Advice on working nights 7P-7A in LTC? Haven't work nights before

Spooky, RN · Mar 11, 2020

Well, you'll become "mustlovecoffee". ? I LOVE nightshift! I worked mainly evenings 2-10pm, but I really enjoyed the 10-6am or 6-6pm. Coffee will help. I'm not sure if you enjoy it, but I got to admit it was a pleasant routine to take a cup to work by 6pm and have a small cup around 12-2am when I'm chart checking or charting. That's another thing... check charts/new orders EVERY night and check the eMAR if they're entered in properly. Depending on med pass/rounds, you may hit the floor running as soon as you receive report. Bedtime meds/blood glucose checks can be a killer depending on how many residents you'll be taking care of. Most likely you'll check a crash cart to make sure all supplies and oxygen are there. Glucometer calibration may be another job duty. Properly lock away or dispose of discontinued or expired meds per facility protocol. I would go through OTC meds. You'll probably need another night nurse to do this/document with you for locking away or disposing meds. Restock supplemental formula (PO or g-tube). Check/document refrigerator temperature and refrigerated meds for expired dates. What else am I missing?? I had maybe 3 med rounds for sure. Bedtime, midnight and 5am meds. Sometimes I had a couple of IVs going. SLEEP... my bedtime was 9am and rise n' shine by 4pm! Get home, shower, eat and sleep. Wake up, eat/prepare lunch for work, grab coffee and GO! Good luck at night! ? I sure love and miss night shift!

amoLucia · Mar 11, 2020

Spooky - how has the old 'TREATMENT' cart individual oints & liquids fit into the newer systems? Lots of places used to ignore the tx cart with old expired (and discharged/discontinued) stuff and the still 'GOOD' stuff but now but unneeded. I used to purge the old tx stuff.***

For OP, there may be the need for that shift to be responsible for changing all the tubings, IV & enteral, and enteral pistons. Oxygen equip might fit in here also if NO resp therapists.

Sometimes routine IV drsgs get foisted on to NOCs. And changing foley/SP caths. Not to mention the almighty collection of specimens, urines & swabs. (This always annoyed me - like don't pts ever pee or poop ? or ooze on other shifts?!?) Lab requests paperwork might vary widely.

*** It was a very surprising eye-opener to see how much otherwise perfectly good oints & liquids had to be thrown away. Surprising & then disappointing and then angry re WASTEFULNESS. ?

Nightshift lover here! ?

Spooky, RN · Mar 12, 2020

6 hours ago, amoLucia said:
Spooky - how has the old 'TREATMENT' cart individual oints & liquids fit into the newer systems? Lots of places used to ignore the tx cart with old expired (and discharged/discontinued) stuff and the still 'GOOD' stuff but now but unneeded. I used to purge the old tx stuff.***
For OP, there may be the need for that shift to be responsible for changing all the tubings, IV & enteral, and enteral pistons. Oxygen equip might fit in here also if NO resp therapists.
Sometimes routine IV drsgs get foisted on to NOCs. And changing foley/SP caths. Not to mention the almighty collection of specimens, urines & swabs. (This always annoyed me - like don't pts ever pee or poop ? or ooze on other shifts?!?) Lab requests paperwork might vary widely.
*** It was a very surprising eye-opener to see how much otherwise perfectly good oints & liquids had to be thrown away. Surprising & then disappointing and then angry re WASTEFULNESS. ?
Nightshift lover here! ?

Hey, amo! Man, I have no idea what kind of carts they're using now?? It used to be some miniature version of the med carts that had a key. Are they different now? Every now and then I would stock our treatment cart, but we thankfully had a wound care nurse most of the time. It was rare we did any treatments/dressing changes as floor nurses. I remember all the individual packets! Wound care pretty much took care of their cart. Hopefully. ? Also, yes! Change of tubing and labs! Night had to change all tubing (including Foley caths) and do specimens! Yes, I would complain about that... it's night time, seriously?! And yup, no other shift would collect urine or change the Foley caths while everyone was awake! ?

amoLucia · Mar 13, 2020

To OP - you realize that when your facility kitchen closed at 7pm, it was CLOSED. Like usually nothing avail for staff. Unless you're somewhere that has something nearby open 24 hrs, you need to bring sustenance or else you're relegated to the dreaded snack machines!!

On NOCs, staffing is bare-bones, so leaving the bldg to go out is frowned upon (and not too safe?) There are multiple postings here that offer recommendations and suggestions for all kinds of knoshings. Just don't forget to hydrate! I always brought my own food in a thermal lunch bag. Sometimes a thermos. You may not have a luxury of relying on any pantry for items.

Likewise there are numerous postings re best sleep approaches. Personally, I liked to grab a quick light meal as soon as I got home, shower then get my sleep. All depended how I felt in the am. Or if I had some appt or task to do. Sometimes, I would get a long nap in in the evening. For me, it could vary. But I live alone. So ...

I was a nite-shifter most of my career. Loved it! Am a nite-owl myself. I still can't seem to get back to sleeping Normal People Hours some 10 yrs retired.

Hardest thing to get used to is that the rest of the world is awake when you sleep. Family and friends are the HARDEST to understand! It really puts a cramp on SOME things. But then you can sched appts (even interviews, shhh)with better flexibility than others.

Also on NOCs, you typically don't make long-lasting, bosom buddy, BFF friends. You're friendly, but that pretty much is it. But you freq will work with others who try to make the shift as good as poss. TEAMWORK works!

