How to keep your cool in any situation, according to a rapid response nurse

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Stressful situations can’t be avoided in daily life.

You’re standing up to speak in front of a crowd. You’re getting ready to meet someone for a first date. Or worst-case scenario, you’re facing an emergency. Your hands start to shake, your heart races, and your mind floods with negative thoughts.

Those are all-too-familiar scenarios for Sarah Lorenzini, a rapid response nurse of 10 years and founder of the Rapid Response Academy, a program that educates nurses on how to train for and handle any emergency.

“I remember being a new nurse in the ER, and even though I had all of the head knowledge of what to do in emergencies, when that patient rolled in from EMS … I found myself having a hard time catching my breath,” said Lorenzini, who is also the host of the nursing education podcast Rapid Response RN. “And if you can’t get your body to work, to do the things that you know how to do, then you can’t help the patient.”

It’s common for the body’s natural “fight-or-flight” response to kick in, and it may be hard to react the way you would otherwise like to under pressure.

But you can train the mind and body so that when the next high-stress situation arises, you are better prepared. Here’s how to keep your cool no matter what happens, according to Lorenzini and other experts.

What to do before a crisis arises

When Lorenzini was 9 years old, she went snorkeling with her family in Florida. At the time, she didn’t have the upper body strength to hoist herself up from the water, so she would need help getting back on the boat any time she left.

But when she encountered a barracuda in the water, she became so scared that the adrenaline her body produced gave her the strength to swim faster than she ever had and jump in the boat on her own.

Lorenzini noted that if she hadn’t known how to swim well or hadn’t practiced attempting to get back in the boat on her own, she would not have been as prepared for her quick escape from the predatory fish. “I would have just still floundered in the water, not knowing what to do,” she said.

Her experience shows how being prepared ahead of time can help in high-stress situations, such as completing a nursing program, practicing a speech in front of a mirror or studying for a big test.

But there are also ways to build up what’s called your nervous system resilience, the ability to keep the body’s stress response in a healthy balance, ahead of such stressful situations, said Dr. Inna Khazan, a lecturer on psychiatry at Harvard Medical School and a clinical psychologist specializing in health psychology and performance excellence.

One technique she often advises is to exercise the heart rate variability, or HRV, which is the way in which a person’s heart rate goes up and down and constantly varies. Having a higher HRV is a sign that your nervous system is healthy and that your heart can adapt better to daily challenges and stressors.

By working on resonance frequency breathing, a slow diaphragmatic breathing that is usually three to seven breaths per minute and synchronizes with your heart rate, the HRV will increase, which will train the heart to recover from stressors more quickly, Khazan said. People with higher HRVs tend to find it is easier to make decisions, focus and respond in challenging situations, she added.

By checking in throughout the day concerning smaller stressors, a person can be more in tune with the way their body responds under high stress, said Julie Uhernik, a licensed professional counselor and registered nurse in Parker, Colorado.

Keeping a physical or mental note of how much stress you feel on a scale of 1 to 10 throughout the day can help you identify not only your stressors but also the natural symptoms of stress that occur, she added, and doing so can help you better react in those high-stress situations.

Basic needs such as eating a healthy diet and getting enough sleep at night are crucial as well for improving your response to high stressors, Khazan said.

How to stay calm in an emergency

When a person starts to feel the sensations of stress, thoughts such as “I can’t do this” or panic begin to happen, Lorenzini said. But when you’re mindful that these reactions, such as a change in breath or heartbeat, are normal, then you can use that awareness to your advantage.

“I call it super nurse, or super Sarah, where I can function at my best,” she added. “With time, I kind of retrained myself to say, ‘Oh, these things that I’m feeling in my body, these are not hindering me. These are actually making me a better clinician, a better nurse.’”

Reminding yourself to take slower breaths is also important, Khazan said. She recommends breathing in normally through the nose for four seconds and breathing out — as if you are gently blowing out a candle — for six seconds to help rebalance the system.

The goal is not to relax but rather “a self-regulation practice, so it can help the body get to that optimal level of activation,” Khazan said.

Using your senses, such as taking note of the feeling of your feet on the ground or looking around to assess the situation and the reactions of others, can help you pause and think before reacting, said Uhernik, who is also a disaster mental health responder for the American Red Cross and a consultant in emergency preparedness for mental health professionals.

Ultimately, it is important to remember that stress is inevitable, especially when emergencies happen, Uhernik said.

“A little bit of stress is good for us. It keeps our nervous systems primed to respond when we need to, and to go back to a state of calm when things are OK and there’s no threat in the environment,” Uhernik said.

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