Panic at the Pyxis: How to Regulate When You Have 30 Seconds and Zero Privacy

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Riva (00:10):
Happy October.
I am so excited that it'sOctober for several reasons, one
being that your girl here I'veonly got two times of the year
it's either summer or it'sHalloween, so spooky season for
me is just as invigorating assummertime for me.
I love everything about it, andalso we have some pretty

(00:32):
incredible things happening thisOctober that are a first for
the Code Team, a first for theRitual Nurse podcast and really,
I think, are going to changethe trajectory of nursing.
But a little bit more on thatin later episodes and
announcements.
Right now, welcome back to theRitual Nurse, the podcast where

(00:54):
nurses finally get the tools tosurvive this job without losing
ourselves in the process.
I'm your host, Riva, and todaywe're tackling something that
every single nurse knows all toowell: those moments when your
body is screaming, your heart isracing, you've got about 30
seconds and zero privacy to pullyourself together before you

(01:15):
walk into the next patient'sroom.
This episode is all aboutregulation in the real world.
Not the spa day, not the take aweek off, but several no joke
things that you can do in lessthan 30 seconds, the thing you
can actually use in the hallway,in the med room or even while

(01:39):
you're pushing that next IV.
Because, let's face it, that'snursing.
You don't get perfectconditions to deal with stress.
You get the med room, thehallway, the supply closet or
maybe just the two seconds ittakes to scan a wristband.
That's all that you havesometimes to regulate your
nervous system before the nextpatient, the next crisis, the

(02:00):
next family member asking youfor something, the next admit,
discharge, fall.
.
.
who knows what it is.
I mean, let's be real, when wesay nursing doesn't give us
privacy, we really mean itdoesn't give us privacy.
When we're on shift, all eyesare focused on us, either
looking to us for guidance andleadership, or looking to us for

(02:23):
answers, solutions.
We don't get to leave to cry itout, to journal it out.
We don't get to take a break inthe middle of a code or when
we've just had a family memberscream in our face or after
we've just watched somethingreally traumatic happen.
Now you may be able to take afew minutes to debrief, to

(02:47):
collect yourself, but usuallywhen we're in transition you're
heading to another patient'sroom to continue care, to do
whatever it was that thesignificant event diverted you
from in the first place.
So nursing is full of thosemoments where your insides don't

(03:07):
match your outsides.
You're standing there trying tolook calm and competent, but
inside your body is absolutelybetraying you.
Your chest feels tight, yourthroat feels like it's closing
on you, your hands may beshaking, your stomach might feel
like it's dropping like anelevator.
Your brain is foggy, blank,maybe scattered.
That's trauma, physiology, andit's not just happening after a

(03:32):
code.
It can be happening dozens oftimes a shift and if you don't
learn how to regulate thatstress piles up and one day it
breaks you.
The trauma stacks up, yournervous system takes the hit and
if you don't know how toregulate, it leaks out in
mistakes and exhaustion, insnapping at the wrong person, in

(03:56):
going home and collapsing intosilence.
It manifests in physical andmental illness and a lot of
maladaptive coping behaviors.
This is where boundaries andethics collide, because we can't
ethically give safe care ifwe're dysregulated.
Regulation isn't a luxury, it'sreally kind of a professional

(04:19):
requirement in order to maintainsafety and accuracy and
standards for ourselves and ourpatients.
So when we have thesesituations where our body is
feeling all these feelings,here's what's actually happening
inside your amygdala thebrain's alarm system is
screaming danger.

