New to Night Shift - How will I survive??
Hello Nurse Beth, I will be starting my first nursing job out of nursing school in a few weeks. I will be working overnights and am just wondering if you can provide any advice for working overnights. I will be working on a renal medical/ surgical floor. Thanks for your help.
Dear Going to Nights,
Congratulations on landing your first nursing job! So exciting and I hope you love it.
Night Shift is Different... and it Takes Time
Everyone is different as to how they respond to working nights and to an alternative sleep schedule. Sometimes it’s hard to know if you’re sleepy, dehydrated, or hungry, you just know you’re out of sorts. Give yourself time to adjust.
I think it’s safe to say you will either love it or hate it. Or you may have a love-hate relationship. But either way, and while it’s a major adjustment, there are some distinct advantages to working night shift. One is higher pay, which is great, and adds up! Another is not having to get up at 0500, and some night shifters throw out their alarm clocks altogether.
My hat is off to the night shifters- major props. They are a special group of nurses, and without them hospitals would be sunk.
Night shift is a completely different environment than day shift. There’s generally a closer sense of camaraderie among night shifters, which means support for you. It’s a great time to build strong connections and bond with co-workers. Some people believe night shifters are a more laid-back, fun group of folks.
It’s not as chaotic. There are fewer interruptions, which makes it easier for you to concentrate. Fewer visitors, administrative-types, doctors. Diagnostic tests often wait until morning, so fewer “road trips”. No meals to serve.
You have more time to spend with patients, and you have time to read the chart. You will learn so much by reading History and Physicals, progress notes, test results, labs. It really helps when you are learning to see the big picture.
Early in your shift, check to see if you need anything from other departments that close for the night. Do you have a question for MRI about what time the procedure the next day will be, or the prep needed? Do you have all the meds you need for the whole shift, before most or all of the pharmacists go home? Do you need more tube feeding or flush bags from Nutrition or Materials Management? Call your doctors for any routine requests early, before they go to sleep, and check with your coworkers to see if they need that doctor as well at the same time.
Two am to four am can be the witching hours when your body slows down the most. You may experience drowsiness, you may be cold (bring a sweater). You may even have trouble talking properly. Plan your tasks before this time or after this time. Walk around the unit, do some squats or lunges if able, walk a flight of stairs, go outside to get a bracing breath of fresh air to get the blood circulating.
Many night shifters grab a quick nap during their thirty minute off the clock break, which can help tremendously. Set your phone alarm to wake you up and find out where there is an acceptable spot for you to do this. Night shift nurses have a risk of decreased vigilance on the job, which means you can make errors (Leman, 2012). Napping can help with alertness.
Sleep disturbances and fatigue can affect mood, especially for those who have a pre-existing mood disorder. You may experience anxiety or depression. See your doctor if symptoms persist.
It’s easy to overeat on nights because you are out of routine, eating/snacking keeps you awake, and there’s usually a lot of food available. You can also easily eat 4 meals (or more) a day- dinner with your family or at dinner time; meal break at work; morning breakfast; and lunch when you wake up.
Stress hormones can make it easier to gain weight. Try bringing your food from home. The key is to make healthy choices before you hardwire the bad habits. Some people do well grazing, or eating frequent, light meals with fresh vegetables, fruits, dried fruit and nuts. What you eat has a major effect on your energy levels and performance. Stay hydrated.
The quality of sleep is just as important as the quantity. A solid four hours of sleep may be better for you than a fragmented eight hours of sleep. You will need to find the sleeping pattern that works for you. Some nurses fall asleep immediately when they get home (that was me). No preamble, just strip off while walking from front door towards the bedroom and fall in bed. (Unfortunately only to wake up in a couple of hours because my bladder was on day schedule). Other nurses need to transition, wind down, read, or practice a relaxing bedtime ritual.
Blackout curtains can be an excellent way to help trick you into staying asleep during the day. Sometimes the problem is falling asleep, and sometimes the problem is staying asleep. Uninterrupted sleep is better than trying to catch up on sleep, which rarely works.
White noise (get an old fashioned box fan, not a silent fan) can be hypnotic, soothing and help drown out the neighbor’s mower. Earplugs and a sleep mask can help as well.
Some people use Melatonin, an OTC sleeping aid, or Benadryl. Others use aromatherapy, such as lavender in a diffuser.
Avoid alcohol and caffeinated beverages close to bedtime. Keep your room temperature even and comfortable- on the cool side, with air conditioning if needed in the summer.
Family and Friends
I can’t count the number of times I was sympathetically told by a well meaning person “Yes, I know just what it’s like to work nights. Once I had a job where I didn’t get off until eleven pm!!”
Educate them, and tell friends and family you will be sleeping during the day and to not disturb you. Oddly, some people think nothing of calling you at 1400 (translate 0200). Turn your phone off if able. Post a sign on your front door saying “Day Sleeper” for UPS.
You can feel isolated or out of step from friends and family and social events in general when you work nights. You have to plan a bit more to get together, and purpose to stay connected.
