How to Keep Calm and Nurse On When Things Go Nuts

By Kati Kleber, BSN RN CCRN

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 new 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? An acute situation is one that means you needs to drop everything and do it immediately. 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 calm 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, so make sure you let them know it needs to be done soon.  

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 because while they did wake up, they are really lethargic, the snoring is new, and they had a stroke yesterday and you’re worried about increasing cerebral edema. While you’re waiting for the doc to call back, 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 the doc doesn’t give you any STAT orders for patient #6, 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.  Then, go do another neuroassessment on patient #6.

BOOM.  You’ve put out 6 fires.  And it’s only been 28 minutes.

Told you – you can totally do this.

What do you think? Share your thoughts in the comments section below.

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  1. This portrayed scenario solution is definitely that of a nursing administrator’s, or hospital’s CEO’s viewpoint of how to prioritize. Obviously this author is not familiar with the fact that it is WRONG to delegate another nurse to medicate your patient 1) for whom the other does not have the history, and 2) for whom that other nurse has not processed the medication themselves!, & 3) the other nurse is as busy as you, because discharging patients takes a lot of time, & they, too, have other patients! The other commenters are also correct: there is RARELY anyone to delegate at an instant, and assign them more than one task! Staffing is always to short for this!! The nurse will get the work done on the adrenaline rush that burns out nurses every day. Thank goodness the nurse also didn’t have 8 -10 patients which is also the norm on too many med-surg. units! SHORT STAFFING SHOULD BE A CRIMINAL OFFENSE for so many reasons! UNDERFUNDED STAFFING FOR NURSES causes so many problems: human errors (resulting in discipline to the nurse), delays in care, unhappy patients & families, burned out nurses, frustrated physicians, A.P.N.’s, & P.A.’s. LET’S HOLD the HOSPITAL CEO’s and CFO’s ACCOUNTABLE: at non-profit hospitals, 80% of them earn $1 to $20.6 million a year – before bonuses! Nurses are working & getting burned out to fill the pockets of the CEO’s & and shareholders! Plus, in the past two months, the PPE’s (especially N95’s) are not readily available, endangering the lives of nurses, and those with whom they come in contact. For all of the money they earn, the CEO’s should have done their homework and reviewed the science to be prepared to protect their staff. Bottom line: the hospital could hire 50 to 250 more nurses if the CEO would only earn $250,000 a year, instead of the multimillion dollars they earn. Let’s see the money be spent on the Hands and Brains that Save Lives in real time, instead of lining the pockets of a few that are in their offices, safely away from the life-threatening action!

  2. The article had some good basic concepts and prioritizing is the key: Delegate to aide, defer family comm’s but offer to respond within a certain timeframe, be strategic to carve out space for time consuming activities (like a transfusion), multitask while walking down the hall (talk to provider).
    And some very not good tactics: have other nurse give med you pulled, not immediately go assess neuro patient having breathing issue.
    First tell yourself you’ve got this. Confidence and calm are great nurse tools. Walk to patient 6 while talking to the doctor. As you go by the nurse station ask the other nurse if they are able to pull and give the Zofran and tell the aide to go answer #5’s call light probably for a BR run and to tell #5 you’ll come with a pain reliever soon. Assess #6 and then (per the scenario) call their provider. Now coordinate the arrival of the blood to coincide with your expected ability to admin it. Go give the Zofran (because that other nurse was actually as busy as you are) and #5’s various meds. Call the family back on pt #3. Let your team know you will be in pt #1’s room for at least the next 15 minutes starting the transfusion.

  3. You forgot cleaning up the puking pt and sheets, another nurse can’t give meds you pulled (!), and in triage Airway/Breathing/Circulation trumps all – go NOW! Do your own, immediate, assessment lest you get really busy with a code! Then the subsequent lawsuit!

  4. In this scenario there is someone to delegate to; two people, actually. But in the real world that rarely happens. The nurse who just discharged two patients has another one coming up and the bed hasn’t even cooled off yet, and the aide is on break; the lucky person on the team who actually gets a break this shift. And having a conversation with the doctor while you’re walking to the Pyxis? Maybe, and maybe not.

  5. That scenario is looking through nursing through rose colored glasses! First, I would never ask another nurse to give my patient meds!
    Second, delegation is wishful thinking in this day and age. It’s not worth the aggravation worrying if someone else is going to do as you have asked!
    It’s much safer to do it all yourself!

  6. The problem with this scenario is that in the real world of nursing, the nurse who you said discharged 2 patients is also very busy with her/his patients trying to catch up with work..and the techs are also very busy either hiding away (lol) or with other patients taking them to the bathroom or other duties. Definitely delegating would be the primary thing to do except it’s hard to find someone on the floor who you can delegate to and not find resistance so pretty much your work is yours. The techs are overly worked and so are the nurses.


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