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

Happy October, fam!!! Spooky season is here (read my favoritest season besides summer), and so are some big firsts for The Ritual Nurse. This month we’ve got special off-schedule episodes dropping, TikTok Lives (Go follow @theritualnurse!!!) in the works (yes, with crystal pulls and live divination), and some major announcements that are going to shift how we do this together.

But today? We’re talking survival. Nursing doesn’t hand out privacy breaks. You don’t get a quiet room to cry it out or a meditation cushion mid-shift. What you get is the med room, a hallway, or maybe two seconds at the scanner and meanwhile your body is betraying you with a racing heart, shaky hands, and a foggy brain.

That’s why this episode is all about regulation in real time. Not the “self-care day” version, but the neurological reset that works in 30 seconds flat.

What you’ll hear in this episode:

• Why nursing leaves you no space to process and what that does to your body
• A step-by-step guide to Code Blue to Code You
• Two add-on micro skills: B.O.D.Y. (your doorway reset) and HEART-REST (your deeper breakroom pause)
• The science of why regulation is not optional. It’s ethical survival
• Coffee, Crystals & Divination: fall coffee rituals with cardamom, Black Tourmaline, and a divination pull that nailed the theme of regulation and resilience

October is going to be huge here at The Ritual Nurse. Don’t just listen! Join in. Hit that fan mail link in the show notes, tell me your spooky season rituals, and come hang out when we go live on TikTok. This month, it’s not just about surviving the floor. It’s about grounding, rising, and building rituals strong enough to carry us through the chaos.

Chapters

• 0:20 Welcome to Spooky Season
• 1:10 Regulation in the Real World
• 3:50 Understanding Trauma Physiology
• 6:50 Code Blue to Code You Method
• 10:29 Layering Micro-Regulation Skills
• 20:06 Dance Break Intermission
• 21:04 Why Regulation Matters
• 24:48 Coffee, Crystals and Divination
• 32:41 Final Thoughts and Resources

Transcript

Riva: 0:10

Happy October. I am so excited that it's October for several reasons, one being that your girl here I've only got two times of the year it's either summer or it's Halloween, so spooky season for me is just as invigorating as summertime for me. I love everything about it, and also we have some pretty incredible things happening this October that are a first for the Code Team, a first for the Ritual Nurse podcast and really, I think, are going to change the trajectory of nursing. But a little bit more on that in later episodes and announcements. Right now, welcome back to the Ritual Nurse, the podcast where nurses finally get the tools to survive this job without losing ourselves in the process.

Riva: 1:00

I'm your host, Riva, and today we're tackling something that every single nurse knows all too well: those moments when your body is screaming, your heart is racing, you've got about 30 seconds and zero privacy to pull yourself together before you walk into the next patient's room. This episode is all about regulation in the real world. Not the spa day, not the take a week off, but several no joke things that you can do in less than 30 seconds, the thing you can actually use in the hallway, in the med room or even while you're pushing that next IV. Because, let's face it, that's nursing. You don't get perfect conditions to deal with stress. You get the med room, the hallway, the supply closet or maybe just the two seconds it takes to scan a wristband. That's all that you have sometimes to regulate your nervous system before the next patient, the next crisis, the next family member asking you for something, the next admit, discharge, fall... who knows what it is. I mean, let's be real, when we say nursing doesn't give us privacy, we really mean it doesn't give us privacy.

Riva: 2:14

When we're on shift, all eyes are focused on us, either looking to us for guidance and leadership, or looking to us for answers, solutions. We don't get to leave to cry it out, to journal it out. We don't get to take a break in the middle of a code or when we've just had a family member scream in our face or after we've just watched something really traumatic happen. Now you may be able to take a few minutes to debrief, to collect yourself, but usually when we're in transition you're heading to another patient's room to continue care, to do whatever it was that the significant event diverted you from in the first place.

Riva: 3:03

So nursing is full of those moments where your insides don't match your outsides. You're standing there trying to look calm and competent, but inside your body is absolutely betraying you. Your chest feels tight, your throat feels like it's closing on you, your hands may be shaking, your stomach might feel like it's dropping like an elevator. Your brain is foggy, blank, maybe scattered. That's trauma, physiology, and it's not just happening after a code. It can be happening dozens of times a shift and if you don't learn how to regulate that stress piles up and one day it breaks you.

