivery of their child. You have been given the opportunity to impact that patient’s memories that will last a lifetime. There is nothing finer than witnessing a parent seeing and holding their child for the first time. The culmination of waiting and dreaming for nine long months leaves them in awe as they gaze upon the miracle that will change their lives forever. You have helped to provide this “pinnacle moment.” Few jobs offer such an amazing opportunity.
5) Meet with peers to address concerns.
If you are feeling overwhelmed with your work environment, chances are you are not alone. In meetings, allow everyone to voice their opinions and formulate a plan of action. Identify problematic areas and develop reasonable ideas to improve areas of ongoing concern. Your organization should be willing to work with you. Organizations that prioritize nurse engagement have shown improved nurse retention and satisfaction.
Daily implementation of these few simple practices can make a big difference. I invite you to consider the following:
- Your job is as good as you want to make it. Be the agent of change to overcome negativity on your unit. Offer your co-workers positivity and support.
- Cherish your strong ability as a nurse to provide your patient with the best “pinnacle moment” possible. End your shift with the mindful practice of giving thanks for the opportunity to help bring new life into the world and knowing you have done your best.
- Incorporate mindfulness and gratitude into your daily routine to create a peaceful inner solace.
- As you leave work, enjoy family and friends. Leave the stress at work behind.
- Focus on healthful practices that will foster continued relaxation and positivity for the remainder of your day.
- Remember to approach your next shift with renewed vitality and enthusiasm.
Unpredictability and uncertainty are the only constant in obstetric nursing. To achieve some control over your day, try to decrease both your personal stress level and the stress of those daily relationships with a few simple practices.
- Start your day with a positive outlook on your assignments
- Respect the charge RN’s final delegation authority
- Create relationships with your patients
- Communicate when you are overwhelmed - you probably aren’t the only one
Want to learn more about reducing stress around Labor & Delivery? It is all about patient safety and we have created this Obstetrics Playbook to provide guidance to increase performance.