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Chapter Seven: Work/Life Balance, Part 1

Work/Life Balance

Whether you work full time or part time, long days or short days, nights, early shifts, late shifts, twilights or any combination of the above; you will spend a lot of your time at work. If you really love your job and can’t think of anything else you will ever want to do (which hopefully will be most, if not all of you) it might not seem like work, but it is still extremely important that you have a good work/life balance.

Life can be a juggling act sometimes; we have so many things that we need to do and it can require some extreme planning if we want to fit it all in. You’ll know from your training how difficult it can be to focus on more than just your student life, and although when you qualify you’ll have less pressure to revise or write essays it can still be difficult to fit everything in. Maintaining a good work/life balance is essential in keeping you happy and healthy, and there are so many aspects to it.

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Maintaining a good work/life balance has so many benefits for yourself, your patients and your colleagues, for example:

Benefits to you ·      A positive work/life balance helps you to stay happy and healthy both in your mind and body. It helps to promote positive mental health, massively reduces levels of stress and helps enable your immune system to work effectively by helping you to get adequate rest.

·      A happier you helps to create a happier home life for yourself and your family, meaning that you’re less likely to be stressed at home

·      Massively boosts your job satisfaction, meaning that you’re more likely to grow in skills and confidence with more ease

Benefits to your patients ·      Your patients will receive the highest standard of care they possibly can from their focused and cheerful nurse (that’s you!).

·      In turn they will have a more positive experience overall which can help them avoid feeling stressed and anxious while in hospital/in the community (depending on your work setting).

Benefits to your colleagues/team ·      Your positivity will have a great effect on the morale of your colleagues. This will help to improve the way your team works together and will create a wonderful working environment.

·      This will then act as a cycle, because the better the working environment, the less stressful it will be, meaning that you’re less likely to suffer from ‘burnout’.

 

Nursing can be very stressful, and we face a lot of pressure both physically and emotionally. If this is all that we focus our time and energy on, we will very quickly get dragged down by it, so it is extremely important that we have a healthy work/life balance. It’s really great to enjoy what you do for a living, and there is a well known saying that goes “choose a job you love and you’ll never have to work a day in your life”. This is all very well and good, but even the best jobs can get on top of you if you throw everything you have at them; if all we do is work, regardless of how much we enjoy it we will quickly start to feel the consequences – stress and exhaustion will in turn lead to burnout.

Get your copy of ‘Being a Nurse: A Personal Account from Graduation to Revalidation’ here, and if you use code LANPUB30 you’ll get a 30% discount!!

 

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Chapter Six: Progression and Confidence, Part 2

Becoming a mentor

As a newly qualified nurse, you’ll already understand the importance of having a good mentor; never forget this, because soon you will be that mentor. The first time you work alongside a student nurse can be surreal; it might feel like only ten minutes ago that you were that student. It’s a great experience to work alongside a student nurse when you’re still consolidating your knowledge yourself because it can really boost your confidence and help you to realise that you do know what you’re doing. Your student will in turn be able to learn a lot from you and it will help to reassure them that being a newly qualified nurse isn’t as scary as it might seem.

Working alongside student nurses at this early point in your career is wonderful because it really allows you to form a unique bond, especially if they are coming towards the middle or end of their training. You’ll have a lot in common which will enable you to strike a positive relationship and you will be able to learn new things together which will be extremely beneficial for both of you.

Personal Account

“When I’d been qualified for three months I was allocated to co-mentor a student nurse who was in her second year of training. I was worried that mentoring someone who was only a year and a half behind me might be difficult, but in reality I found it to be a really wonderful experience and I loved every shift that I worked with her. She was a fantastic student; already so full of knowledge and really eager to learn. In turn I found that she made me want to work harder to show her how wonderful nursing is, and I began to strive to improve my own knowledge so that I could share this with her in teaching sessions. Being able to learn new things together was lovely, but I found it so rewarding to be able to teach her practical skills and it really improved my confidence so early in my career.  I’ll always be so proud of her and I know that she is a truly amazing nurse.”

When you become an official mentor you will get used to working with students and with time you’ll discover the best ways to help them learn. This will be different for every student, so take time to get to know them, how they work and what they are comfortable with.

