The Ritual Nurse

How to Regulate When You Have 30 Seconds and Zero Privacy!

• Riva - The Ritual Nurse • Season 1 • Episode 18

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You’re mid-shift, mid-crisis, and maxed out. You’ve got zero privacy, 30 seconds (if that), and an urgent need to NOT spiral. In this episode of The Ritual Nurse, we’re diving deep into how to emotionally regulate when you’re still on the floor—with tools that actually work.

You’ll learn two trauma-informed, DBT-inspired skills made specifically for nurses:

  • Code Blue to Code You (a must after any traumatic event)
  • The IV Push (for that mid-shift, panic-tinged chaos)

We break down why they work, how to do them in real time, and exactly when to use them—even if you’re a psych nurse, med-surg warrior, floor manager, or burnt-out exec. Trauma isn’t just for codes, and regulation isn’t a luxury. It’s your lifeline.

Plus:

  • A guided mid-episode reset (pause, hydrate, breathe)
  • This week’s Coffee, Crystals & Divination
  • How YOU can help this podcast go viral and heal the soul of nursing

Mentioned in this episode:

  • Free downloads: TCTH.org
  • LET'S GET THIS VIRAL!!! <3 <3
  • Follow @TheRitualNurse on TikTok + @The_Code_Team on Instagram 

Don’t forget: If this episode helped you—share it. Let’s start regulating like our lives depend on it. Because they do.

Hey! Make sure you subscribe to stay connected. Love a nurse? Who doesn't! Share with all the nurses you know. The more we reach, the more we help. We feel like no one deserves center stage focus more than nurses and our mission is to reach the millions of superstars out there. We'd love to hear your stories, your adventures, your wins, and especially your needs and questions! Email us at hello@ritualnurse (dot) com. Also, you can send us fan mail! Use the link at the beginning of the show notes. Resources, classes, blogs, and podcast info can be found on our home site at TCTH.org. The Ritual Nurse Podcast is part of The Code Team educational platform.

Love your FAYCES!

Speaker 1:

Welcome to the Ritual Nurse, where healing meets humor, science and a touch of magic. Hey friends, welcome back to the Ritual Nurse podcast, the place where we care for the caregivers and remind nurses everywhere that healing starts with you. I'm Reba, your host, your fellow nurse and your ride or die in the sacred work of surviving this profession with your soul intact. Questionable about the sanity part, but for the most part, our aim is for sanity and soul to be sacred and intact at the end of the ride. Today's episode is called how to regulate when you have 30 seconds and zero privacy. Let's be real. Some days you don't even have 30 seconds. You have call lights, pain meds, behavioral escalations, charting backed up and your own damn bladder screaming at the injustice of it all. In those moments, emotional regulation still matters, actually more than ever. Regulating mid-shift is really non-negotiable, and here's why the hard truth is that our nervous system is working overtime every shift. Whether you're in psych, med-surg, icu management, outpatient, trauma doesn't always mean a code or a death. It might mean a patient screaming in your face. It might mean a parent watching their child spiral. It might mean your fifth straight hour of being understaffed with no relief or being told that you're not air quotes, allowed to be emotionally upset or cry after something devastating happens. So what do we do when there's no privacy, no break, no peace and, for many teens, no debriefing? We reach for the skills that have been designed for these exact moments.

Speaker 1:

Today, I'm going to teach you two of my favorite nurse specific regulation tools that I created for two specific scenarios. One of them is for acute trauma, one for everyday chaos. Keep in mind this doesn't mean the floor you work on. It means the context, the environment that you find yourself in. Both of these are based on a couple different modalities DBT theory, trauma, informed care. Also aspects of neuroscience imagined for nurses by a nurse, because the language that we speak in the context that we find ourselves in often means we have to have specific tools that are geared for circumstances that we face and understand that a lot of others won't. The first one that we're going to look at is called Code Blue, to code you. Now, if you've been listening for a while and you know, heard, uh, some of the other skills talked about, you're probably thinking why do they all have names? Well, it's because we live in a world where acronyms and mnemonics are common vernacular for us and having skill sets, that pattern, that common language usage makes them easier to remember, easier to incorporate in muscle memory and they fit in the communication and understanding that we use frequently. So Code Blue to Code you is a skill designed for those moments when something traumatic occurs, whether it's a literal code, a patient crisis or an emotionally charged interaction and you're expected to continue functioning without pausing.