Riva: 3:43

The trauma stacks up, your nervous system takes the hit and if you don't know how to regulate, it leaks out in mistakes and exhaustion, in snapping at the wrong person, in going home and collapsing into silence. It manifests in physical and mental illness and a lot of maladaptive coping behaviors. This is where boundaries and ethics collide, because we can't ethically give safe care if we're dysregulated. Regulation isn't a luxury, it's really kind of a professional requirement in order to maintain safety and accuracy and standards for ourselves and our patients. So when we have these situations where our body is feeling all these feelings, here's what's actually happening inside your amygdala the brain's alarm system is screaming danger.

Riva: 4:40

Your adrenal glands are dumping adrenaline and cortisol into your system. Your heart rate is spiking. Your blood vessels are constricting, body diverts blood to your muscles. That's why you might feel hot or flushed or even shaky. Your digestive system shuts down, so nausea, stomach flips or sudden bathroom urgency can be really common. Your prefrontal cortex, the rational part of your brain, goes dark. That's why you can't think straight or remember simple steps.

Riva: 5:16

This is survival mode. Your body is acting like you're being chased by a tiger, when really you're just trying to hang the bag of Vanco. And here's the problem. If we stay stuck in that survival mode, we're unsafe. We can't think, we can't decide and we can't care for patients the way that we need to. We get tunnel vision. That's why you might blank on a simple med calculation, stumble over your words or feel like your hands are shaking, not remember the order that you just repeated three times in a row.

Riva: 5:53

It's not weakness, it's literally your nervous system hijacking you. Regulation skills work by interrupting that hijack, bringing you and your wild nervous system back online and signaling to your body that you're safe enough to function. And that's why we need a reset, not a full-on therapy session. Those are wonderful, valid and so healing. But in that 30 seconds, that 15 seconds, we don't have time for that. But we need something. We need a neurological reset button that we can hit in seconds and that we call Code blue to code you. We discussed this a little bit in the first season, but think of it as a as running an emergency drill. Only the patient is your own nervous system. So how do we break this down? Step one stop Mentally. You call it, code me, just like a code. Naming it takes power.

Riva: 7:02

You acknowledge what's happening instead of getting swept under. The next is breathe. You take one deep inhale through your nose and then a long, slow exhale through your mouth. This signals the vagus nerve, your body's built-in brake pedal to slow down the heart and quiet the alarm bells. You ground, push your feet into the floor, feel your shoes, feel gravity. Your body gets the message I'm here, I'm stable. You orient, use your senses to pull your brain back online. Name one thing you see one thing. You hear one thing you feel. This re-engages the prefrontal cortex, the decision-making part that went offline when your amygdala hijacked you. Then you resume. You've stabilized just enough to move forward. Then you resume. You've stabilized just enough to move forward Now.

Riva: 7:56

You don't need to be 100% calm because, let's be honest, that's probably not going to happen, but you do need to be regulated enough to keep going safely. This works because this interrupts the trauma loop. You're telling your nervous system yes, something stressful happened, but I am not in mortal danger. Our body, as a physical being, cannot tell the actual difference between life and death. As in you are in mortal danger, a predator is chasing you and a jump scare in a movie or a video game, or the panic that you feel when a trauma suddenly happens around you at work, or even high levels of excitement. The physiological signs and symptoms are exactly the same to your body and it is relying on the input that it is getting from you to decipher what, contextually, is happening around it. So with practice, your body learns this skill set over time and you can use it as muscle memory. You're conditioning yourself to use this as muscle memory In those moments of overwhelm, high stress, trauma, super high emotion.

Riva: 9:36

Let's go over the steps one more time. Step one stop Like a code blue. You call it Code me. Step two breathe Deep, inhale through your nose, long exhale through your mouth. Reset the vagus nerve. Step three ground, reset the vagus nerve. 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 to keep going safely.

