Do you feel like your differentials make up for the lack of staffing at night? I love working nights and the crew of people I work with, but I absolutely hate how short staffed we are when compared to day shift! I am a cna on a BUSY med/surg floor where our census ranges anywhere between 30-38 patients. Day shift can have anywhere from 6-7 nurses, including the charge nurse taking patients, and 3-4 aides on the floor with sitters available. Then when it comes to nights we may have only 4-5 nurses, and 2 aides on the floor and maybe a sitter if the need is that great. On nights I can start out with 14 pts and can count on ER in brining me 2 or more patients to add to my census. Management doesn't take into account the type of care needed for each patients. They think everybody will be asleep needing less care. WRONG! There are times when I've had 15 pts, 6 of which were total cares requiring two people to help change and turn and can often be heavy wetters needing a bed change. Lets not forget the other patients who are 1x assist to the commode every other hour and you just wish they had an order for a catheter because their output is about 100mL each time. Then we have combative patients determine to pull their tele, iv, shiley, picc, catheter, and any other tubing in site in no restriants because the family is staying in the room. Our confused patients trying to hop out of bed, so of course bed alarms are going off. To complete the night, multiple trips to the snack room for low BS, answering call lights, and assisting with RR transporting pts to the unit. Granted not everything happens all in one shift, but it comes pretty darn close.
To answer my own question, I say no! They don't pay us enough for all the work we do at night. Not that I am soley about the money, it's just we work entirely way to hard the way we are staff and the pay just doesnt reflect our work. Budget cuts are also hurting us and 70% of our reimbursement will come from good scores from random patient surveys and ours scores are not great, which equals little reimbursements. I just wish they would put 3 aides on the floor at night because it makes a huge difference and relieves some of the stress of the night with all the new night admissions. I love doing what I do and will be starting nursing school this month, but I can't help but feel like I am being spread so thin! Maybe it's just the med/surg enviroment I'm not a fan of. I like staying busy, but this is just ridiculous. During our monthly meetings, the staffing issues has been discussed, but still remains the same. If management could grant 3 wishes, better staffing, new vital machines, and better pay are all I need to be happy camper :)
We have up to 6-7 patients per RN and 1 CNA for 13-14 patients on our tele floor. Used to have 2 CNA's but budget cuts. Hardest thing is only 3 people on the wing and if a patient goes crazy as they invariably do we don't have enough hands.
Hardest thing is dealing with crazy, confused people and bedchecks going off, trying to keep everyone safe in bed. Also cleaning and turning the super-obese 300-500+ pound patients we get.
We have up to 6-7 patients per RN and 1 CNA for 13-14 patients on our tele floor. Used to have 2 CNA's but budget cuts. Hardest thing is only 3 people on the wing and if a patient goes crazy as they invariably do we don't have enough hands.
Hardest thing is dealing with crazy, confused people and bedchecks going off, trying to keep everyone safe in bed. Also cleaning and turning the super-obese 300-500+ pound patients we get.
Im on the code/trauma team. Those get very interesting on nights too!
I don't think i can comment fairly on the staff. I work in med/surg and did most of my clinicals on med/surg and externships. Some of the med surg units pts were ALOT MORE stable and less sick than what I deal with at work.Therefore I don't think all med surg flooors have the same level of pts, must depend on the hospital.One community hospital I did a clinical rotation out seemed to ship most of the very sick pts (who are commonly on my floor) out to other hospitals. Nights has less help where I work. Some nights are busier than some days (i work both!). TO me it is not worth any money to work short staffed, it is a nightmare almost everytime. It takes longer to do things because there is less staff to help.
Specializes in Emergency Dept. Trauma. Pediatrics.
It's worth the differential on my unit. (at least so far, we haven't hit busy season yet) We don't have aides unless we get 7 patents (it's a 16 bed unit) At 7 we get an aide for 4 hrs and at 8 we get an aide for the whole shift. So far though even when we have been busier things still run pretty well. The hardest part is getting docs in a timely fashion. We are working on getting some Pediatric residents or hospitalist. We don't have any ped specific ones and they seem to avoid the kiddos like the plague. When we can get one they can be frustrating to work with because they don't work with kids often and we are pushing for certain tests to be run and they won't order it and will order a test that isn't needed. (not trying to imply we are smarter or anything like that but an example is we had a kiddo that it was pretty reasonable guess they had rota-virus. 2 nurses walked in and were liked UMMMM smells like the kid has Rota. They had all the common S&S. We got a really good stool sample and the doc ONLY ordered C-diff test. The kid was camping, no O&P test, just C-diff) I think had we had a pediatric specific Dr. they would have ordered these. So anyway, stuff like that can be frustrating. But the unit runs pretty smoothly and definitely worth the differential.
Downfalls are like tonight. No kiddos so we transferred the adults off the unit and closed down. That means only on-call pay for me. Thankfully though I can still probably pick up another shift since I don't count in census yet
At where I work both nights and days are short staffed. I like nights better simply because I feel more in control of my environment.
Occasionally pt's have to leave the unit, but not nearly as often as days where they are going to PT, OT, Xray, etc etc etc.
When I get there at 7pm the Dr's have already come and gone. Any new orders from that point on will only get on the chart if I call the Dr and get them so nothing sneaks up on me. During the day the Dr's are in and out writing orders, and the nurses are responsible if any of those orders are late or missed.
I serve snack with bedtime insulin, but otherwise all meals times are over by the time I get to work.
We do not have visiting hours and a lot of our patients have relatives stay until 11p, and usually have one relative spend the night, but still not as bad as days.