Speaker 1:

Now, the neuroscience behind why this works has a lot to do with grounding. When we experience trauma or acute stress, our brain's amygdala, the center for processing fear and emotional responses, becomes hyperactive. This activation triggers our hypothalamic pituitary adrenal axis, otherwise known as the HPA. This leads to the release of stress hormones like cortisol and adrenaline. These chemicals prepare the body for a fight or flight response. So increasing the heart rate, respiration, muscle tension, grounding techniques counteract this response by engaging the prefrontal cortex, the area responsible for executive functions like decision-making, attention and emotional regulation, by focusing on the present moment, through sensory input or cognitive tasks, we can activate this region, which in turn helps to modulate the amygdala's activity and reduce the intensity of the stress response. Having a stress response isn't abnormal and isn't negative. Having an overwhelming intensity of stress response is something that we need to mitigate, just so that there's clarity that this isn't designed to make you emotionally unresponsive or deadened or disassociate from the environment that you're in. This is simply designed to lower the intensity of the stress response so that you can choose and navigate with healthy coping mechanisms, instead of maladaptive coping behaviors or getting locked up and not being able to function at all in that moment, which in turn doubly increases the sense of overwhelm because we're in a position, in a situation where we have to function. So, additionally, grounding practices enhance interoceptive awareness, which is the ability to perceive internal bodily sensations. This is crucial for emotional regulation. Improved interoception has been linked to better management of emotional responses and reduced symptoms of anxiety and PTSD.

Speaker 1:

So how to practice something like this? So, first of all, you're going to acknowledge the trauma, name it. You mentally note I just experienced a traumatic event. Or you say something like that was really disturbing, that was terrifying, that was upsetting, that was scary. You actually acknowledge it and name it. Recognizing the impact is the first step towards processing it. And then you're going to find a brief moment of privacy, even 10 seconds, in a supply room, bathroom, a quiet corner, a few steps down the hall, even actually shifting your physical position to turn around and face the computer or to turn around and face away from the situation for just 10 to 15 seconds will suffice. You're going to engage your senses touch, hold a cold object or press your feet firmly into the ground site. You can focus on a specific color or specific object in your environment Sound, listen to ambient noises or listen to your own breathing.

Speaker 1:

Recite a grounding mantra, silently or out loud. Say that was a code, this is me, I am alive. I choose calm. And that mantra can be changed to relate to whatever it is you're doing, can be changed to relate to whatever it is you're doing, but there's a specific formula. You are identifying the traumatic context as separate from yourself. So that was a death, this is me. That was an extremely angry and furious mother. This is me. And then you're establishing safety I am alive, I am safe. I am not who that person is actually angry at. And then you tell your nervous system what choice you're making. I choose to be calm, I choose to regulate. So that mantra can definitely be be changed.

Speaker 1:

In the moment I find it's more helpful to have you know the four pieces of that formula, kind of kind of repetitious when I practice it, so that the muscle memory in that moment is intact and it's not something that you feel like you're having to come up with in the moment right then, because that really blocks the ability. Our cognitive ability in that moment is already impaired because we're struggling with that fight or flight response. So if you work in particular situations, if you deal with particular traumatic context or environment, you might want to structure that four piece very succinct mantra to fit your needs specifically and then keep that pretty much the same when you practice it. And you're going to want to practice it over and over, because the whole point of going over these skills and learning them is for you to have real life application of them and muscle memory of them. So let's kind of go over.