Riva: 10:10

Now, sometimes code blue to code you is enough, but sometimes you need a little more. And this is where you can layer other micro skills. So you might use code blue to code you in the moment and then in the ensuing moments after, in the ensuing moments after, as things come to their natural conclusion wind down, patient transfers, resuscitation, whatever it may be you can layer these other micro skills on top of the code blue to code you skill. In the interim, before you actually have that time can, can carve out that time to fully reset and do a full body check and self-awareness and reground yourself. And we know from experience that even though one trauma may be, you know, ebbing down, the unit might be coming down in temp, things are cooling off a little bit. That doesn't necessarily mean that you suddenly have free time. In fact it's usually the opposite More orders, things to do, tasks to carry out, possibly delayed patient care to other patients while you were dealing with the situation that has to resume. So we know that it might be till the end of your shift, when you're sitting in your car in the parking lot, before you actually get to debrief with yourself, or maybe not till you get home. So layering these micro skills is a way to kind of drip feed yourself resilience, building structure, applying support over this time period throughout the rest of your shift.

Riva: 12:08

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're going to take one steady breath to anchor yourself. Orient, notice where you are, drop in, feel your body, notice your feet, your posture, your hands, just kind of like a ripple moving from your forehead over your shoulders, your diaphragm, your knees, your feet. And yield, soften, let your muscles release a fraction of their tension. You can't afford to unwind or completely come undone. But that bracing tension that you're holding we crack that You're still on the move, you're still focused. But that 6,000, 7,000 RPM level red line that you're sitting in, we crack that level of tension and release that energy a little. This is your doorway reset. You can use it right before walking into a patient's room, right before starting a new task. You can do it while scanning an armband. It takes split seconds to do this. By orienting and yielding, you activate those parasympathetic pathways. Again, you're reminding yourself, you're reminding your physical body that you are safe enough to proceed.

Riva: 13:35

I want to liken this to almost kind of how we administer Narcan. Narcan has a very short half-life. So when we have patients that are overdosing, they have a lot of the drug in their system and we may administer Narcan and it works, blocks the receptors, pulls them out of it, but it's got a short half-life and there's more drug floating around in their system. So as the Narcan leaves the receptors and the drug refloods the receptors, they go right back down. So kind of analogous to what we're doing during the shift, when it is a really spicy shift and the unit might be hot. There's a lot going on, a lot of pressure, maybe actual, a lot of actual trauma, maybe not, maybe it's just overwhelm and pressure and admissions coming going in out. One patient fell, this patient's on the call light. Family members are relentless, orders are persistent and endless, that kind of thing. Okay, there's a lot in the system and our initial code blue to code you blocks those receptors and you can come up for air for a minute, but then it swirls around again. So we have to keep drip feeding these practices to keep your nervous system within regulation and to keep you above water, keep you from drowning in the shift.

Riva: 15:09

There is another one called heart rest and it's hydrate exhale, allow, release and tune in. Hydrate, focus on taking a sip of water to reset your system. Oftentimes we find that taking a sip of ice water the shock of the cold, the temperature reset water, the shock of the cold, the temperature reset helps refocus your body's attention, your brain's attention, on your core. Inhale and then exhale, long, slow, breath out and allow, give 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 down by your clavicle, where they're supposed to be, and not your cranium, where they're tucked up against, and tune in. Notice any signal that your body or mind is screaming at you at the moment.

Riva: 16:17

I need air, I need space, I need whatever it may be that you need this skill is best when you're heading into an actual break or if you can catch a real quick five minute, 10 minute pause in the break room, because this skill is asking you to go a little deeper and to give yourself a little more. It extends regulation beyond those short seconds. We're not just interrupting the nervous system and the fight or flight reaction parasympathetic stillness and rest for a few moments to actually allow your physical self to sync with where cognitively you need to be and then remain there for a few minutes. Hydration and slow exhalation resets your sympathetic overdrive. You're adding intentional permission and intentional release to allow the nervous system to shift into recovery rather than just staying stuck in that fight or flight, in that hyper arousal state on pause.

Riva: 17:47

And these micro skills and learning 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 them anywhere and they don't require equipment. These aren't extras, they're really survival gear. Each one of these is designed to be immediate, portable, quick and they teach your nervous system to come back online faster and faster. Every time you use them, as they become muscle memory, you begin to unconsciously repeat these actions before you have to prompt yourself to even do it, and that's the whole point. That is the goal of practicing these over and over.

Riva: 18:41

Initially we have to start out by consciously prompting ourselves to do it.

