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 :)
Specializes in Emergency Dept. Trauma. Pediatrics.
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 would have been with you until this point. I have been on many night shifts that were far busier then day shifts I have had. Both shifts have their crazy and quieter days. From this post you make it sound as if night shifts are pretty low key. Definitely the case some times and not the case a lot of times too. I always see more patients tank at night too. Like somehow everyone made it through the day and the patient decides they need to spice it up a bit. Gets pretty crazy to have 3 codes and minimal docs in the house to run them. I don't think any shift is better or less then the other. They are different for different reasons. A lot of it is perception as well. Chaos for you might not be a big deal for me and so on.
I would have been with you until this point. I have been on many night shifts that were far busier then day shifts I have had. Both shifts have their crazy and quieter days. From this post you make it sound as if night shifts are pretty low key. Definitely the case some times and not the case a lot of times too. I always see more patients tank at night too. Like somehow everyone made it through the day and the patient decides they need to spice it up a bit. Gets pretty crazy to have 3 codes and minimal docs in the house to run them. I don't think any shift is better or less then the other. They are different for different reasons. A lot of it is perception as well. Chaos for you might not be a big deal for me and so on.
Boy if this isn't the truth ... When I worked peds (nights), they got absolutely gonzo if we didn't go "in order" with admissions- even if I was done with mine and volunteered to take the next one, it wasn't "in order", so they'd rather get behind.... To me, whoever is available takes the patient. And this was on nights ! Three patients on a regular (not PICU) peds floor was the usual "normal" load- 4 patients was getting a bit overwhelming (to them), and 5 patients- well, call EAP and arrange counseling for everyone !!! ... I was used to a LOT more. Sure, it could be very busy. (why 'work' is a verb) But it made no sense to me to have one nurse caught up, and others in the middle of admissions insisting they take another one.... go figure. :) If we had NICU boarders (NICU too full- had 3 sets of triplets delivered in one week, so we got 3 feed-n-grows) one nurse would be in the room with those three....that was the pits. But other nurses didn't mind being holed up.. I'd rather run....back when I could Good thing that there are enough different preferences to get it all done
Specializes in Emergency Dept. Trauma. Pediatrics.
Yea, I am a total type B personality and I see people stressed out and going bonkers all the time and I just think BREATH. I see people spending HOURS AND HOURS on charting and I honestly just don't understand what the heck takes so dang long to chart that much when I have the same patient load. It takes me like 15-20 mins to do all my charting on each patient initially. That is all my forms I have to fill out for the shift, (Assessment, vitals, IV maintenance, Patient Education, problem list etc.etc.) I do it right after I finish my assessments and so rest of the shift I have very minimal charting. At times things get crazy and everything seems to happen at once but I am a very flexible person and just go with it. That stuff doesn't throw me off. Now taking report out of the room order when I have my sheets in sequential order WILL throw me off. LOL I guess we all have our things.
Yea, I am a total type B personality and I see people stressed out and going bonkers all the time and I just think BREATH. I see people spending HOURS AND HOURS on charting and I honestly just don't understand what the heck takes so dang long to chart that much when I have the same patient load. It takes me like 15-20 mins to do all my charting on each patient initially. That is all my forms I have to fill out for the shift, (Assessment, vitals, IV maintenance, Patient Education, problem list etc.etc.) I do it right after I finish my assessments and so rest of the shift I have very minimal charting. At times things get crazy and everything seems to happen at once but I am a very flexible person and just go with it. That stuff doesn't throw me off. Now taking report out of the room order when I have my sheets in sequential order WILL throw me off. LOL I guess we all have our things.
When I was in charge on a 24-27 bed (changed floors, so count changed !) med-surg/ortho floor, it was well known that I color-coded report. Back when we still counted narcs manually, I was doing that with the off-going charge nurse. I got back to take report, and the ink looked weird (black was sort of bluish)...then the green was purple, red was pink, etc.... THEN the giggles started around the room. One poor nurse had come in just before I sat down, and was told nothing except to say "I'm sorry, it will never happen again" when I started looking confused I had to have my system, or I was thrown off- give me a bunch of patient craziness, but do NOT mess with my system
In agreeance with Miss Vida, sounds like OP just needed a place to vent. I'm sure we can all relate to the shift from hell, feeling stretched like a piece of bubblegum and no support. Venting is good for the soul, I'm sure she'll do just fine in her future studies and as a nurse when passing her boards. If we were failures just because we had question or a crap orifice day, then man none of us would be nurses today.
