Sometimes, a shift will hit you like a freight train. It’s that day when everything seems to spiral out of control: patients are climbing over bed rails, call lights are blinking like Christmas trees, and every five minutes, another unexpected problem pops up.

Let’s talk about a few actions you can take, particularly when you’re dealing with confused or agitated patients who just won’t stay put. These tips will keep your sanity in check while also ensuring safe, compassionate care.

1. Sit with the Patient While You Chart

Sometimes, being present can calm a confused patient down. Take your computer or charting materials, pull up a chair in their room, and get your documentation done. It keeps them company and lets you keep an eye on them.

2. Identify “Golden Moments” for Charting

Identify natural lulls in your workflow to quickly catch up on documentation—like right after a meal pass or during a quiet moment. Taking advantage of these golden moments ensures you don’t end up rushing to chart everything at the end of the shift.

3. Request PRN Medications for Anxiety

If the patient is highly agitated and potentially unsafe, don’t hesitate to ask the provider for PRN medications to reduce anxiety. This is a proactive step that often helps to stabilize the patient without escalating behaviors further.

Whenever possible, preemptively prepare commonly needed PRN meds, such as those for pain or anxiety. Having these on hand can save time and reduce stress if a patient suddenly becomes agitated or uncomfortable.

4. Ask a Colleague to Watch the Patient Briefly

When you need to step away to see another patient, ask a trusted colleague to sit by the door or keep an eye on the patient. We’re all in this together, and asking for a few moments of help is totally fair game.

5. Wheel Them Around the Floor

Sometimes, a little movement is all it takes. Wheel the confused patient around the unit for a few minutes. This redirection can calm them and provide a brief distraction from their restlessness.

6. Bring the Patient to the Nurses’ Station

If the patient is easy to redirect and not disruptive, consider bringing them to the nurses’ station. The noise and activity may provide enough stimulation to keep them settled, and you’ll have them in sight.

7. Use a Fidget Toy

Consider giving the patient something to keep their hands busy, like a soft ball, stress toy, or even a washcloth to fold and unfold. These small items can be surprisingly effective in reducing agitation and keeping the patient occupied.

8. Prioritize Tasks in Blocks

Start your shift by mentally or physically organizing tasks into blocks—such as “med passes,” “vital checks,” “charting,” and “patient interactions.” Having a mental flow helps you stay on top of time-sensitive responsibilities and keeps you ahead.

9. Take a 5-Minute Breather

Even on the most stressful days, you deserve a quick pause. Step away for just five minutes to take a deep breath, stretch, or grab a drink of water. It’s amazing how this small act can refocus your mind and improve your mood.

10. Speak Up When You Need Backup

When the unit is stretched thin, don’t hesitate to voice when you need help. Asking for backup when you’re dealing with a challenging patient isn’t a sign of weakness—it’s a critical step to ensure everyone’s safety, including your own.

11. Set Clear Boundaries with Yourself

Tell yourself, “I will do my best, but I can’t do everything perfectly.” This isn’t about lowering standards; it’s about realizing that some days, perfection isn’t realistic. Set small goals and celebrate every accomplishment.

12. Use Repetition to Redirect

Confused patients often respond to simple, repetitive statements. Gently repeating phrases like “You’re safe here” or “I’m here with you” can sometimes be more effective than explaining in detail. Stick to calm, concise language that’s easy for them to process.

13. Simplify Patient Choices

For agitated patients, too many options can be overwhelming. Instead of asking open-ended questions, offer two choices (“Do you want water or juice?”). This strategy can help reduce decision fatigue and keep things calmer.

14. Adjust the Environment

Noise, bright lights, or an overly busy room can add to a patient’s confusion. Whenever possible, dim the lights, close the door to reduce noise, or play calming music to create a more peaceful environment for your patient.

15. Document Everything

Keep thorough notes on your patient’s behaviors and your actions. Not only does this protect you, but it also helps the next shift pick up where you left off, understanding what worked and what didn’t.

16. Choose a Calming TV Channel

If your patient is okay with you choosing the TV channel, pick something neutral and calming like a talk show, sports, or news. These channels offer consistent content, are less likely to upset or overstimulate, and can keep you and the patient entertained as you sit with them.

17. Establish a Familiar Routine

Patients with confusion often find comfort in a predictable routine. If possible, create a simple, repetitive schedule throughout the day. This consistency can make your shift feel more organized and help the patient feel more secure.

18. Use Simple, Direct Communication

Speak in clear, short sentences. Avoid giving complex instructions or too much information at once. This approach helps prevent further confusion and keeps the patient calm.

19. Enlist Family Members

If a family member is willing and able, encourage them to distract the patient for a while. Sometimes, familiar faces can bring a sense of peace and familiarity that’s difficult to replicate.

20. Utilize Bed Alarms as Needed

If you’re concerned about the patient’s safety, especially when they’re likely to get out of bed unexpectedly, set a bed alarm as a backup safety measure. It’s a helpful reminder and alerts you if they try to move on their own.

21. Offer Simple Comfort Measures

Sometimes, a warm blanket, a cup of tea, or simply adjusting the pillows can help soothe an agitated patient. Small gestures of comfort can make a big difference in their mood.

22. Use a Visual Checklist

Create a quick checklist of essentials for each patient and keep it visible. This can be a mental or physical list that includes reminders for routine checks, PRNs, and patient updates. A checklist allows you to stay organized even on hectic days.

23. Know When to Involve the Charge Nurse

If you feel that a patient’s safety or behavior is beyond your control, inform the charge nurse. They can assess the situation and may offer additional support or guidance.

24. Focus on Basic Needs First

Prioritize tasks by focusing on the essentials: safety, comfort, and basic hygiene. Sometimes, getting these basic needs met first can help reduce patient stress and improve cooperation.

25. Use Humor to Connect

If the moment feels right, a little humor can help lighten the mood for both you and the patient. It’s a way to build trust and shift the focus from stress to connection.

26. Ensure Adequate Hydration

Offer sips of water or juice to keep the patient hydrated. Dehydration can sometimes increase confusion, so this simple step can contribute to better mental clarity.

27. Bring a Snack (If Allowed)

Sometimes, a little snack can provide a calming distraction for a restless patient. Check with dietary guidelines first, but this can be a handy tool in certain situations.

28. Document Agitation Patterns

If you notice patterns in the patient’s behavior, document them. This can help other staff members and the care team develop a plan to address potential triggers or times of heightened agitation.

29. Learn to take a “Step Back” When Needed

Sometimes, giving the patient space can actually reduce stress. Step back for a moment if you sense your presence is increasing their agitation and allow them a few moments to self-regulate.

30. Reinforce Boundaries with Positive Phrasing

Rephrase instructions in a way that reinforces safety. Instead of saying “Don’t get up,” try saying “Let’s stay safe by resting here.” This subtle shift can often reduce resistance.

In Summary

In the end, no matter how overwhelming a shift may feel, remember that each small action you take—whether it’s giving a patient the comfort they need, leaning on your team, or simply organizing your pockets—is a powerful step toward providing your best patient care. Nursing isn’t easy, and some days will test you in ways you didn’t expect. But those moments of calm you bring to a confused patient, the gratitude you show to a colleague, and the resilience you demonstrate when things get tough are exactly what make you a true caregiver.

Every shift is another chance to learn, grow, and make a difference, even in the smallest ways. On days when it feels like the chaos will never end, remember: you are not alone. You’re part of a community of nurses who are all facing similar challenges, finding strength in the shared mission of caring for others. So keep going, take pride in every patient you comfort, and know that your work is invaluable. The tough days don’t define you—your strength and dedication do!