Riva: 18:45

But as you practice more and more, your body remembers the physical triggers, the physical context, and then oh, wait a minute, we pause. Here it's going to remember by muscle memory, you implementing these skills and bringing yourself back to center or keeping yourself below that red line enough so that you can function, that you can have clarity, that you can be safe, you are regulated enough to function, and then, when you get the chance to an actual, valid chance to move into recovery mode, then you can do so. We are at the point now where we're going to do a little of that. It's our dance break, as you know. So shake it out, stretch your hands, drop those shoulders, remind yourself that even a few seconds of movement can shift your whole state of being. Get hydrated. If you're headed back to the floor, have the best shift ever. We'll see you on the way home or at another break. If you're hanging out with us, we'll see you after the break for the whys and integration and for 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 finding me there's no love under the portrait Moon.

Riva: 20:53

Welcome back. Let's keep going. We're going to discuss why any of this even matters. It should matter for several reasons. One, because your physical health should be a priority. You get to be a priority. Secondly, because, ethically, how we practice is deeply important to the success of our practice, and unregulated nurses make far more errors, have higher rates of compassion, fatigue and are more likely to leave the profession. Regulation isn't soft, it's survival, it's ethical, it's the line between burnout and sustainability.

Riva: 21:36

And here's the best part the more that you use these skills and these quick resets, the more your body learns. We have neuroplasticity for our entire life, and neuroplasticity means that your brain rewires your vagus nerve tones. Your regulation gets faster, easier and more automatic. You want to practice these skills all the time, and not just at work. They're useful anywhere that you run into overwhelm, stress, trauma, high levels of labile or volatile emotions. I mean that can be right in your own kitchen.

Riva: 22:17

These are also exceptional skills to model if you're a parent, if you have kids around you. Littles can do these skills, maybe not with the big words that we do, but they can mimic exactly what you're doing. These skills would be absolutely life-changing if they were taught to teenagers, if they were taught to kids in middle school. So it's really really important that our why, that we state it, that we connect with it really clearly. You are worth it. Everything that you have put into getting to where you are you as a person, everything that you sacrifice, your hopes, your dreams, the things that you believe in, the things that you want. You are worth developing regulation, skill sets and enhanced resilience, because you deserve an exceptional quality of life. You deserve an exceptional quality of life.

Riva: 23:30

You deserve an exceptional professional experience as well. I want you to remember that and I want you, when you're practicing your self-care throughout the week, to really be reminding yourself of just how deeply you are worth in this work yourself. I'm just how deep with you all worth in this work. And speaking of self-care rituals, it is spooky season. Let us get into everything Coffee, crystals and divination. Let's do it. This is my absolute favorite segment. In fact, you may or may not have a few special episodes in October that are coming out off schedule that just solely revolve around coffee, crystals and donation. We'll see you on guests and on food lists, so take what works for you and leave the rest, but join us for the fun and join us for the good thoughts and amazing manifestations. Let's get it. Regulation isn't just about the nervous system. This is also about grounding ourselves in our small, intentional practices that remind us that we are so much more than things of the chaos around us. Coffee of the week October fall. Some places it may be spring. Some places it may be the day for just that brisk crisp fall. Other places might be hot.

Riva: 25:06

The Virtual Nurse is in over 120 countries around the world. I'd love to know your feedback. What are you guys experiencing in October? What's your Halloween tradition that you like? What's the best season that's for you? The text link at the top of our show notes you can smash that text link and send me your fan mail. You can reach as completely, utterly anonymous as you like, in fact, the fan mail system. They will ever see a fan mail from you, it will be from them and it also doesn't sign up for anything like that. So you can just send me a fan mail and send me messages and I would love to get it, love to get it For me.

Riva: 25:51

This spicy kind of just delicious fall season I'm going to go ahead and say it because I absolutely love it A bold, dark roast with a hint of cardamom and a splash of either cream or coconut milk or even sweetened condensed cream.

Riva: 26:09

I find that the addition of the spices, cinnamon is a really good addition here too, but cardamom has been used for centuries to soothe the stomach and ease tension. It's a perfect pairing for everything that we're talking about in today's episode.

Riva: 26:27

Some people really like chai also. .

Riva: 26:31

That is amazing and spicy and warm and filling Kind of serves the same purpose. Let me know minutes you're getting into this spooky season. at

Riva: 26:41

Let me know what you're incorporating into your self-care ritual in those 5, 10, 15, however many months you're carving out for yourself each day in practice. Share it on socials and on TikTok the Ritual Nurse. I'd absolutely love to see some of my podcast listeners on the live. It's so fun. I may or may not be also doing some lives on TikTok. That are live donation polls and live crystal prescriptions.

