Burning out on night shift - how does ANYONE do it?

[pinkiepieRN]

I've been a house supervisor for a nursing home of 110 avg. (126 max) bed nursing home on 11-7, M-F, since October. Things were going relatively smoothly; sure, every 2 weeks or so I'd have to pull a shift on the floor for a last minute call out or because the staffing coordinator doesn't know what she's doing, but it wasn't a big deal. One of our regular night shift nurses has been out for 2 weeks now and I've been doing most of her shifts, on top of supervisor duties.

Now, the supervisor duties aren't particularly heavy by themselves (helping with transfers/change in status, liaising between the ED and NH if a resident went out on 3-11, making sure the census in the computer matches the number of heads in beds, babysitting GNAs who don't want to get their work done, getting a pulse on the building because the 3-11 supervisor is usually busy focusing on little things rather than the big picture and other miscellaneous duties), but when you tack that onto working a 30 bed unit (a mix of sub-acute and long term, but less acute than I've heard of before), it feels horrible. Obviously they're not so heavy that management thinks I can't work the floor AND supervise at the same time, so why am I crying?

I didn't sign up to work full-time weeknights 11-7 as a floor nurse. I would much rather take care of the whole house than pass out 6 a.m. meds for 30 residents who receive about 2-5 medications, answer call lights (because the GNAs are overworked if they're not hiding or slacking off), deal with pharamacy, get people ready for dialysis, falls paperwork at least once a week and usually at least one set of neuro-checks for a fall earlier in the week, and of course reporting off to day shift.

We just oriented a nurse on 11-7 who'll be working with us part-time, but the last night shift nurse we trained quit shortly after orientation (gee I wonder why?). The full-time night nurse *should* be coming back soon but I've got a feeling that something ominous happened and she really isn't coming back (she didn't say she was taking a vacation the last time I saw her, no one no one knows what's going on or where she is and she called in to "call out" last week when she wasn't on the printed schedule I had in front of me, saying she'd be back on Monday 12/23).

I make an additional measly $4/hour more being the supervisor, which I get paid whether I'm on the floor or not, but it's impossible to do two jobs well. I feel like I either supervise more than I nurse and take care of residents or the opposite and there's never a balance. Although I knew there would be some shifts I'd need to work on the floor, it's too stressful most of the time. I left busy busy 7-3 because I was overwhelmed constantly with docs, residents going in and out on LOA to dialysis, appointments, the ED, wound care and other treatments and management. I would have begged for a 3-11 staff nurse position if this position phrased as a "promotion" hadn't been offered to me.

I turn into a miserable monster towards the end of my shift and when I get home from work when I work on the floor. I put on a good face for my co-workers, but when I come home, the tears come out. I tell DH that I want to quit my job, that everything is so awful that I don't know how much longer I can do this for...

When I wake up, it's a completely different story. I feel refreshed, I know that my job isn't so bad (at least usually the shift doesn't start with me feeling that way), and I don't feel like I'm going to quit right on the spot after completing my shift when I go into work tonight.

I plan on talking to my DON about possible switching to a 3-11 floor nurse position because this is not what I signed up for. I know that something happened quickly with this nurse but the only times I've not worked on the floor since this nurse has been off have been when other nurses have stayed over. I don't what happened to our PRN night nurses (and we had at least 3) but either they don't want to work or are too busy. Something needs to happen, one way or the other.

I can't just leave my job because I have a chronic health condition and NEED the benefits desperately, and I LOVE the residents and feel good about what I do when I have the time to actually take care or residents rather than fling pills at them while flying down the hallway attached to a med cart, but I can't live like this.

So, night shifters anywhere but particularly in LTC, HOW DO YOU DO IT?!?

Anyone else, any advice for my current situation other than "get out"? I do my best to have "shift brains" with 6 a.m. meds highlighted in pink, g-tubes highlighted in yellow, finger-sticks highlighed in blue, not to mention that I organize things from my cart to my routine as much as possible.

[classicdame, MSN, EdD]

I worked 12 hr shifts 3 nights a week for several years. The advantage was the other days of the week allowed me to recuperate. Some people cannot work nights at all, their body will not adjust. I doubt your employer will take that into consideration because they have a need at that time of night and you are available. As for what to do - you have to make sure you are not disturbed when you sleep. Make sure family and friends know NOT to phone or come by. Do not make appts. during your sleep time. Think of sleep as medicine - if you do not get the right "dose" you will be ill.

[NightNurseRN13]

I work 8-12 hour night shifts sometimes 5 days a week, but I've always been a night owl. Snack often (fruits are great), caffeine (but not too late in your shift or you won't be able to sleep) and stay busy.

Sure it's hard, especially when you have things that need to be done while the sun is shining (doctors appointments, sick kids, general errands), but you learn to adjust and even then you have bad days/nights.

Like the person above me said though, not everyone can do it. I would just talk to your DON and tell her how you are feeling.

Best of luck.