Speaker 1:

You know an example or two of of what this might look like. So imagine you've just witnessed a patient rapidly deteriorate and pass away despite all interventions. The family is grieving and you are filled with a rush, a mix of emotions and adrenaline sadness, maybe guilt, maybe helplessness. You step into the medication room, take a deep breath in through your nose, feel the coolness of the countertop under your hands and recite that mantra and you're going to do each thing intentionally. You're going to acknowledge the trauma. You're going to take that 10 seconds in the supply closet, the med room, or even just step around the corner to where your charting station is and you're going to feel the coolness of the wall, the countertop, the metal pole of an IV pole, maybe in the hallway, and you're going to recite that mantra while you inhale through your nose, count to four and slowly exhale. It takes 10 seconds at most to do that, but this brief practice helps to center you, allowing you to return to the ensuing chaos in that moment with a clearer mind and a steadier heart. With a clearer mind and a steadier heart, it's like pumping the brakes on that fight or flight response, pumping the brakes on the amygdala, kicking us into overdrive. By incorporating these evidence-based grounding techniques, you're not only addressing the immediate emotional aftermath of traumatic events, but you're also fostering long-term resilience and emotional well-being.

Speaker 1:

The body remembers trauma. The body remembers trauma by encoding our physical responses in that moment, in the context of that moment, as a memory. So if we allow our fight or flight response to run unchecked and overwhelm us, those physical responses, that physical state of being in the moment, is what the body is going to encapsulate as our response to that situation. So when you later on, when you, when you recall that situation, when you remember that situation, your body brings up that coding, that picture, that pattern that was created of the physical responses and status of your body, and slaps that back on when you're revisiting that memory, because the body has associated that event in that context with that physical picture. So every time we utilize these skills I know it seems brief, it seems like it wouldn't even be a panacea in the moment, but it actually is the science actually shows that these brief interventions keeping the modulation of our physical response to the context of the trauma that we're surrounded, by keeping them modulated and keeping them from going out of control does build that longer term resilience and maintains our emotional wellbeing. Because then when you debrief, when you think about the event, what your body is remembering is you bringing it back to safety, you bringing yourself back to emotional grounding and a feeling and a sense of control and purpose, and that is what the body is going to associate with that context.

Speaker 1:

So these practices are really quick, they are proven to be effective and they can be seamlessly integrated into our demanding environment of nursing. Heck, they can be integrated into a fender bender that you get into and your adrenaline spikes and you want to jump out of the car, sit still, evaluate, make sure that you're not hurt, passengers aren't hurt, whatever might be going on, and go through your CBCY before you step out of the car or before you make your next decision in that moment. It's not just nursing, we're talking about it in a nursing application, because that's the muscle memory I'm trying to help you build so that we can use it on the floor to thrive in our profession instead of getting crushed by it. Crushed by it All right. So take a deep breath. We're right at the midpoint. This is your pause point.

Speaker 1:

So if you're in the middle of a shift and you need to stop here, do it. You showed up for yourself today. That counts, and we will be here holding space for you for the next break, for the car ride home. We're going to discuss the second skill set and, of course, our coffee crystals and divination. So you've got some really good stuff waiting for you when you return to the podcast. But if you have another few minutes, stay with me, stretch your neck, sip your water, hydrate your damn soul. We've got another tool coming up that's built for that everyday drama. So just sit with me for a few minutes here and just inhale through your nose and exhale through your mouth. Love it. So we are back for the second half of the podcast.

Speaker 1:

All right, so the next skill that we're going to talk about is called the IV push. This technique is designed for those moments when the demands of the shift are overwhelming Multiple call lights and unexpected patient admission, critical lab results requiring immediate attention and action. It's a rapid intervention to help you regain composure and continue providing care effectively. So again, let's look at the neuroscience behind why this works. What we're doing is activating the parasympathetic nervous system. The PNS is often referred to as our rest and digest system. It counteracts our fight or flight response that's initiated by the sympathetic nervous system during stress. Those of you that have been listening for a while have heard me talk about the balance between these two systems and other skills that I've taught in earlier episodes, and engaging the PNS helps slow the heart rate, reduces blood pressure and promotes a state of calm.