On 11-7, you need to be strong in your assessment & decision making. There usually aren't too many other nurses around with whom you can confer - do try. You might have a supervisor or an on-call nurse (use when you absol have to for the BIG things).

Two things I HATED with a passion - NOCs usually has to start to cover staffing call-outs. It all depends who does it - just be aware. And secondly , make sure your early dialysis pts (and early appts) have arrangements for some kind of breakfast if they go out. Am dang serious about this!

And make your own collection of phone #s. In-house extensions, doctors, dept heads, hospitals, ambulance, DIALYSIS, etc. Just take my word for it.

Good luck for nites.

kbrn2002, ADN, RN · Mar 18, 2020

Good advice so far! I can think of a couple of things to add though. Make a small bag/container of office supplies you usually use at night and keep it in your locker. If you run out of post-it notes, tape, paper clips, staples etc you can't go to the business office for refills and not many facilities keep that kind of stuff in central supply.

Depending on how good your place is about actually leaving vital signs equipment where it belongs you might also want to invest in your own. Sounds like you've been working there already and this is just a shift change so you probably already know if oximeters grow legs and walk away though.

Expect NOCS to be bare bones staffing so you will be doing more turning/lifting and providing incontinent cares than on any other shift. The CNA will probably need your help more than on other shifts. There is definitely more of a teamwork attitude on nights than other shifts just because there are so few of you that you really do have to work together.

You'll probably be responsible for any needed lab draws, midnight census, preparing paperwork for daily resident doctor appointments, cleaning and stocking the med carts, changing out equipment like oxygen tubing etc. Plus for some weird reason management seems to think nights hasn't got much to do since the med passes are so much smaller than other shifts. They tend to add the most random tasks to night shift duties.

I don't know how your facility is about mandating staff to cover call outs but expect it to be the night shift supervisor's job to deal with any day shift call outs and fill the hole by either trying to call other staff in and/or mandating somebody to stay. Since there are so few staff working nights it seems to be the same few people, both CNA's and nurses that get stuck all the time.

Bring food. Snacks, lunch, coffee...lots of coffee! Though I have to say when I worked nights for 15 years it seems somebody is always bringing treats. I ate more junk working nights than any other shift by far.

Adjusting to a new sleep schedule can be a challenge. Black out curtains, white noise or ear plugs if you can tolerate them will be a must just to be able to sleep during day hours. Oddly enough the neighbors like to do things like mow their lawn while you are sleeping, the nerve [LOL]! Seriously though, you won't realize just how much ambient noise there is during the day until you have to try and sleep through it.

Not to mention the eight dogs! Holy man, I have two and they are needy buggers. I couldn't imagine keeping up with eight. Just getting them into a routine of morning potty runs, breakfast and then your sleep time will definitely be an adjustment so unless you have somebody else at home to take care of them while you are sleeping expect interrupted sleep at least until they get used to your schedule.

As far as normal sleep schedule, you'll find what works for you. I typically stayed awake for most of the day when I got home in the morning and slept through the late morning/afternoon until I had to get up for work about an hour and a half before I had to leave. You might do just the opposite and go right to bed in the morning and wake up a few hours before work. Do whatever works for you. Expect it to take some time to adjust no matter what sleep schedule you find works.

People that work nights either seem to love it or hate it. Not much in between in my experience. Welcome to the dark side!

amoLucia · Mar 18, 2020

kbrn - your comment re office supplies can be sooo right on! I think now how I never really had toooo much of a problem, but yes, it does exist. I used to keep some CHART stationery forms and a few others, like incident reports. Used to keep death certificates until they went computerized. (Actually had to borrow a few death certificates from Funeral Homes, also on my phone-numbers-to-have list.)

And BATTERIES!! Had bunch of spares in my locker! I knew which were needed for which tool. There was NO replacements avail on NOCs.

I used to have my own O2 oximeter. I used to have a battery thermometer. Some how ours would just disappear (poof!) or be broken. OP needs to know how get ahold of new pumps, IV poles, NEBULIZER MACHINES, suction machine & supplies, and ostomy equip. (Just putting a towel over an active colostomy just doesn't cut it!)

NOC responsibilities for lab draws will vary per each facility and processing lab provider. At one place, I had to include ICD9 diagnosis codes for each lab test to be done. I made a 'cheat' sheet list, kept it inside the lab manual so I could add the code for diabetes, a-fib, UTI, hypothyroidism, etc. My favorite code was the special one for medication monitoring, like Dilantin level for seizure disorder.

And speaking of labs, NOCs may have to draw labs themselves off PICC lines. Some lab techs might be permitted, but usually it always had to be the RN. So I also made my own list which color lab tube top was req for which lab test. And just to alert OP, Vanco peak & trough were usually definitely a NOC draw (and they were time consuming). Also know that lab tubes have expiration dates, so check them out. (You prob have a supply of them in the med room.)

NOCs were often required to have early AM appt pts up & dressed & ready to go after breakfast. Dialysis pts go out on NOCs, so getting them a breakfast is nec.

And just to be aware - new admissions might arrive on NOCs. Just might. Although rare, you could possibly receive an admission. Facilities are 24/7, because there's NO payment for empty beds! I rec'd several admits - and all the steps settling in a new pt need to be started.

We used to do 'chart checks'. (Are they still needed?) With computerization, not too sure how that would work, esp since nsg would have to be accessing ALL charts. (HIPAA HIPAA HIPAA)

I prob could think of a few more if I tried. Have prob overwhelmed OP.

Again good luck.