Sometimes, the students that we have worked with become our colleagues, and although this can be strange at first, it’s really wonderful to see how well they have developed since day one. Many of my colleagues started out as students with us, and they have all become really amazing nurses who fit into the team extremely well.

Get your copy of ‘Being a Nurse: A Personal Account from Graduation to Revalidation’ here, and if you use code LANPUB30 you’ll get a 30% discount!!

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Chapter Six: Progression and Confidence, Part 1

Confidence

Confidence is a big thing within nursing, and you will find that the longer you’re working, the more confident you’ll become. Some people start work with a great amount of confidence; they can get into the swing of it very quickly and you’d never know they are new. Others (including me) take a lot longer to come out of their shell and properly settle into their role. This doesn’t mean that the latter are not as competent as the former, it simply means that we doubt ourselves more and maybe worry more. This isn’t a bad thing; but it might mean that at the very beginning it’s harder; bad days will seem much worse and good days will offer little consolation for this.

Confidence is a funny old thing; you can lose it as quickly as you gain it, and vice versa. You might start a shift feeling like SuperNurse, but something can happen that will knock you off your game and you’ll spend the rest of the shift trying to claw back any kind of faith you had in yourself. I find that the amount of confidence I have varies from shift to shift and depends on a variety of different factors, as I’m sure it does for most people. These factors might be:

  • Patient load – if I have a lot of patients, or patients who are particularly unwell, my confidence might drop a little until I am sure that they are stable and that the care I’m giving them is working.
  • Skill mix –this one is more psychological I think, but I find that the more senior support I have, the more I feel like I need it. For example, if I am the second most senior nurse on the shift, my confidence is generally higher than if I am the most junior.
  • Recent events – if something has happened recently that has knocked my confidence, it can take a while for this to build back up; even if it something small.

Being confident in your job is the best feeling in the world – you feel like there is nothing you can’t handle; all of your patients have received the best care they possibly can and you’re having an amazing day. If you think back to your shifts recently, I’m sure you can pinpoint the times when you felt like this, and (almost certainly) that’s the majority of the time.

If, like me, you feel like you’re lacking in confidence, please let me reassure you that it does come with time, even if you have set-backs along the way. If you’re looking to improve this, there are many ways in which it can be done:

  • Experience – the more experience you have in your job, or in a particular aspect of your job, the more confident you will become.
  • Knowledge – With knowledge comes confidence. This might be a bold statement to make, but I really believe this to be true (at least most of the time). If you have knowledge about something in particular, whether this be a system within the body or a piece of equipment used in your field, having knowledge about this and applying it to practice will have a monumental affect on your confidence as a nurse, particularly when you see the positive affect it has on your patient(s).
  • Skill – the more skills you have under your belt, the more faith you’ll have in yourself as a nurse. The ability to put these skills into practice is a great way to help build your confidence, especially when you do it often or if it’s something you’ve struggled with in the past.
  • Teaching – as you progress you might start to mentor students, work with newly qualified nurses or be able to share your experience with others in your team. Passing on your knowledge and skills is a great way to helping you acknowledge just how much you know; even if this is the first time you realise it.

Get your copy of ‘Being a Nurse: A Personal Account from Graduation to Revalidation’ here, and if you use code LANPUB30 you’ll get a 30% discount!!

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Chapter Five: Good Days and Bad Days, Part 2

What Makes a Bad Day?

The answers to this question are mostly the reverse of the previous section. There are many factors that contribute to bad days, such as a heavy patient workload or poor staffing levels or skill-mix.  A busy day doesn’t always mean a bad day, but there is a fine line between ‘busy’ and ‘too busy’, and when that line is crossed it becomes very difficult. There are three main reasons that we might have a bad day:

¶ Poor staffing levels or skill mix – When you’re not fully staffed the workload instantly increases and this can put extra strain on you and your colleagues. Similarly, if the skill-mix is poor your workload might increase; this will become more prominent to you as you progress in your career.

¶ Heavy patient workload – Having a lot of patients doesn’t always equate to a busy shift if they are straightforward ones, but when there is a lot to be done or things don’t go to plan, this can instantly increase your workload and might mean that you have less time to spend with them or other patients.

¶ Poor outlook –as explained above, if your outlook at the start of the shift is negative, you’re more likely to have a bad day. Don’t feel bad if this happens to you though, we are all entitled to our ‘down days’ and things that are happening outside of work can impact the way we feel inside work. I will expand on this further in Chapter Seven – Work/Life Balance.