Speaker 1:

Techniques such as deep diaphragmatic breathing have been shown in research to stimulate the vagus nerve, a key component of the PNS, thereby inducing relaxation and reducing stress levels. And the thing about stimulating the vagus nerve is that it has an almost immediate effect. And nurses, you know this if you've had patients, especially my cardiac nurses, if you've had patients that have a really high heart rate, and you know, give them the old plunger trick, here you go. Here's a 10 CC syringe. I want you to blow the plunger out of the back of it. And we're trying to get them to vagal. What we're doing is intensely stimulating the vagus nerve and that response in order to cause a cardiac response. Stimulating the vagus nerve and that response in order to cause a cardiac response.

Speaker 1:

The IV push for the skill set isn't that intense, but it's along similar principles. So another thing that is involved is progressive muscle relaxation. Pmr involves tensing and then relaxing muscle groups, which can interrupt the stress response cycle. So this practice not only reduces physical tension, but it also signals to the brain that it's safe to relax, thereby decreasing the production of stress hormones like cortisol or the release of adrenaline. Visualization techniques, which is also incorporated, like guided imagery and visualization, those can shift attention away from stressors and towards calming mental images. This redirection can modulate the activity of the limbic system, which is our brain's emotional center, thereby reducing feelings of anxiety and promoting emotional regulation. Reducing feelings of anxiety and promoting emotional regulation. So how do you practice the IV push, like when it comes to nurses, and not an illegal one on yourself?

Speaker 1:

So the first thing you're going to do, you're going to inhale deeply, you're going to take a slow, deep breath in through your nose. While counting to four, focus on the sensation of air filling your lungs. To four, focus on the sensation of air filling your lungs. Visualize clouds moving by or clouds filling your lungs. You're going to visualize stress release. As you hold your breath briefly, you're going to imagine the stress as a physical substance that's being gathered. You're going to exhale slowly through your mouth and you're going to release. You're going to count to six. While you're doing that, as you breathe out, you're visualizing those clouds, water, whatever substance it was that you were visualizing being gathered and held. You visualize that leaving your body and dissipating into the air.

Speaker 1:

And remember, this is only for a quick count of sixcle tension and release. So, as you start to inhale, you're going to either clench your fists tightly or you can press your thumb and your pointer and index finger together tightly. If you're standing somewhere where clenching your fists simultaneously might look rather odd, you can pinch the seam of your scrub pants between your thumb and forefinger and middle finger tightly and count to five seconds. So you're going to start the muscle tension as you start to inhale through your nose. You're going to count to four and that brief second that you hold it is that fifth count of you having that muscle tension, that muscle flexion. And then, as you start to do your six count, exhale. You release the tension, you allow your hands to relax completely, like to complete laxity. By the time you get to the end of that six count and you're going to repeat that as needed. You can perform the cycle two to three times or as necessary to regain a sense of calm. And if you think about it, you counted to four, you held for one, you released for six. That's basically 10 seconds. That's it. It's that fast, but neurologically and therapeutically it is so deeply significant.

Speaker 1:

A real life application of this could be something where, imagine you're in the middle of documenting patient notes when an urgent lab result comes in requiring immediate action and simultaneously a family member approaches with concerns and a colleague sticks their head out of the room and asks for assistance. The mounting pressure can trigger a stress response, feeling overwhelmed. So you want to take 10 to 15 seconds to perform the IV push. That'll help you reset. It'll allow you to address each task with a clearer mind and steady your hands. And you can take, you know, even longer. You can take 20 or 30 seconds to run through this once or twice, or you can simply run through it once as as kind of a break point to steady yourself and move forward.

