A Passionate Note in Support of All Night Shift Health Care Staff

[Hockeydoll88]

Hey everyone,

Recently, at my current nursing job as a RN on a hospital medical/surgical ward, I began working the night shift as it worked better with the hustle bustle of my daily living and I enjoyed the extra difference in my paycheck. While my body may not necessarily love staying up all night long, I have enjoyed the switch, and respect my fellow night shift co-workers. Of course, as with any floor, there are a few that do the absolute minimum amount of cares for their patients, but overall, we are a hard-working group of angels

Unfortunately, though, at lunch today, one of my co-workers (who has been a nurse on the unit for 9 years), made some statements that made me want to scream. Since I have only been a nurse for 2 years, I didn't want to step on the toes of one of the "Senior" nurses, so I had to bite my tongue. However, what she said has been eating at me all night, so much so that I knew I couldn't sleep until I recorded my mind. Essentially, she insinuated that night shift nurses are lazy. She felt it was unfair how we do not conduct skin assessments (as it normally assigned to day or eve shift on my unit), how we don't have the patients bathed before the day shift, and how we goof off on the internet during our down time.

Now granted, I have no idea if this person has ever worked a night shift in her career, and if she has, I would be shocked concerning how poorly she talked about night shift staff. Yet my soul cannot let this stand without educating not only this person, but anyone else also who shares this skewed idea of the work night care workers do.

Thus, as provided below, I am defending night shift health care workers (in particular, nurses) by giving detailed accounts on how we work just as hard, if not harder, than day or evening staff:

(As a disclaimer, I have nothing against people who day or eve shifts, as I still continue to work these shifts as well)

• Some may feel that we are lazy because our patients are not bathed or showered by the time day shift comes on. This is ABSOLUTELY ABSURD. The sole purpose of a night shift care worker is to, after assuring our client's safety and making sure their health/vital signs are stable, is to provide an environment for restful sleep. Anybody with a brain knows that sleep is probably the most important factor in improving someone's health and well-being. The majority of the population does not normally bathe themselves at 4 or 5 in the morning, unless you have an early morning job and/or long commute. So, to wake a sick client up (who often has been bombarded the last 16 or so hours by doctors, nurses, pharmacists, therapists, procedures, you name it, with barely a break in between) at 4 or 5AM to ask them if they would like to be bathed is ridiculous. The client NEEDS TO SLEEP. And as any night shift worker knows, from about 6AM to the end of your shift, with passing meds, giving insulin, transporting clients to procedures, and feeding/dressing clients, there is NO TIME to offer hygiene cares. In addition, many clients are in so much pain or have such difficulty breathing/getting short of breath that they will refuse offers of hygiene cares during their stay in the hospital, as this is too much effort for them (even with assistance from the caretaker). Is hygiene important? Of course. More important than controlling a client's pain and/or managing their breathing? HELL NO---any smart health care worker would tell you that. Now, granted, if a patient is awake the majority of the night because their hygiene is poor and affecting/prohibiting them from restful sleep, than yes, most definitely, let's get them cleaned up so they can rest easy. But to say that night shift workers "should have clients bathed by the time day shift comes on" is just illogical and not conducive to the patient's well-being.
  

• "Night shift nurses should do skin assessments". This is just a tie-on to my previous point. No, night shift nurses should not be doing skin assessments, as it will disrupt the patient's sleep. Yes, if we have a total cares patient who cannot turn themselves, and thus we need to turn them every 2 hours, then if possible, we can sneak a peek at their skin. Otherwise, the patient NEEDS TO SLEEP. I know day/eve shifts are commonly much more hectic than a night shift, but those shifts' nurses have far more opportunities to view patient skin without waking them from restful therapy.
  

• Night shift nurses ALWAYS work with less staff. We have more patients assigned to us, and often have much less assistance from pharmacists, physicians, nurse aides, etc. Guess what happens? When one of our patients starts to go south, and we have 4 or 5 other patients that are assigned to us as well, all Hell breaks loose. Not only do we have to use our critical thinking skills without much guidance or assistance from physicians to save this patient, we got to be looking out for our other ones, too. We will bust our ass for the rest of our shift trying to catch up on all the other patients' cares. It is total oblivion, I tell you. Now guess what happens when that same scenario happens to a day shift nurse? Your doctors, pharmacists, interns, residents, nurse aides, etc. are THERE TO HELP YOU OUT. Night shift does not have that luxury so, quite frankly, we often times probably work harder than a day shift nurse.
  