(04:40):
Your adrenal glands are dumpingadrenaline and cortisol into
your system.
Your heart rate is spiking.
Your blood vessels areconstricting, body diverts blood
to your muscles.
That's why you might feel hotor flushed or even shaky.
Your digestive system shutsdown, so nausea, stomach flips

(05:01):
or sudden bathroom urgency canbe really common.
Your prefrontal cortex, therational part of your brain,
goes dark.
That's why you can't thinkstraight or remember simple
steps.
This is survival mode.
Your body is acting like you'rebeing chased by a tiger, when

(05:22):
really you're just trying tohang the bag of Vanco.
And here's the problem.
If we stay stuck in thatsurvival mode, we're unsafe.
We can't think, we can't decideand we can't care for patients
the way that we need to.
We get tunnel vision.

(05:46):
That's why you might blank on asimple med calculation, stumble
over your words or feel likeyour hands are shaking, not
remember the order that you justrepeated three times in a row.
It's not weakness, it'sliterally your nervous system
hijacking you.
Regulation skills work byinterrupting that hijack,
bringing you and your wildnervous system back online and

(06:09):
signaling to your body thatyou're safe enough to function.
And that's why we need a reset,not a full-on therapy session.
Those are wonderful, valid andso healing.
But in that 30 seconds, that 15seconds, we don't have time for
that.
But we need something.
We need a neurological resetbutton that we can hit in

(06:34):
seconds and that we call Codeblue to code you.
We discussed this a little bitin the first season, but think
of it as a as running anemergency drill.
Only the patient is your ownnervous system.
So how do we break this down?
Step one stop Mentally.

(06:57):
You call it, code me, just likea code.
Naming it takes power.
You acknowledge what's happeninginstead of getting swept under.
The next is breathe.
You take one deep inhalethrough your nose and then a
long, slow exhale through yourmouth.
This signals the vagus nerve,your body's built-in brake pedal

(07:17):
to slow down the heart andquiet the alarm bells.
You ground, push your feet intothe floor, feel your shoes,
feel gravity.
Your body gets the message I'mhere, I'm stable.
You orient, use your senses topull your brain back online.
Name one thing you see onething.

(07:38):
You hear one thing you feel.
This re-engages the prefrontalcortex, the decision-making part
that went offline when youramygdala hijacked you.
Then you resume.
You've stabilized just enoughto move forward.
Then you resume.
You've stabilized just enoughto move forward Now.
You don't need to be 100% calmbecause, let's be honest, that's

(08:02):
probably not going to happen,but you do need to be regulated
enough to keep going safely.
This works because thisinterrupts the trauma loop.
You're telling your nervoussystem yes, something stressful
happened, but I am not in mortaldanger.
Our body, as a physical being,cannot tell the actual

(08:28):
difference between life anddeath.
As in you are in mortal danger,a predator is chasing you and a
jump scare in a movie or avideo game, or the panic that
you feel when a trauma suddenlyhappens around you at work, or

(08:48):
even high levels of excitement.
The physiological signs andsymptoms are exactly the same to
your body and it is relying onthe input that it is getting
from you to decipher what,contextually, is happening
around it.

(09:09):
So with practice, your bodylearns this skill set over time
and you can use it as musclememory.
You're conditioning yourself touse this as muscle memory In
those moments of overwhelm, highstress, trauma, super high

(09:31):
emotion.
Let's go over the steps one moretime.
Step one stop Like a code blue.
You call it Code me.
Step two breathe Deep, inhalethrough your nose, long exhale
through your mouth.
Reset the vagus nerve.
Step three ground, reset thevagus nerve.

(09:57):
Step three ground.
Press your feet into the floor,feel your shoes, feel gravity.
Step four orient.
Look around, name one thing,you see one thing, you hear one
thing you feel.
Step five then move.
You've reset just enough tokeep going safely.
Now, sometimes code blue to codeyou is enough, but sometimes
you need a little more.
And this is where you can layerother micro skills.

(10:20):
So you might use code blue tocode you in the moment and then
in the ensuing moments after, inthe ensuing moments after, as

(10:55):
things come to their naturalconclusion wind down, patient
transfers, resuscitation,whatever it may be you can layer
these other micro skills on topof the code blue to code you
skill.
In the interim, before youactually have that time can, can
carve out that time to fullyreset and do a full body check
and self-awareness and regroundyourself.
And we know from experiencethat even though one trauma may
be, you know, ebbing down, theunit might be coming down in
temp, things are cooling off alittle bit.