Riva: 27:20

And your girl has so many you better run.

Riva: 27:26

Let's not talk too much about that. My husband does listen to these podcasts religiously.

Riva: 27:37

He has an incredible support system and I really would like to know if I don't have guests and it's just me on an episode would you guys want to?

Riva: 27:57

see the podcast in video format, or would you want to see it only with guests? I have followed several podcast people that do video podcasting and it's just that they don't have guests, and I like it.

Riva: 28:10

I usually listen to the audio version of the podcast, but if that's something that you guys would be interested in, we have the studio, the equipment.

Riva: 28:19

The podcast does actually already stream to our YouTube channel just audio only, and I would like to start doing video with guests. But if just video in general is something that you would be interested in, let me know. Send me some things and let me know your thoughts. So we had Amazonite jump out of the Christian prescription. Take a look at what Amazonite means. Amazonite says empowerment, truth, compassion and integrity. Embrace the power of Amazonite and maybe some truth If you've got time. Empowerment it's time to cut through any self-doubt. Make your truth feel strong. Let the energy of Amazon guide you as you stand tall, speak your mind and conquer self-doubt. Trust in your strength and let your authenticity shine.

Riva: 29:17

You are a force to be reckoned with. So step into your power and let your truth be heard loud and clear.

Riva: 29:27

Sounds an awful lot like stepping into your power and taking control of your nervous system and standing strong in your power and your strength, speaking the truth to be grounded, to be regulated, to be over and over.

Riva: 29:52

I often wonder if any of my listeners have gone and picked up these decks that I use. If you have, let me know. Tag me in pictures of you guys using them, if you have them. I'm absolutely enamored with these decks. I have been since I got them. I have multiple versions of them. I currently pull with the silver foil version of the decks both of them and the full size version. She does have smaller versions that are like, I guess you could say, travel size. Versions of the gold and the silver cards on her site are oftentimes sold out and, trust me, I can see why. 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 of silver edged people, like black and silver.

Riva: 30:48

So let's see what our cards have to tell us. Divination, wise in regards to oh, wow, okay, two jumped out immediately. So we have Chrysoprase, which is the page of wands, and then I have the nine of wands, which is hematite. So let's see what these mean. The page of wands is creativity, ideas, free spirit. Chrysoprase is joy, inspiration and playfulness. Your creative, curious and whimsical spirit are taking you on various unknown journeys where you may not know the destination. Continue on these journeys to learn more about yourself and hone in on who you really are and which direction you should be heading in. I think this card is a really, really apt reminder to continue carving out time for that ritual space for yourself, that self-care, diving deeper into your dreams, your hopes yourself, your strengths, your needs. Your dreams, your hopes yourself, your strengths, your needs Great journaling prompts, great manifestation prompts. Now let's look at the nine of wands. The nine of wands is courage, persistence and boundaries. Hematite stands for resilience, courage and strength. You may be feeling exhausted right now, but this card comes as a reminder to stay vigilant as you fight through life's obstacles. Your resilience and persistence will pay off as these tough times begin to pass. This card was literally the cliff notes of this entire episode. Oh, these are beautiful cards and very apropos to the episode and to the meaning of the episode. So next time that you feel the panic rising and you've got 30 seconds and zero privacy, call it Code blue to code you.

Riva: 33:06

If you need to layer in the micro skills of body or heart, rest when you can. You deserve regulation, you deserve safety and your patients deserve a nurse who knows how to bring herself back online, especially in the chaos. If today's episode gave you something you can use, share it with as many people as you can. Share it with all the nurses that you know that need the reminders, that need the skillset, that need the support. And if you want the tools that we talk about here in printable form other resources head over to tcthorg.

Riva: 33:47

Check the show notes for links to our resources. Especially, check the show notes for the links to the fan mail and send me feedback. Send me feedback on your spooky season, on your October, on your self-care rituals, on things that you'd like me to podcast about, if there's things that you want me to cover, and tell me what you think about the whole moving the podcast or adding to the podcast in terms of video. So this has been the Ritual Nurse. I'm Reva, reminding you that your survival is sacred, your regulation is your armor and your resilience is life-saving. Until next time, keep your rituals strong and your practice stronger. Love your faces.