Personal Account

“Looking back on the bad days I have had, there always seems to be one common thread; when ‘busy’ becomes ‘too busy’. I find that organisation is extremely important in managing a heavy workload and I am getting better at that as time goes by (but I do still have a lot of room for improvement in this area). My main worry however, is when it becomes unsafe; I’ve had too many shifts where I find myself unable to do any more than the absolute basics of what is required of me and it really scares me. What if I make a mistake? What if I miss something? What if my patient is really sick and I’ve been too busy to notice? These days are, of course, massively outweighed by days where I don’t have this worry, but at the time it can be really scary.”

I will leave you with a reminder that you are an amazing nurse. Bad days are inevitable and sometimes are more frequent than we would like them, but a bad day doesn’t mean a bad job. Don’t give up what you’ve worked so hard for unless you’re absolutely sure that your current place of work isn’t for you. If you are struggling please talk to someone; whether this is a family member, your line manager, a fellow colleague, anyone – don’t bottle it up and let it get you down. Focus on the good times and they will get you through the bad; you’re doing a really great job.

Get your copy of ‘Graduation to Revalidation: A Personal Account from Graduation to Revalidation’ here.

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Chapter Five: Good Days and Bad Days, Part 1

What Makes A Shift Good?

Most days at work are good ones, even if they are busy. There are several reasons that this is the case, such as:

  • Great patients – As explained in Chapter Three, we have the opportunity to build up a great relationship with our patients, and we spend most of our day with them. They are usually the determining factor as to whether we have a good day or a bad one. Sometimes, this can be the patients themselves, and sometimes it’s the situation involving our patients.
  • Great staffing – Any shift you’re working with a team who are just that – a team – is going to be a good one, regardless of what the ward is like at the time. I mentioned this back in Chapter Two, and I firmly believe that if there is a great team on (and you have the right amount of staff), you’re almost guaranteed to have a good day. When you know that no matter what happens there’s always someone who can help is a great reassurance, and if you get those rare times where you can sit and have a laugh with your colleagues it really lifts your spirits. At the end of the shift you can party out of the doors together knowing you’ve all done an amazing job!

Personal Account

“There have been so many instances where we have had a really good day because of the team we’ve been working with. Even if it has been incredibly busy or there has been a heavy workload, having the help of brilliant colleagues is priceless and when we all stay positive we really lift each other up. We always joke that we are ‘The A Team’ or ‘The Dream Team’, and most days that is so true; it’s great to work with your friends!”

  • A great outlook- Always believe in the power of positive thought. I’m sure you’ll recognise that I’ve said this a lot throughout this book, but I really do think it works. If you’re sceptical about this, let me expand: If you can start your shift thinking “It’s going to be a good day” and maintain this outlook, it will take a lot to stop you having a good day. It’s important to try and see the good in every situation – if you can do this, then your whole outlook will improve. Although this is difficult, I would definitely recommend that you give it a try.
  • When things run smoothlyThe most satisfying kinds of days are those when everything goes exactly to plan: all of your observations are performed on time, your patients are lovely and extremely compliant with absolutely everything that you need to do, the doctor’s round finishes promptly and the discharges are ready when you need them, all of your IVs are given perfectly with no cannulas tissuing and you are up to date with your notes by the time handover rolls around. This might sound like a fairytale or the plot for the latest Disney film, but there are occasions when it happens and it feels really great! There have been many instances when things have gone exactly to plan, but there have also been many instances where they haven’t. Although it is a wonderful feeling to be able to do absolutely everything when it is required, don’t write it off if it doesn’t.

Get your copy of ‘Graduation to Revalidation: A Personal Account from Graduation to Revalidation’ here.

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Chapter Four: Difficult Situations, Part 2

Breaking bad news

Breaking bad news is never easy for anyone, and these situations are some of the hardest to be involved in. It’s extremely rare that you’ll be the one to break the news as these things should always come from the doctors, but there is a chance you will be with the patient or relative when they are told. Your role in this will be to support your patient through whatever this news is, to help answer any questions they might have and to help them to come to terms with it. It is very important that this is done sensitively and with compassion in order to ensure the patient receives no additional emotional upset.