Speaker 1:

Another example you just got an admit dumped on you mid charting. You haven't caught yet up on the two discharges you had, and orders just came in to take your other patient to CT for imaging. You're starting to feel overwhelmed. You just step to the side, hold your fists tight or pinch the seam. You're going to breathe in. You're going to visualize that pressure and then you're going to release it like a flush. You're pushing and it's that IV push Sometimes I find, since it's called the IV push visualizing that saline flush connected to the port and the moment right before you depress the plunger of that 10 ml flush is that fifth count. Your muscles are tense. You're going to push and flush all of that tension. You're flushing that saline into that line, just like you are exhaling and releasing that stress and overwhelm, releasing that tension as you completely and utterly relax your hands to the point of laxity, complete relaxation. Your brain resets just enough in that moment to not spiral.

Speaker 1:

By incorporating the IV push into your routine, you're equipping yourself with a scientifically grounded tool to manage stress effectively. This practice not only enhances your wellbeing but also ensures that you can provide the highest quality care to your patients with a clear and directed mind. The most important thing in addition to your patient outcomes is care of self. Just like code blue to code you, the IV push gives you emotional reset buttons that are fast, that are easy and that enhance resilience, because you're teaching your body that, instead of roller coaster swings of emotions and reactions in a chaotic environment, you have a much narrower band of natural and normal human emotional cycles of reaction to your contextual environment and demands that are placed on you. But they are regulations that you control. They are cycles and depths that you regulate and control as you move through and cognizantly choose your actions. It's implementing coping behaviors instead of reactionary behaviors.

Speaker 1:

So, just as a reminder for the IV push, I you're going to inhale slow through the nose for four seconds. V, you're going to visualize stress, leaving you as if you're flushing a line and the push part of it is when you're tensing that muscle group. You start tensing the muscle group as you inhale slowly through your nose. You do that four count. That fifth count is where you're holding it and you're starting to visualize stress, leaving you as if you're flushing a line as you're breathing out for six and that relaxation of the muscle group happens at the same time that you're breathing out for that count of six. That's one round, that's maybe 10 seconds at most, so you want to do two if you've got the time.

Speaker 1:

It's not therapy, but it is triage for your sanity and it's a skill set that you can utilize anywhere, anytime. This is also something that you can use for anxiety prior to doing something, an exam, a procedure, a difficult conversation with someone. If you're somebody that doesn't like conflict not many people do, but for some it's more comfortable than others and if you're somebody who conflict is intensely anxiety provoking, before you have that conversation, before you face that confrontation, iv push is absolutely effective as a skillset to use to reset, to remind yourself of your goal posts for that conversation and continue forward. So at this point we've made it to our ritual part of our episode, our favorite coffee, crystals and divination. It's our moment to recenter reset, really kind of tap into the magic that matters for us.

Speaker 1:

Tea, it can be decaf, but the protein blend part is really the part that we're hitting on. So it's kind of like a cinnamon vanilla protein blend. Cinnamon really supports circulation and energy, our protein for nourishment and substance. And well, the espresso, the caffeine for survival. Iced coffee, vanilla protein shake for your creamer or protein powder, and like an oat milk or even cream. Um, if you're not lactose intolerant, it could be coconut milk. If you are, whatever your vibe is, you're going to pour that over ice. You're going to add cinnamon and stir. It's a pretty good amount of cinnamon. Um, really as much as you can tolerate flavor wise. If cinnamon isn't your thing, um, it can be ginger, it can be all spice, anything that has that kind of warm hint of spice. Iced golden milk, like the turmeric golden milk, accomplishes the same thing, and you can also make that with protein powder or vanilla protein shake. But it's refreshing, it's sweet, it's perfect for right now when we're feeling the urge to maybe start to get more active and enjoy the nicer weather, depending on where you live. This past Saturday, where we live, northern Nevada lost its damn mind and it was hailing, so take it or leave it. Hopefully, where you are, there's nicer weather happening.