(11:17):
That doesn't necessarily meanthat you suddenly have free time
.
In fact it's usually theopposite More orders, things to
do, tasks to carry out, possiblydelayed patient care to other
patients while you were dealingwith the situation that has to
resume.
So we know that it might betill the end of your shift, when

(11:42):
you're sitting in your car inthe parking lot, before you
actually get to debrief withyourself, or maybe not till you
get home.
So layering these micro skillsis a way to kind of drip feed
yourself resilience, buildingstructure, applying support over

(12:05):
this time period throughout therest of your shift.
So there's a skill called BODY.
The acronym stands for Breathe,orient, drop In, yield.
And what BODY means?
You're going to breathe, you'regoing to take one steady breath
to anchor yourself.
Orient, notice where you are,drop in, feel your body, notice
your feet, your posture, yourhands, just kind of like a

(12:28):
ripple moving from your foreheadover your shoulders, your
diaphragm, your knees, your feet.
And yield, soften, let yourmuscles release a fraction of
their tension.
You can't afford to unwind orcompletely come undone.
But that bracing tension thatyou're holding we crack that

(12:52):
You're still on the move, you'restill focused.
But that 6,000, 7,000 RPM levelred line that you're sitting in
, we crack that level of tensionand release that energy a
little.
This is your doorway reset.
You can use it right beforewalking into a patient's room,

(13:13):
right before starting a new task.
You can do it while scanning anarmband.
It takes split seconds to dothis.
By orienting and yielding, youactivate those parasympathetic
pathways.
Again, you're remindingyourself, you're reminding your
physical body that you are safeenough to proceed.

(13:35):
I want to liken this to almostkind of how we administer Narcan
.
Narcan has a very shorthalf-life.
So when we have patients thatare overdosing, they have a lot
of the drug in their system andwe may administer Narcan and it
works, blocks the receptors,pulls them out of it, but it's
got a short half-life andthere's more drug floating

(13:56):
around in their system.
So as the Narcan leaves thereceptors and the drug refloods
the receptors, they go rightback down.
So kind of analogous to whatwe're doing during the shift,
when it is a really spicy shiftand the unit might be hot.

(14:17):
There's a lot going on, a lotof pressure, maybe actual, a lot
of actual trauma, maybe not,maybe it's just overwhelm and
pressure and admissions cominggoing in out.
One patient fell, thispatient's on the call light.
Family members are relentless,orders are persistent and
endless, that kind of thing.

(14:38):
Okay, there's a lot in thesystem and our initial code blue
to code you blocks thosereceptors and you can come up
for air for a minute, but thenit swirls around again.
So we have to keep drip feedingthese practices to keep your

(15:01):
nervous system within regulationand to keep you above water,
keep you from drowning in theshift.
There is another one calledheart rest and it's hydrate
exhale, allow, release and tunein.
Hydrate, focus on taking a sipof water to reset your system.

(15:23):
Oftentimes we find that takinga sip of ice water the shock of
the cold, the temperature resetwater, the shock of the cold,
the temperature reset helpsrefocus your body's attention,
your brain's attention, on yourcore.
Inhale and then exhale, long,slow, breath out and allow, give

(15:49):
yourself permission to pause,release, let go of any muscle
group that you're clenching,your fists, your jaw, bring your
shoulders all the way back downby your clavicle, where they're
supposed to be, and not yourcranium, where they're tucked up
against, and tune in.