I work on an ortho unit so it feels like I am always passing pain meds. Some patients get them q 4, and some as often as q 1. In addition, we have regular meds, dressing changes, and patients who have other issues in addition to their ortho issues.
My biggest problem is not having enough tech support. When all the foley's come out we have patients that are min assist x 1, 2 and sometimes even 3 to get to bedside commode, bathroom or sometimes even bedpan. When we only have one tech or two, but each has 15 + patients then its a mess. I find myself trying to run around doing total care for the most part because they are stuck in a room, or I have a patient who I need help with, but that help isn't available.
If you are this overwhelmed now, it will be much, much worse when you are in nursing school. Nursing school is a total commitment; you must have time to study outside of class, or you might not pass your state boards. Are there any other jobs you can do, such as unit clerk? I hated night shift due to constant sleep deprivation, and it took a tremendous toll on my home life (kids, husband.) The only thing that may improve by working dayshift is your circadian rhythm.
If you are this overwhelmed now, it will be much, much worse when you are in nursing school. Nursing school is a total commitment; you must have time to study outside of class, or you might not pass your state boards. Are there any other jobs you can do, such as unit clerk? I hated night shift due to constant sleep deprivation, and it took a tremendous toll on my home life (kids, husband.) The only thing that may improve by working dayshift is your circadian rhythm.
And worse than that after YOU are the one in charge of the decisions that are now made by your charge nurse... :) Are you sure you really want to be a nurse? What do you expect to do as a nurse? (seriously- I'm not being sarcastic). :)
Specializes in Emergency Dept. Trauma. Pediatrics.
I really don't think it's that serious to keep suggesting the poster won't hack it as a nurse or a nursing student. Sounds like she had a rough night shift with little support and came to vent. I think most of us have had a bad day or week which made us question everything. Then we vent and brush it off and do what we have to do to get through. I think a lot of aides are over worked and underpaid and to be honest, I will take my job over theirs any day. I always do what I can to help out the aides. I also didn't think Nursing school was bad at all and I managed just fine without giving up my life any.
Day shifts require more staff because, quite simply, there is more to do during the day. Showering, medications, dressing changes, doctors to deal with. Yes okay so there are the Q6h medications that still need to be given over night (for example), and perhaps the odd blood glucose check, some roaming patients who don't want to sleep etc ... but it is work after all, and the reason they have night shift staff at all is to deal with that kind of stuff.
Even quiet day shifts are busier than the busiest night.
Day shifts require more staff because, quite simply, there is more to do during the day. Showering, medications, dressing changes, doctors to deal with. Yes okay so there are the Q6h medications that still need to be given over night (for example), and perhaps the odd blood glucose check, some roaming patients who don't want to sleep etc ... but it is work after all, and the reason they have night shift staff at all is to deal with that kind of stuff.
Even quiet day shifts are busier than the busiest night.
And yes, I did just type the "Q" word. :-P
I've worked all shifts, so agree that days have more scheduled things to do. However, I've also worked nights that have been downright nuts- partly because of the differences in staffing (which I do agree with), and patients just being wacko some nights. Med-surg, neuro, LTC (they were actually the best- there were Q2H bed checks, but you knew where they were- lol- most of the time), alcohol/drug rehab, coma stim, adolescent psych, peds... all had insane nights that could rival any day.... so it's not always true that nights aren't nuts :)
So night shift is only good to babysit??? What about night shift admissions, emergency surgeries, transfers to ICU, deaths, declining conditions, etc.... If that's the rationale, then the only reason there are more staff on days is to babysit the doctors.... just saying' :)
You work NICU and peds-- not the same PLANET as adult nursing. At all :)
I prefer nights because on days you deal with demanding families more often. Not saying we don't on nights, its just more frequent during the day. Doc's do their rounding. Surgery does their rounding. Patient's are in and out of appointments all day (X-ray, PT/OT, CT etc.) Discharges occur during the day. Which i think are worse than admissions especially if going to a nursing home. Takes me the WHOLE day to get everything perfect for the nursing home because god forbid if i send my patient over on 4L of 02 as opposed to 3L of 02. Social work consults are during the day and they are ALWAYS asking questions that i never know the asnwer to "In 1999 where was this patient's living? did their house have stairs?" ...how the heck would i know?? They are here with Pneumonia, i know everything up until days before their pneumonia occured. Not from 15 some years ago. My goodness. Have you thought about asking the patient yourself??
Docs are ALWAYS trying to find you because they never know the asnwer to anything. "Why is this patient not wanting PO antibiotics and only IV?"...."in the 15 minutes you spent trying to find me and get ahold of me, you could have had the patient explain to you why they don't want to take PO. So why didn't you do that?"
Families, don't even get me started. "My wife has had the call light on for 15 minutes."..."No sir, she hasn't. it has been on for about 15 seconds."
STUDENTS!! students during the day. Don't mind having students, but it sure has heck slows me down by alot. when i have students, you can FORGET me being on time with any medications or discharges. Eeek
night time, although busy, is my time to not deal with that crap that i hate and just take care of the patients and keep them alive til 7am the next day.
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brandy1017, ASN, RN
2,910 Posts
Not very good staffing ratio's if you ask me.
We have up to 6-7 patients per RN and 1 CNA for 13-14 patients on our tele floor. Used to have 2 CNA's but budget cuts. Hardest thing is only 3 people on the wing and if a patient goes crazy as they invariably do we don't have enough hands.
Hardest thing is dealing with crazy, confused people and bedchecks going off, trying to keep everyone safe in bed. Also cleaning and turning the super-obese 300-500+ pound patients we get.