Speaker 1:

But we're going to do our live draw of our crystal of the week and see what it has for us. I really would love to see pictures of you guys, uh and tag the ritual nurse of you guys with your crystals, your bangles, bracelets or, if you have like a little worry, stone or crystal that you keep on your person. I mean, we carry crystals and we don't judge, so even if you have a bra buddy that you tuck in your bra and you, uh, you keep with you on your shift away from all the goo and ick of the floor. Like I said, we carry crystals and we don't judge. That's the whole thing. But let's see what this week's crystal prescription will be. Let's get a good shuffle going, all right.

Speaker 1:

Radiance oh, it's agate, and this one looks like a beautiful fiery orange one and it signifies radiance. Oh my gosh, this card is absolutely stunning. So this signifies confidence, courage and ground grounding totally irrelevant, right, the radiant energy of agate and the empowering warmth of the sun symbolize a profound moment of self-discovery and confidence, this card signifies a transformative journey towards embracing your inner radiance and finding the courage to shine brightly. Just as agate brings grounding and stability, allowing you to find balance and harmony within, the sun's light illuminates the path to self-assurance and belief in your own abilities. Welcome this moment of radiance. Trust in your inner strength and step into the light with confidence and grace, knowing that you are supported by the universe on your journey towards fulfillment. Absolutely, amazing.

Speaker 1:

I am so in love with this week's poll this week, um, and it's something that you're going to hear about in a future podcast episode, so I'm not going to give too much away, but I am in the middle of something uh, incredibly stressful, positive, positive, positive. It's very positive, but incredibly stressful. And that card and that imagery is just so absolutely fitting for this week. And, amazing, I am using these skills myself in real time. Oh, my goodness, um, this entire week, uh, just just constantly. A because they work and b because when I tell you that this is stressful, this is stressful.

Speaker 1:

So, while I was talking, I had immediately had a card jump out um, and it is the nine of pentacles and it is a beautiful image of bumblebee Jasper. So let's find pentacles. No matter how many times I look through this, my brain always likes to reshuffle the order in which the suits are actually. So the nine of pentacles. So we are looking at financial independence, comfort and gratitude, and bumblebee Jasper is celebration, positive attitude and abundance. Treat yourself. You worked so hard to create all of this abundance in your life, so don't be afraid to splurge and enjoy the fruits of your labor. Celebrate your achievements. You deserve it.

Speaker 1:

So these are absolutely stunning. The images almost match perfectly the radiant colors of the sun, shaded agate and the beautiful piece of bumblebee jasper. I mean they look like they're almost cut from the same stone. That's incredible. But these messages together are celebratory and really significant. Definitely celebrate yourself. Definitely celebrate how far you've come to keep yourself in emotional grounding and regulation and every time you do that, acknowledge how amazing you are for being able to.

Speaker 1:

Nobody is ever going to tell you that the context isn't going to provoke emotional reaction or that the stress is just going to melt away. It isn't, it's going to be there. And also these skill sets give you the opportunity to withstand that in a healthy manner and continue to be effective and thrive and provide the best patient care or survive the moment in the best way possible, while taking care of yourself. All right, my ritual nurse family. This podcast is growing and it's because of you. So if today's episode helped you, please share it. Text it to your work. Bestie, your precept T, even your deal in. For heck's sake, leave a review, hit that star rating, post it in your group chat.

Speaker 1:

I really would love to start seeing pictures of you guys with your crystals, skill sets, anything, and tag the Ritual Nurse. But we are creating a new culture in nursing and we're just at the beginning. So follow me at the Ritual Nurse on TikTok, the code team. On Instagram. You can visit tcthorg. We've got tons of free downloads tools. Our new store has been up, but what we are doing is so damn important, because healing nurses heal nursing, and I see you. So until next time, breathe deep, regulate often and stay sacred. I love your faces. Breathe deep, regulate often and stay sacred. I love your faces. This is your Ritual Nurse Reva. Thanks for tuning in to the Ritual Nurse podcast. You can find us wherever you listen to podcasts, so don't forget to subscribe and stay connected For all our social links free education classes, blogs and podcast notes with resources head over to tcthorg. No-transcript.