(16:10):
Notice any signal that yourbody or mind is screaming at you
at the moment.
I need air, I need space, I needwhatever it may be that you
need this skill is best whenyou're heading into an actual
break or if you can catch a realquick five minute, 10 minute

(16:35):
pause in the break room, becausethis skill is asking you to go
a little deeper and to giveyourself a little more.
It extends regulation beyondthose short seconds.
We're not just interrupting thenervous system and the fight or

(16:59):
flight reaction parasympatheticstillness and rest for a few
moments to actually allow yourphysical self to sync with where
cognitively you need to be andthen remain there for a few

(17:22):
minutes.
Hydration and slow exhalationresets your sympathetic
overdrive.
You're adding intentionalpermission and intentional
release to allow the nervoussystem to shift into recovery
rather than just staying stuckin that fight or flight, in that

(17:43):
hyper arousal state on pause.
And these micro skills andlearning how to use them,
learning what works best for you, is going to be really highly
independent on your personality,on the unit or environment that
you work in.
But anyone can use themanywhere and they don't require

(18:05):
equipment.
These aren't extras, they'rereally survival gear.
Each one of these is designedto be immediate, portable, quick
and they teach your nervoussystem to come back online
faster and faster.
Every time you use them, asthey become muscle memory, you
begin to unconsciously repeatthese actions before you have to

(18:31):
prompt yourself to even do it,and that's the whole point.
That is the goal of practicingthese over and over.
Initially we have to start outby consciously prompting
ourselves to do it.
But as you practice more andmore, your body remembers the
physical triggers, the physicalcontext, and then oh, wait a

(18:56):
minute, we pause.
Here it's going to remember bymuscle memory, you implementing
these skills and bringingyourself back to center or
keeping yourself below that redline enough so that you can
function, that you can haveclarity, that you can be safe,
you are regulated enough tofunction, and then, when you get

(19:18):
the chance to an actual, validchance to move into recovery
mode, then you can do so.
We are at the point now wherewe're going to do a little of
that.
It's our dance break, as youknow.
So shake it out, stretch yourhands, drop those shoulders,
remind yourself that even a fewseconds of movement can shift

(19:38):
your whole state of being.
Get hydrated.
If you're headed back to thefloor, have the best shift ever.
We'll see you on the way homeor at another break.
If you're hanging out with us,we'll see you after the break
for the whys and integration andfor our fave coffee, crystals
and divination, as always.

Music Break Lyrics (19:59):
All I'm keeping track of is the weather,
and there's no wind, no sun,nothing, 80 days, unknown.
Not feeling better.
But a sweet relief Is findingme there's no love under the

(20:25):
portrait Moon.

Riva (20:53):
Welcome back.
Let's keep going.
We're going to discuss why anyof this even matters.
It should matter for severalreasons.
One, because your physicalhealth should be a priority.
You get to be a priority.
Secondly, because, ethically,how we practice is deeply
important to the success of ourpractice, and unregulated nurses

(21:20):
make far more errors, havehigher rates of compassion,
fatigue and are more likely toleave the profession.
Regulation isn't soft, it'ssurvival, it's ethical, it's the
line between burnout andsustainability.
And here's the best part themore that you use these skills
and these quick resets, the moreyour body learns.

(21:43):
We have neuroplasticity for ourentire life, and
neuroplasticity means that yourbrain rewires your vagus nerve
tones.
Your regulation gets faster,easier and more automatic.
You want to practice theseskills all the time, and not
just at work.
They're useful anywhere thatyou run into overwhelm, stress,

(22:10):
trauma, high levels of labile orvolatile emotions.
I mean that can be right inyour own kitchen.
These are also exceptionalskills to model if you're a
parent, if you have kids aroundyou.
Littles can do these skills,maybe not with the big words

(22:30):
that we do, but they can mimicexactly what you're doing.
These skills would beabsolutely life-changing if they
were taught to teenagers, ifthey were taught to kids in
middle school.
So it's really really importantthat our why, that we state it,

(22:55):
that we connect with it reallyclearly.
You are worth it.
Everything that you have putinto getting to where you are
you as a person, everything thatyou sacrifice, your hopes, your
dreams, the things that youbelieve in, the things that you
want.
You are worth developingregulation, skill sets and

(23:17):
enhanced resilience, because youdeserve an exceptional quality
of life.
You deserve an exceptionalquality of life.
You deserve an exceptionalprofessional experience as well.
I want you to remember that andI want you, when you're

(23:38):
practicing your self-carethroughout the week, to really
be reminding yourself of justhow deeply you are worth in this
work yourself.
I'm just how deep with you allworth in this work.
And speaking of self-carerituals, it is spooky season.