I can't say the staffing sounds that bad, as med surg here is 29 beds with only two RN's and an EN staffed for a night shift. However you can't know what the wards like, some are super heavy and others lighter when it comes to med/surg in particular, so am in no position to judge.
I myself love the night shift, can't stand getting up at the crack of dawn --.-- horrible horrible so can only give kudos to those day shift morning birds. I do all shifts however. My hospital they're 8hr, 6hr and 10hr nights so a little more versitile in choice. Also disagree that days are busier then nights. 'Generally' that is the case due to rounds, wound dressings, treatments, administration, meetings the hoardes of interrupting vistors or student mentor/preceptoring in a day. However nights can go horrific, for me personally codes tend to happen in the night, your IVC's and tubing can screw up and you have like nil personal to help you out. Wanderers, mental health escapes occur more on the nights for me then elsewhere and there's less management to arrange staffing help if everything blows up.
Sooo to me, each shift has it's own hardship and neither is 'harder' or 'more skilled' then another. It's just the luck of the draw and sometimes you just have to focus and breathe trying to swim your way through the mess to the other side. But that's my own personal opinion.
Hope everything works out for you in the future and that your management get in some more staff if it's really that awful all the time. Sometimes places like that it's better for your own being to get out and find a nicer place to work, who wants to live strung out everyday at work due to management issues?
I work both nights and days now, and enjoy them each for different reasons. At least at my hospital (25-bed oncology unit), the pace is much slower during the night. But, the lack of resources makes up for it. I am usually busy but not crazed at night, with the opportunity to have a peaceful dinner break and check email. During the day, unless I have a lot of discharges and no new admissions (fat chance), the entire day is crazy.
Hey guys! WOW, looking at the different types of responses, I guess I should probably wait 24hrs before posting after a long shift lol . Well, I welcome all types of opinion, whether negative or positive, who am I to judge...
I TOTALLY agree both shifts are busy in their own ways, no doubt about that! I hope nobody got the impression that I implied that working day shirt is easier because of staffing. I've orientated on days when I first started and I've seen the activity that goes on! Trust me, they are as busy as can be even with the number of nurses I've mention above. The point I was trying to make is that nights can often be just as busy an it would to nice to have an extra nurse/aid on the floor during those wild nights. Let me not forget to mention our med/surg is a 50 bed floor if that helps paint a picture. I know you can't honestly tell me that at any point during your nursing career you never experience a time that you wish you had an extra nurse/aid on the floor to help with the load?! If not, then my hats off to ya :)
I work nights because a.) that was the only position available and b.) ironically, it works best with my school schedule. It's my first job working nights and I am surprised on how my body has adapted to the change quickly! I try to keep a routine sleep schedule and eat healthier so my body's cycle isn't totally thrown through a loop haha.
I applaud Mi Vida Loca and other posters who hit the nail on the head! It was differently a rough night and I wanted to vent to a group of people who understands the nursing world. Granted, not all nights are like that, just some. Day shift goes through the same roughness too. Plus it's better to vent it out and get it outta my system then hold it in right?! Anywho, it's premature to say that nursing school will be overwhelming for me. I am competent person who understands what this career entitles and the commitment involved. I choose this career because nursing is what I want to practice as I further my education and take on advance roles within this field. There isn't a career that doesn't carry it's own stresses, you got to take the good with the bad, that's life. Come back at the end of May and ask me how I'm doing after my first year of school. I'll be waiting
I do find it ironic for posts that question my choice of career and they list out all the cons of their duties. It kinda makes me question why you continue nursing if you believe it worse from here. Like I said, who am I to judge. You chose this profession for a reason that only you can justify for yourself, not others. "To each their own" will properly conclude this paragraph.
Hopefully, I replied to all your responses as best I could.