Your Days Off
Some night shift nurses sleep the same every day whether they work or not, to keep their body on a consistent schedule. That means staying awake all night at home on your night off, or shopping at Walmart at 0300. That never worked for me, but I have a hunch it’s healthier for your body. You will have to decide.
Take a nap before you go back to work if you’ve been off. Sometimes the first night on, you operate on adrenaline and actually feel Ok. Then go home in the morning and sleep for as long as you can. Try taking a short nap again if you can before you go back into work.
Pull over immediately when driving home if you are sleepy. Tragic accidents have happened when fatigued healthcare workers drive home after a night shift. If you commute from out of town, consider getting a motel room for your stretch of nights on if feasible. If you drive, try talking (hands free) to someone on the way home, and try chewing gum.
The National Sleep Foundation (NSF) says that if you find yourself turning the volume of the radio way up and opening the car window in an effort to combat sleepiness….you should immediately pull over. These tactics do not work effectively, and are a serious warning signal that you are too fatigued to drive.
The NSF further says:
“Cognitive impairment after approximately 18 hours awake is similar to that of someone with a blood alcohol content (BAC) of 0.05 percent. Cognitive impairment after 24 hours awake is equivalent to a blood alcohol content (BAC) of 0.10 percent, which is, higher than the legal limit in the U.S.”
Please be safe, and I hope you enjoy your new job! What tips do you online night shifters have for a newbie?
Gaba, D. M., & Howard, S. K. (2002). Fatigue among clinicians and the safety of patients. New England Journal of Medicine, 347(16), 1249-1255.
Lerman, S. E., Eskin, E., Flower, D. J., George, E. C., Gerson, B., Hartenbaum, N., ... & Moore-Ede, M. (2012). Fatigue risk management in the workplace. Journal of Occupational and Environmental Medicine, 54(2), 231-258.
National Sleep Foundation accessed January, 2016 https://sleepfoundation.org/sites/de...-CSG-FINAL.pdfLast edit by Joe V on Oct 19, '17
About Nurse Beth, MSN, RN
Joined: Mar '07; Posts: 1,281; Likes: 3,845
Nursing Professional Development Specialist; from CA , US
20+ year(s) of experience in Med Surg, Tele, ICU, OrthoFeb 3, '16A pretty good article. I worked nights for several years and my rules were: 1) If you work nights, you work nights. You don't work a rotating shift. 2) Keep your wake/sleep hours the same whether you're scheduled to work or not. My girlfriend would attempt to normalize on her days off and was constantly exhausted. I did much better keeping my routine. 3) Both a sleep mask and white noise are necessary for decent sleep during the day.
I had a boss who used to call me around 1300 to see if I'd be willing to come in at 1500 and work a double. She invariably would start the conversation with: "Whatcha doing?". "Sleeping", I'd say. "Must be nice to sleep all day", she'd say. Well, that got old in a hurry. I broke her of it by blowing up at her on the phone when she'd done one time too many. I used every cuss word I knew, and coming from a military family, my vocabulary is both vast and varied. She couldn't get off the phone quick enough.
The next time I saw her, I gave her my usual greeting and a smile. She said she needed to talk to me about what I said during the phone call. "What phone call?", I said, "I didn't get any phone calls. I slept all day without anybody bothering me. And I surely didn't talk to you; I'd have remembered."
I got away with it! No more daytime phone calls, either.Feb 3, '16Nights are the greatest thing on Earth. A double 16 to 20 with nights not so much. Love 12 hour nights you have the whole day to yourself. In the summer you chill outside relax at the beach it's great.Feb 3, '16Good tips here. It can be hard to adjust to a backward life! Often the hardest part is sleeping through the normal daytime noise that just can't be stopped. Things like kids playing, dogs barking, the neighbor mowing the lawn [or shoveling depending on the season]. I have found an ambient noise app to be a life saver, or at least a sleep saver. That with blackout curtains and my room is as dark as night and the outside noises are not nearly so distracting.Feb 3, '16I've worked nights for 22 years. The most important thing for me is good sleep. Make sleep a priority. Day shift people don't generally think 3 or 4 hours is adequate and night shifters shouldn't either. We need just as much sleep. Blackout curtains are great but they let a lot of light in around the edges. Here's what I did. Get some sticky back Velcro and place it around your window frame on the inside. Buy some blackout curtain liner fabric (this can be bought cheaply on line) cut it to the size of the window plus one inch all around. Hem the 1" as you sew the other side of the Velcro to the edges. Presto you have complete blackout and you can just roll it up and put it under the bed when you don't need it. I don't keep completely to a night shift schedule but I stay up later than most and sleep a little later on my nights off. I wasn't able to do this when I had kids who had to get to school but on those days I would try to take a short nap. Eat a healthy diet. Take snacks to work. Veggies and fruit are good. Keep away from the energy drinks. They may make you more alert but they are damaging to your heart and kidneys and they won't help you drive home safely. If you can, take a short walk on your break. Good luck. Night shift is great. I like less suits and better camaraderie plus you can have some amazing conversations with your patients at 2am and often time to really listen and make a differenceFeb 3, '16Hi!