(23:58):
Let us get into everythingCoffee, crystals and divination.
Let's do it.
This is my absolute favoritesegment.
In fact, you may or may nothave a few special episodes in
October that are coming out offschedule that just solely
revolve around coffee, crystalsand donation.
We'll see you on guests and onfood lists, so take what works

(24:24):
for you and leave the rest, butjoin us for the fun and join us
for the good thoughts andamazing manifestations.
Let's get it.
Regulation isn't just about thenervous system.
This is also about groundingourselves in our small,
intentional practices thatremind us that we are so much

(24:45):
more than things of the chaosaround us.
Coffee of the week October fall.
Some places it may be spring.
Some places it may be the dayfor just that brisk crisp fall.
Other places might be hot.

(25:06):
The Virtual Nurse is in over 120countries around the world.
I'd love to know your feedback.
What are you guys experiencingin October?
What's your Halloween traditionthat you like?
What's the best season that'sfor you?
The text link at the top of ourshow notes you can smash that

(25:27):
text link and send me your fanmail.
You can reach as completely,utterly anonymous as you like,
in fact, the fan mail system.
They will ever see a fan mailfrom you, it will be from them
and it also doesn't sign up foranything like that.
So you can just send me a fanmail and send me messages and I
would love to get it, love toget it For me.

(25:51):
This spicy kind of justdelicious fall season I'm going
to go ahead and say it because Iabsolutely love it A bold, dark
roast with a hint of cardamomand a splash of either cream or
coconut milk or even sweetenedcondensed cream.
I find that the addition of thespices, cinnamon is a really

(26:14):
good addition here too, butcardamom has been used for
centuries to soothe the stomachand ease tension.
It's a perfect pairing foreverything that we're talking
about in today's episode.
Some people really like chaialso.
.
That is amazing and spicy andwarm and filling Kind of serves

(26:36):
the same purpose.
Let me know minutes you'regetting into this spooky season.
atLet me know what you're
incorporating into yourself-care ritual in those 5, 10,
15, however many months you'recarving out for yourself each
day in practice.
Share it on socials and onTikTok the Ritual Nurse.

(26:59):
I'd absolutely love to see someof my podcast listeners on the
live.
It's so fun.
I may or may not be also doingsome lives on TikTok.
That are live donation pollsand live crystal prescriptions.

(27:20):
And your girl has so many youbetter run.
Let's not talk too much aboutthat.
My husband does listen to thesepodcasts religiously.
He has an incredible supportsystem and I really would like

(27:44):
to know if I don't have guestsand it's just me on an episode
would you guys want to?
see the podcast in video format,or would you want to see it
only with guests?
I have followed several podcastpeople that do video podcasting

(28:08):
and it's just that they don'thave guests, and I like it.
I usually listen to the audioversion of the podcast, but if
that's something that you guyswould be interested in, we have
the studio, the equipment.
The podcast does actuallyalready stream to our YouTube
channel just audio only, and Iwould like to start doing video
with guests.
But if just video in general issomething that you would be

(28:31):
interested in, let me know.
Send me some things and let meknow your thoughts.
So we had Amazonite jump out ofthe Christian prescription.
Take a look at what Amazonitemeans.
Amazonite says empowerment,truth, compassion and integrity.
Embrace the power of Amazoniteand maybe some truth If you've

(28:56):
got time.
Empowerment it's time to cutthrough any self-doubt.
Make your truth feel strong.
Let the energy of Amazon guideyou as you stand tall, speak
your mind and conquer self-doubt.
Trust in your strength and letyour authenticity shine.