• Now, on the flip side of this, if we have a lucky night when all the patients assigned to us are stable throughout the shift, then we may have more down time then a regular day or eve shift nurse. After we have completed all the tasks the night shift requires, and in the brief spurts of time our patients are stable and sleeping, we may find a quiet hobby to move the shift along. Surfing the internet, knitting, crossword puzzles, and reading are common activities we will utilize. Should this be constituted as "goofing off"? Quite frankly, in my opinion, NO. If our patients' needs are being met i.e. they are pain free, sleeping peacefully, vital signs normal, ward tasks completed, etc., then we are simply finding an appropriate activity to do until our patients need our assistance once again. Let's be honest: if day shift staff had more frequent moments of free time inbetween patient cares, they would be doing the EXACT SAME THING.
  

To conclude, if any night shift health care workers/nurses out there are sick and tired of being viewed as generally lazy, and you got something you want to say about it, then please respond to this thread with your thoughts and the other misconceptions you have heard about the work that we do! Let us educate those who dare to pass judgement without fully knowing what it is like to work a night shift and never receiving any respect for it! Let our voices be heard that we ARE NOT LAZY, and that we deserve tremendous RESPECT and APPRECIATION for the work that we do!!

Thanks to all for reading and God Bless! :redbeathe

[artsmom, BSN, LPN]

The DON is probably telling you that's how SHE behaved when SHE worked graveyard. Oh, yeah!!!!! You can see right through her.

Wow, what a terrible DON she must be! A DON believing stuff like that, without proof, really galls me. Doesn't she think there'd be more decub's and pt's complaining if that stuff were true? Where is her brain? Never mind, I know where it is.

Absolutely. She is relatively new to our little facility as a DON. and its her first DON position. I was floored when she said all that to me, because as you said, we have one decub- and the pt was admitted with it! That is proof of good care on every shift, including the "lazy" night staff.

[LPNnowRN]

I have worked all shifts at my LTC facility, and let me tell you some sundowners are UP all night long!! Never a dull moment with residents up in their wheelchairs.

[Tweety, BSN, RN]

Let that stuff roll off your skin. You do not have to justify anything you do on nights.

I've been on day shift for 5 years, but was on nights 13 years prior to that. Keep up the good work.

[Hockeydoll88]

Honestly, if she expects the night shift nurses to do all that before she even gets there, SHE is the one who's really lazy! Usually, when someone acts like a jerk and complains about someone else, that person needs to take a look in the mirror because he or she is probably guilty of the very thing they're complaining about.

Extremely well put, CFitz. God, I would love to say that to that nurse's face, lol!

[Hockeydoll88]

Thank you for your support

[Riseupandnurse]

Just another example of why nursing as a profession cannot get any respect or any real authority. We are far more interested in putting each other down than sticking together. I worked night shifts for several years. It did major damage to my health and I had no real life. My husband was management at the same hospital (different discipline, not nursing) and he frequently said he couldn't understand why I was in such bad shape. Administration had told all the department directors that the patients slept all night (hah hah) and that we enjoyed a long "lunch" hour because the house supervisor came around and relieved everyone so night shift personnel could go take a nice long break. get real!!!!! There wasn't even anything to eat, because the cafeteria was closed and how a supervisor was supposed to cover for the whole house, one by one, is beyond the understanding of anyone who gave it any thought at all. Once I fell asleep for five minutes on nights. It was the most delicious feeling I've ever had, but scared me so much I stayed on my feet from then on. Nights is hard, hard, hard, and I'll never forget it even though it has been at least 10 years since I pulled a night shift. If it were up to me, nights would get DOUBLE the pay of other shifts.

[Ruby Vee, BSN]

i rotate days and nights, and i agree with the co-worker. i don't think it's reasonable to expect the day shift to do all of the bathing, and we all know that few patients actually do sleep all night. day shift may or may not have more nurses, but they definitely have more going on and less time to get everything done, so if i can help them out by bathing a few patients i'd be a jerk not to.

as far as skin assessments -- decubs can develop very quickly -- i've gone home at 7pm leaving my patient with intact skin and come in at 7am to find a decub.

night nurses work hard, and i'm not knocking any night shift workers. but day shift workers work hard too, and we can all help each other out by getting as much done as possible.