Main I worked a graveyard shift 3-4days a week then I've done it in nursing as well in 12hr shifts.
My my advice I tell people working graveyard is:
1. Sleep. No one can tell you a good schedule. You will have to see what works for you. I have done both ways sleeping straight until I have to go to work and being up a few hours before work. You just have to find out which you can handle. In the beginning I worked at 11pm so I would wake up at 9:45 or 10pm then when I got home I'd be up a few hours then fall asleep. NOW I fall asleep as soon as I get home sleep 5 hours then that's the start of my new day. If I'm really sleepy I'll take an hour or hour and a half nap straight before work.
2. I don't have fabric blackout curtains, I have something called paper shades. They are black and make my entire room dark and they fold up on my off days because I will over sleep if it's so dark in my room lol. They are cheap and so convenient! You can buy them online or Home Depot or lowes.
3. Have a small meal before going to work so you have energy for your shift. Bring a lunch or snack to work and make sure you have water. I do coffee when I wake up or am going in- you can try that too if you're a coffee person.
Lastly balancing aocial lofe life will be a skill you will attain over a few weeks to a a few months in. You will learn how to adjust your sleep to others peoples "normal schedules"
i really think it's just getting your routine. You have to be around people who understand you don't sleep and work like others and as long as people in your life understand it goes smoothly.
It took my bf months to put up with my schedule because I was working graveyard a few months then I'd be off then back at it.
I have alove love hate relationship with graveyard to me. I sacrifice sleep on off days so I can enjoy time with my friends and family and I almost feel I'm barely working because I make so much use of my free time. I love it I just hate being sleepy at 6pm when others are wide awake hahahaha
good luck everyone has given good advice. You will find your routine :-DFeb 3, '16The paper shades are great but I have found that they come in limited sizes and I've had odd and large sized windows in my last two homes
I'm always amused when I watch HGTV and they're gushing over the "lots of natural light" in the bedrooms and all I can think about is what it would take to blackout those windows.Feb 3, '16Black roll plastic and duct tape. My husband did this to our bed room for me. He even put plastic flaps at the top and bottom of doors. You think over kill, I needed it. On his days off the poor man would tip toe ask day until I woke up. I never could sleep past 2pm though. I did it for a year but didn't adjust well. I was always nauseous. It is easier on nights thoughFeb 3, '16Anyone with young kids who work nights? I was offered a night position but don't know if I can keep up.Feb 4, '16Quote from jouRNey8i did have pre-teens when I first started working nights and it was difficult. I don't know if you're a single parent but it can be hard to find good child care, especially on weekends. Many of the people I work with on nights have young kids and they work opposite from their spouses (a challenge in itself)Anyone with young kids who work nights? I was offered a night position but don't know if I can keep up.Feb 4, '16Quote from jouRNey8It's tough if the kids are younger than school age. You really need somebody that you 100% rely on to watch the little ones when you need to sleep. It got easier for me when my daughter was in school as I could stay up to get her off to school, sleep while she was at school and be awake to spend time with the family and put her to bed for the night before I went to work.Anyone with young kids who work nights? I was offered a night position but don't know if I can keep up.
Thankfully I had my husband, my Mom and my Sister who all helped out when needed.Feb 4, '16Any advice when you get sick while working night shift? I came down with a cold about two weeks ago and then worked one shift. Then, still sick, I had to work two night shifts in a row during the bad snow storm bc we were short staffed. I called out sick for my 3rd shift. But my cold got worse from all of that working overnight. I had 4 days off so I thought I'd get better. After my days of rest, feeling better, I went back to work for a shift and it was awful!! I finally went to the doctor and had to start antibiotics bc my cold turned into acute sinusitis. I learned my lesson and called out sick for the next two shifts. Now I am finally feeling better. Do you think working nights screws with your immune system worse than working a 12 hour day shift? I wish I would have never worked while I was sick. It made me worse and not to mention having to interact with patients while I have a runny nose, sore throat, cough and barely any voice left by the end of my shift! The patients must have been scared of me! Also, I put my other co-workers in a bad situation because I was definitely contagious. Oh well that's probably a topic for another board - working while your sick. I think night shift makes it worse though.Feb 4, '16Thank you Ellie and kbrn!
My little one is in early grade school and my husband leaves for work very early (before I would return from night shift and before the little one wakes up for school.) Hubby then returns most nights after the little one gets out of after school (5.) I was think about getting a sitter to watch her sleep in the morning and then get her ready and bring her to school. I could pick her up from after school by would need to hire someone to watch her from between when I leave to when the hubby returns.
Another concern is just feeling like a zombie even especially with t being hard to sleep on days when the little one is off of school.
Have a day offer but for a very tough unit.
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