Personal Account

“Breaking bad news is never easy, and luckily it’s not something I’ve often had to do. There is one instance that comes to my mind when thinking of this; I assisted a doctor who was informing a family that their child had leukaemia. This doctor is one of the most kind-hearted people I’ve ever been privileged to work with, and the way he informed the family of this news will stay with me forever; he was kind and compassionate in his words and he made the family feel so comforted. He allowed them time to come to terms with what they had been told, encouraged them to ask questions and didn’t ever make them feel like they were eating into his time (even though he was meant to have finished his shift an hour prior – he didn’t tell them that). It was only when the family went back to their room that he then became upset himself.”

People’s perceptions of what news is bad can be variable; one family will be very upset at something that another family will take in their stride, so be aware of this when informing them of any new diagnosis or change in their plan of care. For example, one family might be upset at the news of a chest infection, but another might be relieved that it is not something more sinister.

You’re in the most caring profession, so I know that whichever way you approach this it will be handled with empathy and understanding. I can’t tell you exactly what to do or say in these situations because they are all subjective, but as long as you provide support and compassionate care to whoever needs it you’ll have done the best you can.

Get your copy of ‘Graduation to Revalidation: A Personal Account from Graduation to Revalidation’ here.

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Chapter Four: Difficult Situations, Part 1

Emotional Difficulties

Patients can be a source of difficulty to us for a number of reasons, and possibly the hardest thing can be seeing a patient suffering or in pain. This isn’t something that you will necessarily get used to, even as the years go on. Not all patients will affect us in the same way (see Chapter Three), but there are some who do and this can make our job particularly difficult. To be a nurse you need to have a unique balance of both compassion and hardiness; we can’t be upset all the time about our patients, but we can’t be robots either. It’s a fine line and there will be instances when our patients will pull on our heartstrings.

It is common that we will encounter these emotional difficulties during our work – after all we are all human – so there is nothing wrong with letting it affect us. Everyone copes with this differently; some people switch off emotionally, others have a good cry and let it all out. You will find your own way to deal with these feelings, but if you’re struggling you can talk to anyone you trust about these.

Uncooperative Patients

As nurses we can sometimes find ourselves trying to provide treatment or care to patients who are unwilling to cooperate. Depending on the setting you work in you might experience this more than others, for example patients with mental health problems might be typically more uncooperative than those without. As a children’s nurse (and I’m sure any parents out there can back me up on this), there are many times where I have found myself trying to bargain with a tiny person in order for them to take their medicine; sometimes you win and sometimes you lose. I’d be lying if I said this was my favourite aspect of my job, but it is sometimes nice to see their true personalities come out.

If you’re nursing an adult with full capacity who is refusing treatment, I imagine this to be very difficult; particularly if you know that without it they will become very unwell. You know there is nothing you can do and that this decision must be theirs, but that doesn’t stop you feeling like a bad nurse (which you’re not, I promise). I sometimes don’t know which would make me feel worse; pinning them down and making them take medication or having no option but to let them go without it; both eventualities place you in a very difficult situation.

If your patient is refusing a drug, don’t write them off instantly as being ‘awkward’; take some time to talk to them and try to find out why they don’t want it.  They might be worried about a side effect, there might be a misconception surrounding the drug that they have concerns about, or if it’s an injection they might simply be scared of needles. Talking to them about their concerns might make them feel a lot better or make them change their mind, but even if it doesn’t you will know that you’ve done all you can.

Dealing with Challenging People

As nurses we deal with members of the public on a day-to-day basis, and it is inevitable that we will encounter some who are more understanding than others. It is becoming increasingly common to experience some sort of hostility, violence or intimidation from patients or their relatives, and therefore it is important that as nurses we know how to keep ourselves, our colleagues and our patients safe.

Conflict resolution is a mandatory skill that is taught in most (if not all) trusts, so you’ll definitely be trained in this within your first few weeks. It was taught to us in university and was part of the induction process when I started my job, so it is something that I will always remember as being very important. I won’t delve too deeply into it, but the main aim of conflict resolution is preventing a situation from escalating. This is done by becoming more aware of our body language and tone of voice. Here are five key points to remember:

  •  Remain calm and adopt an ‘open’ stance
  •  Never rise to someone or argue back – this will cause the situation to escalate quickly
  • You are permitted to use minimal force, but only if this is reasonable and required – don’t hit out if there is another way around it
  •  Always remain near the door and never let yourself be backed into a corner
  • Get out and get help if you’re worried a situation is escalating – there is safety in numbers so if possible, try and find back up.