[VivaLasViejas, ASN, RN]

When I started out in healthcare, I worked nights and loved it......in fact, I'd probably still be doing nights if I hadn't gone through some sort of transition in my early 40s when I started forgetting where I was and what day it was when I woke up in the afternoons after a hard night shift. And they were ALL hard---it was 12 hours of running up and down the floor, chasing the sundowners, keeping folks from crawling OOB, dealing with the crises that inevitably arise in the wee hours, taking admissions, entering pages full of orders (no unit secretaries at night), doing all the daily weights and 24-hour chart checks, and cleaning IV poles, tele units, commodes and other used equipment whenever we had some "downtime". That's "lazy"??!!

[Hockeydoll88]

I agree, Ruby, it is not reasonable to expect day shift to give all the baths, as they work very hard too. And if anybody feels days should be giving all the baths, then they are no different than my co-worker who thinks night staff should do all the bathing.

It kind of just turns out to be a juggling act between which nurse on their shift ends up having a little extra time to squeeze in a patient's bath. I, too, rotate between day and night shifts, but mainly work nights. On night shift, if a patient is fully awake around the 5AM time, I will offer to assist the patient with hygiene cares. From my experience though, albeit short-lived as being fairly new to night shifts (been working them for 3 months), the majority of the patients on my floor will want to forgo bathing for quiet time and rest, and request they be bathed later on in the morning, which of course runs into the day shift. So all I can do at this point is respect their decision and chart that, "Patient refused offer of hygiene cares." Unfortunately, the co-worker in discussion thinks this is just a "cop out statement" because we don't want to perform the cares, which couldn't be farther than the truth. If a patient refuses my offer to get cleaned despite briefly stressing its importance to promote their overall well-being, I am not going to push it further with them (not saying nurses do, per say). An 80 year old man has lived far more life and knows way more about the world than me, so I am not going to try and tell them what to do. If asking once and providing some education is not enough, then that is where my attempts at hygiene ends. But this co-worker, this probably wouldn't be "trying hard enough" for her.

In response to your statement on a patient getting a pressure sore within 12 hours, do you check all their skin every 2 hours when you turn them? If you do, kudos to you, wow, that is super. :) However, on nights, in order to see a patient's skin, you need good lighting, so I guess (I feel) it is a bit much to be placing bright light on a patient every 2 hours during the night when you are turning them. IMO, if they are getting turned Q2H, and pillows are being placed inbetween pressure sore areas, normally this should suffice to get them through the night. I guess, if I was in a patient's shoes, I would not want someone performing a full skin check on me every 2 hours during the night as they are turning me when I am trying to sleep. But that could just be me.

[JulieCVICURN, BSN, RN]

In the ICU that I used to work in, we really didn't have any night/day conflicts. We divided up the baths in the most sensible way possible - completes, which are people who are vented and sedated, or anyone who is bedridden and cannot help do their own bath in any way, would be done on the night shift. We usually banded together in pairs or threes and did an assembly line - all of us would do one patient, then another, until we were done. It was actually a lot of fun because it's always more fun to do stuff with a coworker than alone!

Setups for people who could mostly do their own bath or needed a little help would be done on days. Some nights every patient was a complete and the night shift did them all, and sometimes it was all setups and days did them all. It worked out and baths were only a sore point when someone obviously slacked off and gave stupid excuses for why they didn't do a bath.

As far as not giving that change of shift med - if I have a med due at shift change (5am or 7am or whatever that time is for the facility), it is the responsibility of the offgoing nurse to give it. If I didn't have time for some reason, I would explain to the oncoming nurse why I wasn't able to give it and offer to give it before I left so that she could have time to get her act together before hitting the floor. I also always made sure to leave my rooms spotless and set up with supplies for the next shift, and they did the same for us (mostly - there were always people who did the bare minimum and we all knew who they were and hated to follow them).

