Articles

Working the Night Shift

*Original post released on 5/11/2020

Many of you have considered what it would be like to work night shift and whether or not it’s for you. I’m here to give you a little perspective about working night shift, my routine, and some helpful tips if you decide to do so. Keep in mind, that I was in no way someone who typically stayed up late or even all night. The new grad residency job placement I accepted was a night shift position, so I had to adjust. Night shift can be incredibly rough on your body and mind, especially while you are adjusting to the new routine. For me, that adjustment period took approximately 3 months. This might be different for you though.

I’ll start off first by telling you why I enjoy working the night shift, because I’m sure you can list many reasons to avoid such a position. In my opinion and experience, things tend to move a bit slower on at night. This may be the ideal setting for a new grad who’s adjusting to everything that comes along with working as a nurse, especially if you’ve taken a position in a specialty unit (Ex: ER, ICU, CVICU, etc.). At night, I also find that I’m able to build a better relationship with my patients. This is because I can spend more time with them, I’m expected to bathe my patients at night, and I can devote more time to reading up on their medical history and current status. These are all KEY components of nursing practice! A day shift nurse may have to devote more time to fielding calls from doctors, other units (imaging, transfers, lab, etc.). In addition to this, patients do tend to sleep more at night than during the daytime…unless they’re sedated of course. This can put a day shift nurse at a slight disadvantage as they may not be able to fully familiarize themselves with the patient. Patient care isn’t the highlight of our job, nor is it our most favorite task; however, I find this is the time where I learn most about my patient’s current health status. We’ll talk more about that shortly.

There are a couple of other advantages too. I work in an ICU, so we are assigned code duty for the rest of the hospital with the exception of the emergency department (usually). Now with the addition of COVID-19 cases, we are also assigned to assist with ER code blues. Whether or not I get assigned codes for the night or decide to assist a fellow ICU nurse with codes, I don’t feel the guilt of leaving my patients as much at night nor do I find myself having to play “catch-up” on documentation and patient care. This also allows for enhanced learning when I can be fully present during a code situation. Enhanced learning does not only occur with code situations, however. I find that, at night, I have more time to consult with my charge nurse, my colleagues, work-related resources, and so much more. I also have noticed that doctors who round at night are typically more willing to explain concepts to new grads. I once had a cardiologist explain cardiac stress tests and their different applications to me when I asked about my client’s orders.

Night shift is also its own community…and that’s a fact! We are a very close group and enjoy working together. I know I can ask any of my colleagues for help without worrying about their judgments or disapproval. This goes for patient care, admissions, transfers, discharges, codes, etc. Any of them would have my back and they know I’d have theirs. We also make time to build our relationships with each other outside of patient-related duties. You have a birthday coming up, baby shower, or other major milestone? We always come together to celebrate achievements and support each other in times of loss. I can’t tell you how many pot-lucks we’ve had “just because” we felt it would lift each others’ spirits at night.

Now, let me tell you a bit about my usual sleep routine to get ready for work. Then I’ll share my typical night shift routine. My facility and unit allows for us to self-schedule within reason and the needs of the unit. Because of this, I usually schedule myself to work three shifts on and four shifts off. I find it more conducive to recuperation as well as allowing for family time. After my last shift of three, I typically stay up as late into the day as I can or take only a shortened nap. Then I’ll head to bed with my family that night to get on their schedule. The next three days, I assume a “normal” daily schedule and try to get necessary errands completed while I’m home.