By following these tips you can help ensure your safety and that of your patients. If you are in this situation you must escalate it as per your trust guidelines; for example, call security to remove the person (if appropriate) and report it using your incident reporting system.

Get your copy of ‘Graduation to Revalidation: A Personal Account from Graduation to Revalidation’ here.

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Chapter Three: Patient Relationships, Part 2

A Positive Relationship

Personal Account

“I recently worked a shift that was extremely busy, with each of my patients requiring a slightly higher level of care than usual. At the end of this shift, although I was exhausted, I felt very happy and came home smiling. This can sometimes be very unusual for me (mainly because I get grumpy when I’m tired), but on this occasion every patient and parent that I was caring for was lovely, making it impossible for me to think I’d had a bad day. I built very strong relationships with the patients I was caring for, and they were open and honest with me about every aspect of their care; if they didn’t think something was right, they’d tell me and we would work out a different way to do it. Although I was busy I knew that I was providing the best care I possibly could for each of my patients, and it’s on days such as those that I really love being a nurse – even if it does take at least 12 hours of sleep to recover.”

When you’ve built a rapport with your patients the experience becomes so much more positive for both parties. Establishing this relationship can be difficult at times, so here are a few handy hints on how to achieve this on your initial meeting:

  • Introduce yourself – this should be the first thing that you do when you meet your patient. You might have seen the #hellomynameis campaign floating around, and this is an extremely good way of reminding us of the importance of our initial meeting. For example, my usual introduction goes something like this: *big welcoming smile* “Hello, my name is Lauren, I’m one of the nurses on the ward and I’ll be looking after you today. If you need anything at all just let me know, but I’ll be in and out anyway.” (or “You’ve got me again!” if I’ve looked after them on the previous day). This way my patient knows my name and role and can begin to trust me instantly.
  • Ask them their preferred name – when nursing adults in particular, this will definitely go a long way in helping you to show your respect for your patient, for example “Hello Mrs Smith, is that what you’d like me to call you?” This will immediately help your patient feel at ease and will show that you care about them.
  • If they have a parent or relative with them, ask them their names too. This is something I didn’t do when I first qualified, but one day I was working with a student nurse and felt almost ashamed when she asked the patient’s mum her name and shook her hand – I couldn’t believe that I’d never thought to do this before! It will really go a long way in promoting the therapeutic relationship and shows that you care for the whole family unit, not just the patient.
  • Ask if you can get them anything – who doesn’t love a cuppa first thing in the morning? (or evening if you’re on the night shift). Offer to get them some tea, or ask if they’re hungry or need pain relief. This will help them feel immediately comfortable and you’ll have a good relationship for the rest of the shift – especially if you bring them tea.
  • Always be cheery – a big smile goes a long way!

These things may seem menial to you, but to your patient and their relatives they will go a long way in reassuring them that they are in safe hands. Making a good first impression is extremely important, but keeping this up is equally so. It is vital that throughout your patient’s time in hospital they see you as someone they can trust, and therefore you must always remain their advocate, no matter what the doctors or other care providers have decided for them.

Find more info like this in ‘Being a Nurse: A Personal Account from Graduation to Revalidation’.

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Chapter Three: Patient Relationships, Part 1

Caring for our patients is the single most important thing that we do at work, and it is extremely important that we can begin and maintain a relationship of trust with our patients and their families. Patient care can be a difficult subject to discuss, so before I start this post I will apologise if anything I’m telling you sounds bossy – I will try not to get on my high horse too much, and of course every patient is different so not everything I say here will apply to absolutely every situation. Conversely, when I find myself being too overbearing I tend to try and lighten the mood with humour, so if you find I’m trying to make light of any situation, it’s only so I don’t sound too overbearing, not because I don’t take this topic seriously – patient care is the single most important part of nursing.

Therapeutic Relationship

The term ‘therapeutic relationship’ is commonly used when discussing the relationship between a patient and a healthcare professional. This relationship is one of mutual trust, respect and understanding and is extremely beneficial for both parties. In children’s nursing a commonly used term is ‘family centred care’; the principal here is the same as a ‘therapeutic relationship’, but applied to the family unit as a whole, rather than just the patient.