To be honest, the majority of nights were not as busy as a typical day shift. We did have nights that were absolutely nightmarish - one code after another, horrible families, rude and confused patients. But for the most part, I wouldn't trade nights for days for anything. The atmosphere is so much nicer without administration breathing down your neck and the nurses are a little more laid back and fun at night, probably because we don't have to watch out for the boss all the time!

I can honestly say that in my entire tenure I only saw someone fall asleep on the job a few times, and it was always the same one at 3:30 am!

I guess I was lucky to work in a unit where we had mutual respect for each other and had similar work ethics in the majority of the staff. The ones who didn't weeded themselves out fairly quickly and didn't last more than a year or so.

[Ruby Vee, BSN]

i agree, ruby, it is not reasonable to expect day shift to give all the baths, as they work very hard too. and if anybody feels days should be giving all the baths, then they are no different than my co-worker who thinks night staff should do all the bathing.

it kind of just turns out to be a juggling act between which nurse on their shift ends up having a little extra time to squeeze in a patient's bath. i, too, rotate between day and night shifts, but mainly work nights. on night shift, if a patient is fully awake around the 5am time, i will offer to assist the patient with hygiene cares. from my experience though, albeit short-lived as being fairly new to night shifts (been working them for 3 months), the majority of the patients on my floor will want to forgo bathing for quiet time and rest, and request they be bathed later on in the morning, which of course runs into the day shift. so all i can do at this point is respect their decision and chart that, "patient refused offer of hygiene cares." unfortunately, the co-worker in discussion thinks this is just a "cop out statement" because we don't want to perform the cares, which couldn't be farther than the truth. if a patient refuses my offer to get cleaned despite briefly stressing its importance to promote their overall well-being, i am not going to push it further with them (not saying nurses do, per say). an 80 year old man has lived far more life and knows way more about the world than me, so i am not going to try and tell them what to do. if asking once and providing some education is not enough, then that is where my attempts at hygiene ends. but this co-worker, this probably wouldn't be "trying hard enough" for her.

in response to your statement on a patient getting a pressure sore within 12 hours, do you check all their skin every 2 hours when you turn them? if you do, kudos to you, wow, that is super. :) however, on nights, in order to see a patient's skin, you need good lighting, so i guess (i feel) it is a bit much to be placing bright light on a patient every 2 hours during the night when you are turning them. imo, if they are getting turned q2h, and pillows are being placed inbetween pressure sore areas, normally this should suffice to get them through the night. i guess, if i was in a patient's shoes, i would not want someone performing a full skin check on me every 2 hours during the night as they are turning me when i am trying to sleep. but that could just be me.

if you ask a patient "would you like your bath before you go to sleep or at 5am with your pills," they will probably make a choice between the two times offered. but if you wake them at 5am with a half-hearted offer for a bath, they'll probably say they want to sleep. if you grudgingly offer the choice between a bath now and letting day shift take care of it, they're probably going to prefer the day nurse, who may (or may not) be so grudging about it. although i don't know you personally, i do know from experience that charting "patient refused hygiene" is often a cop-out. i know it from having done it myself a time or two, and i know it from working alongside (and following) nurses who do it habitually.

and no, i don't check all of the skin every two hours when i turn the patient. but i do check the areas that have been dependent or are likely to have issues. and not checking every two hours is totally different from not checking for 12 hours straight.

i'm going to offer a guess that this day shift nurse you're so angry with may have been indirectly offering you a choice to examine your own practice and reconsider a few things. or maybe i'm completely off base.

we often hear from folks who claim they've been totally blindsided by their firing -- when i know for a fact that many of them have been offered many such opportunities to examine their practice or compare it to the unit standard, whether directly or indirectly. directly is better, and it's my preference, but not everyone is wired that way. if you expect everyone to flat out tell you "hey, you're getting a reputation for being a lazy sod", you're going to miss a lot of valuable cues.

[littlemammanurse, BSN, RN]

I work night shifts and I am very busy with med pours,assessments on all my kids especially those who are not able to roll themselves,documentations,rounds every 1/2 to an hour,laundry,making breakfasts for 12 residents,preparing tube feeds,and then I have to get them dressed and help feed in the morning while doing a med pass,just to name a few things I have to do, my list is endless!I am very busy on my shifts and I am appalled that someone would say that to you!Night nurses do have a lot to do.We don't just babysit sleeping patients!