*P.S. on the catheter issues. The patient is an elderly patient who's been in the hospital for a while. The pt has been restless due to a lack of sleep. That tends to happen being that a hospital is a change of environment, not like home. This pt has urges to urinate, but the output is pretty low for the amount of times the pt goes, which is equivalent to every other hour. I have no problems assisting the pt to the commode, it concerns me how frequently the pt goes with little output and ends up being pretty restless throughout the day. I notify my nurse about the pt situation. A catheter could possible be an alternative mean to help train the pt bladder. Obviously, if the doctor feels that the need of the catheter to help the pt is a beneficial process that outweighs the potential risk involved, the order would have already been place. Anywho, just looking out for my patient :)
An old thread, but wanted to reply anyway. Days as an RN is SO stressful for all the reasons mentioned. Not only are you pretty much doing the same stuff you are doing at night....but during the day you have less personal space with all ancillary staff everywhere, families looking to you for all that amazing resort style customer service (thanks a lot Quint Studer....if ya don't know him yet, look him up PLEASE!). So you are in the limelight WHILE you feel at times as if you are going to explode. Management is often there burning holes in the back of your neck watching everything but somehow forgeting what it is actually that you are busy doing all day. (" Please come here for a minute, I want to educate you on .......while you have already 5 issues pending at the same time). I speak of RN work here. But a good RN will also be knee deep with the poop and pee and crazies right along with their harried CNAs. Because at the end of the DAY....you, RN are entirely responsible legally for everything that happens to your patients. You, RN are the gate keeper for ALL other staff working with the patient, including physicians....who sometimes may be less than competent in their diagnostics and orders!
Now, nights, you have the endless streams of admissions, the crazies, the fall risks jumping out of bed like they are kids again, the lonley patients, the combative ones who won't stay in the room, and yes.....the patients seem NEVER to sleep.Oh, yes, and more MIs happen at night too (yay for telemetry). And we are always short staffed! BUT, I can tell ya, nights are a lot less stressful because no one is breathing down your neck as much as in the day. I work nights after many years of days as an RN. I FEEL for you. A good CNA will change a good RN's entire shift. BUt a good RN will BE HELPING THE CNAs ALL NIGHT TOO! Yes, in addition to all of their exclusive responsibilities.
When you are an RN you will be happy to make more money. And people will tell you "yay, well, you get a lot for your time at work, you make GOOD money, easy life!". ANd you will laugh your butt off because every morning after your 12 hours, you will feel as if you have earned every penny with blood, sweat, and tears. I agree, CNAs in general should be paid much more!!!! Hang in there!!! There are different areas to work. Med surg will never change and is this way forever. The hotbed of the hospital.
Keep it up, become an RN, and you will be one who the techs love because you will know what they are going through.
I was a tech on dayshift before I went to nights as an RN. I will tell you from the tech/CNA perspective working on days with more staff, it was still WAY more hectic and busy than the techs on nights have to deal with. Not that nights can't be busy too, but it's different. I was shocked at how much more free time the techs on nights have compared to what I was dealing with on the day shift. First of, dayshift techs did all the baths and linen changes, had to offer it to each patient. Along with obtaining blood sugars before every meal (3 times on dayshift) and vitals every four hours. Mix in all those same confused and incontinent pts along with the ones who want to get up to the bathroom with assist or need a bedpan every hour or more. Then also, because the nurses have more going on, they require more assistance from the techs so are hitting you up a lot more to do things that they just don't have time to do.
Like I said I work nights now and know that things can be crazy on nights as well. But I would never want to work days on my floor again, as a tech or an RN. However, I will be looking for a dayshift elsewhere soon. The nightshift differential is not enough to replace my sanity and my well being. I'm not getting enough sleep and it's wearing me down. If it weren't for that, I would stay on nights.
... When I worked peds (nights), they got absolutely gonzo if we didn't go "in order" with admissions- even if I was done with mine and volunteered to take the next one, it wasn't "in order", so they'd rather get behind.... To me, whoever is available takes the patient. And this was on nights ! Three patients on a regular (not PICU) peds floor was the usual "normal" load- 4 patients was getting a bit overwhelming (to them), and 5 patients- well, call EAP and arrange counseling for everyone !!! 
But other nurses didn't mind being holed up.. I'd rather run....back when I could 
Good thing that there are enough different preferences to get it all done 
.thumb.jpg.5aa4d55557c0228e31b94de19666bbbb.jpg){kind=small}
. Well, I welcome all types of opinion, whether negative or positive, who am I to judge...
~Mi Vida Loca~RN, ASN, RN
5,259 Posts
I would have been with you until this point. I have been on many night shifts that were far busier then day shifts I have had. Both shifts have their crazy and quieter days. From this post you make it sound as if night shifts are pretty low key. Definitely the case some times and not the case a lot of times too. I always see more patients tank at night too. Like somehow everyone made it through the day and the patient decides they need to spice it up a bit. Gets pretty crazy to have 3 codes and minimal docs in the house to run them. I don't think any shift is better or less then the other. They are different for different reasons. A lot of it is perception as well. Chaos for you might not be a big deal for me and so on.