(29:17):
You are a force to be reckonedwith.
So step into your power and letyour truth be heard loud and
clear.
Sounds an awful lot likestepping into your power and
taking control of your nervoussystem and standing strong in
your power and your strength,speaking the truth to be

(29:47):
grounded, to be regulated, to beover and over.
I often wonder if any of mylisteners have gone and picked
up these decks that I use.
If you have, let me know.
Tag me in pictures of you guysusing them, if you have them.
I'm absolutely enamored withthese decks.

(30:14):
I have been since I got them.
I have multiple versions ofthem.
I currently pull with thesilver foil version of the decks
both of them and the full sizeversion.
She does have smaller versionsthat are like, I guess you could
say, travel size.
Versions of the gold and thesilver cards on her site are
oftentimes sold out and, trustme, I can see why.

(30:34):
But I use the full size.
I do have the gold.
I prefer the silver.
It's just kind of my vibe.
I'm just one of those kind ofsilver edged people, like black
and silver.
So let's see what our cards haveto tell us.
Divination, wise in regards tooh, wow, okay, two jumped out

(30:58):
immediately.
So we have Chrysoprase, whichis the page of wands, and then I
have the nine of wands, whichis hematite.
So let's see what these mean.
The page of wands is creativity, ideas, free spirit.

(31:19):
Chrysoprase is joy, inspirationand playfulness.
Your creative, curious andwhimsical spirit are taking you
on various unknown journeyswhere you may not know the
destination.
Continue on these journeys tolearn more about yourself and
hone in on who you really areand which direction you should

(31:41):
be heading in.
I think this card is a really,really apt reminder to continue
carving out time for that ritualspace for yourself, that
self-care, diving deeper intoyour dreams, your hopes yourself
, your strengths, your needs.
Your dreams, your hopesyourself, your strengths, your

(32:03):
needs Great journaling prompts,great manifestation prompts.
Now let's look at the nine ofwands.
The nine of wands is courage,persistence and boundaries.
Hematite stands for resilience,courage and strength.
You may be feeling exhaustedright now, but this card comes

(32:26):
as a reminder to stay vigilantas you fight through life's
obstacles.
Your resilience and persistencewill pay off as these tough
times begin to pass.
This card was literally thecliff notes of this entire

(32:46):
episode.
Oh, these are beautiful cardsand very apropos to the episode
and to the meaning of theepisode.
So next time that you feel thepanic rising and you've got 30
seconds and zero privacy, callit Code blue to code you.
If you need to layer in themicro skills of body or heart,

(33:10):
rest when you can.
You deserve regulation, youdeserve safety and your patients
deserve a nurse who knows howto bring herself back online,
especially in the chaos.
If today's episode gave yousomething you can use, share it
with as many people as you can.

(33:31):
Share it with all the nursesthat you know that need the
reminders, that need theskillset, that need the support.
And if you want the tools thatwe talk about here in printable
form other resources head overto tcthorg.
Check the show notes for linksto our resources.

(33:51):
Especially, check the shownotes for the links to the fan
mail and send me feedback.
Send me feedback on your spookyseason, on your October, on
your self-care rituals, onthings that you'd like me to
podcast about, if there's thingsthat you want me to cover, and
tell me what you think about thewhole moving the podcast or

(34:13):
adding to the podcast in termsof video.
So this has been the RitualNurse.
I'm Reva, reminding you thatyour survival is sacred, your
regulation is your armor andyour resilience is life-saving.
Until next time, keep yourrituals strong and your practice
stronger.
Love your faces.

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Panic at the Pyxis: How to Regulate When You Have 30 Seconds and Zero Privacy

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