On my last day off, I make sure to go bed with my family and stay asleep as long as possible through the next day, typically awakening around 4pm the day of my first shift. When you have family members who are on an opposite schedule, it can be difficult to recuperate and rest while switching back and forth from nights to days. I found an herbal patch called Klova that helps me stay asleep when I lay down so that I feel completely rested without any type of “hangover-like” effects. I definitely recommend it to everyone. If you’re interested, here’s a link to a coupon for $10 off : http://i.refs.cc/EytP36dW?smile_ref=eyJzbWlsZV9zb3VyY2UiOiJzbWlsZV91aSIsInNtaWxlX21lZGl1bSI6IiIsInNtaWxlX2NhbXBhaWduIjoicmVmZXJyYWxfcHJvZ3JhbSIsInNtaWxlX2N1c3RvbWVyX2lkIjo0MDIzNzgyNzd9

As for my typical night shift routine, I wake up around 4pm even though my shift doesn’t technically begin until 6:45pm. I find it less stressful to wake up a smidge earlier and not have to rush to get ready. I shower, get dressed, and eat. Then I say hello to my husband as he gets home mere minutes before I’m due to leave. I drive to work, typically leaving myself about 15-20 minutes of wiggle room once I get to the hospital. I use this time to listen to music and decompress prior to the start of my shift. Once I get on the unit, I gather my typical supplies (two pens, a pencil, pen light, clipboard, paper, stethoscope, water bottle, and trauma shears), clock in, grab a hospital phone, and proceed to get report. We then do bedside report, which takes anywhere from 15 min to 45 min depending on the number of patients I’ve been assigned and whether it’s a full report or simply updates.

After I get report on my patients, I use my ICU pocket patient organizer to write down the meds and their assigned times for administration, PRN meds, and lab results. This helps me better plan out my shift from the very beginning. I also find it is better to be prepared for anything that might happen by knowing which PRN meds you have available than finding yourself in an emergency situation without this information. Once I have this information in my pocket, I go assess each of my patients. What happens next depends on how chaotic the shift is as well as how demanding my patients are.

Next, I either complete my 8pm documentation requirements or start giving meds (if they’re already due to be given). Patient care always trumps documentation. However, this is also why I keep the organizer sheet in my pocket. I can use the inside portion to jot notes/times related to each patient and the interventions I perform, doctors/family I’ve contacted, and more. After medications have been given, I catch up on charting if need be. Then I try to get patient care activities out of the way before midnight and before the patient officially attempts to go to sleep. This allows me to let the patient sleep in the longest time intervals possible. If I have a patient who is particularly prone to messes or requires a lot of care and assistance, I typically wait as long into the shift as possible to assure that I hand off a clean and well-kempt patient to the oncoming nurse. It’s simply good manners to do so.

When providing the patient’s care (bathing, dressing, etc.), there are many aspects you need to pay attention to in order to gather thorough assessment data. Are they alert enough to assist you? Can they follow simple commands? How is their skin integrity? Strength? Range of motion? Do their vitals change as you move or turn them? If so, is it safe to continue doing so? Can they physically tolerate you moving them? What are their pulses like? Is the patient experiencing pain? What is the status of their lines/drains/dressings? These are all major points to consider when providing care to your patient.

I also have documentation requirements due at 12am and 4am. I am usually able to complete those assessments and documentations right on time. I use the time between 12-5am to read up on my patient and re-do their Kardex so that it’s up to date. If you’re not familiar with it, a Kardex is a tool we utilize that lays out the patient’s information, history, current admission information, current focused assessment data, and imaging results. At about 5am, I begin rounding on my patients and administering any morning medications due. I calculate and chart their intake and output, weight, and fluid balance status.

Once I’ve completed this, I take a blank sheet of paper and fold it in half. I use one half of the page for each patient and list their current status. This usually includes their neuro status, febrile status, cardiovascular trends, respiratory status/oxygen use, GI and GU updates, any drips/fluids, and morning lab results. This sheet really comes in handy when giving updates to your charge nurse and during change of shift to set the expectations for the oncoming nurse. Plus, if you only have to give updates to a returning nurse, it makes doing so that much easier and quicker! Then I provide change of shift report, return my phone, pack up, and clock out.

I hope this helps demystify the night shift for many of you. Maybe it even makes you consider taking a night shift position or switching to the night shift. I’d love to hear about your routine as a day shift nurse for those of you willing to share!

XOXO

Andra Alyse

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