An essential part of this relationship must be the understanding that your patient is a person. They have lives, hobbies, families; they have life experience behind them and the person that you see in the hospital bed is only a fraction of the person that they are. It is vital to bear this in mind when forming a relationship with your patient and you must remember to treat them as a whole person, not just a condition or illness. This is easy to forget sometimes (especially if you work in a very matter-of-fact manner) and it’s something that I’m making a very conscious effort to do. When discussing a patient, even if you’re not near them, always make an effort to refer to them by name, not bed number or condition. For example, instead of saying “the chest infection in bed 4” say “Steve in bed 4, with a chest infection.”

As nurses, we have the unique and wonderful opportunity to build relationships with our patients; we can get to know them and their families, build relationships with them and know that we have made a positive impact on their lives. This is the most rewarding aspect of nursing and for most of us it is the reason that we chose this vocation. Forming relationships with our patients is a wonderful thing to do; it provides them someone to talk to when there might be no-one else, it allows us to learn about their lives and can even change our perspective about the world. As a nurse, it is the greatest feeling to know that we have made a positive impact on the lives of our patients and their families.

 

Find more info like this in ‘Being a Nurse: A Personal Account from Graduation to Revalidation’.

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Chapter Two: Teamwork, Part 2

Team Work in an Emergency

During an emergency situation, teamwork is particularly important. If your team is organised and you work together you can alleviate almost all of the stress from an emergency situation, thinking and acting in a logical and strategic manner that is best for both your patient and your team. Of course, it is all very well and good for me to tell you this, but when you’re caught up in the moment emergencies can be scary and frantic – especially if they are unexpected. Becoming calm and thinking logically during these situations will come with time and confidence, but working as part of an effective team can go to great lengths in allowing these situations to become far less intimidating.

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Particularly when you’re newly qualified, emergency situations will scare the pants off you – especially if they aren’t something you see often. I’m still terrified of being in these situations; it’s something that I’ve only been involved in once or twice and it doesn’t become less daunting. Being taught what to do is one thing, but being in that situation is another, and in that moment you will act one of two ways:

1) You will snap into gear and know exactly what to do

OR

2) You will freeze and wait to be given directions

Whichever of these you do will be fine – if you can stay calm and take control then that’s amazing – it’s something I don’t think I can do (you’ll have to teach me how!) but if you find yourself frozen and awaiting command, that’s fine too –as long as you don’t put your patient at risk. In order to ensure an emergency situation runs as smoothly as possible and in order to provide the best possible outcome for your patient, working within a team of people is of utmost importance. You’ll have had training on emergencies as a student, and you’ll definitely have more training when you start working so I’m not going to go through the dos and don’ts – I just want to reiterate the importance of working as a team in a situation such as this.

Personal Account

“I recently worked a shift where there was an emergency situation that was very different to any I’ve been involved in before. I’ve had many study days in dealing with such events but when faced with a real patient, I was surprised at how unprepared I felt. I had a brief moment of thinking “I don’t know what to do!”, before my instincts kicked in and I was able to assist my colleagues. Working as part of the nursing team and alongside the doctors who were also present really highlighted to me the importance of team work in times such as these, and the nurse in charge who was leading the situation remained extremely calm, enabling us all to do the same. The patient was very quickly stabilised and made a full recovery almost within hours, and as a team we were able to take time to discuss what happened and reflect on how well we worked together. My colleagues are an amazing group of nurses and this situation made me feel more proud of us than ever before. It is times like these that we realise how strong our team is, and the importance of working together and supporting each other.”

Having a supportive team is of particular importance in the aftermath of an emergency situation. Depending on the type of emergency and its outcome you might find that when you begin to reflect on the events you will need your team more than ever. Events such as these will pull you closer together and enable you to support each other through the rollercoaster of emotions you might be feeling. Having a debrief and talking things through with your colleagues is extremely important, especially with those who were also present at the time; between the team you can help establish what happened, why it happened and how you each feel about it. Don’t ever shy away from these discussions, as they will help you cope with the emotions of the situation, as well as helping you to learn from the situation and gain confidence if it were to happen again.