Do you feel like you have no "down time" on the midnight shift???

Bird2 · May 12, 2005

I work 11-7:30, and I feel like I can't get a break. We have SOOOO much work at night. We are responsible for everything, b/c "you have a lot of down-time on the midnight shift".
Which brings me to my next question: Is the nurse to pt ratio different on midnights? Normally it is 1:36, but often there is one nurse for 2 wings, which puts us at 1:67. I was told that it is ok on midnights...any input???

This does sound like a lot of pts. The facility I work runs 3 noc nurses for 100 pts. Your facility is possibly following State staffing minimums which often are low but legal. We can actually run legally with 2 nurses but the nurses would be running all night. I would be interested on how many cna's they have on the noc shift. Along with the 3 nurses we have 4 cna's. So, our total staffing is 7.

Blackcat99 · May 12, 2005

There is no down time on my night shift at the LTC. I am too busy waking up patients at night for all these treatments, meds and skin checks that the nurse managers always put on the MAR for night shift to do. No wonder so many elderly people are confused. I would be too if I didn't get any sleep. :angryfire

CapeCodMermaid, RN · May 12, 2005

I hate to make myself a target for irate night nurses, but there is a huge amount of down time on that shift. No families, no rehab, no appointments, no treatments, hardly any meds....I did it on the alzheimer's floor and was bored silly. I had to keep running up to the sub-acute floor to get care plans and MDS's to work on. And they nurses tell me they have plenty of down time too....compared to the craziness of days and 3-11

LPN01112005 · May 12, 2005

I hate to make myself a target for irate night nurses, but there is a huge amount of down time on that shift. No families, no rehab, no appointments, no treatments, hardly any meds....I did it on the alzheimer's floor and was bored silly. I had to keep running up to the sub-acute floor to get care plans and MDS's to work on. And they nurses tell me they have plenty of down time too....compared to the craziness of days and 3-11

I wouldn't call it HUGE amount of down time, CapeCodMermaid. No, we don't deal with families as often, but at my facility there are a couple of resident's whose family members are there day/night! No treatments????Are you serious? What in the heck do you call trach suctioning for three trach patients, and peg tube care for over 10 tube feeders? What exactly would you call the tx's that are done to the residents who have a tx ordered with EVERY BRIEF CHANGE? What would you call the nebulizer tx for the few residents that get them q4h around the clock and those that are PRN? Or the 02 tubing/humidification change outs we do at night? No meds? What would you call the 34 finger sticks we start at 5 am? And the 3 that are done at midnight? What would you call the 15 nitroglycerine patches that are placed every morning at 6 a.m.? and What exactly would you call the bolus feeds that are given to the non-continuous feed peg tubers? What would you call all those insulin injections we give at 6:30 for the largest majority of those 34 finger sticks we did at 5 a.m.? I also have enzymes to give just before breakfast to a few residents, and a few who get atarax at 6 a.m. and a couple of dilantins to give before the resident eats. We also do the med room ordering, put away meds from the pharmacy (that came in on another shift, btw), central supply ordering, file all the new orders that have been taken on every other shift. Do full head to toe assessments on all those residents that require it. Last night, I had 14 to do. We also do the glucose monitor controls, refrigerator controls, and Crash Cart controls. ALL THIS with just two nurses and 6 CNA's (when fully staffted) in a facility with 120 residents. Add to this MAR change out on the last day of the month. No, there aren't as many meds to pass and families to contend with on nights, but there is also not 6 LPN's 4 RN's 14 CNA's, 2 Social Workers, a DON, an ADON, an Administrator, plus dietary staff and housekeeping to help with all the "confusion" on days. Give me a break. On days, if a resident is confused and pees on the floor, housekeeping cleans it up. ON nights, if a resident pees on the floor, the NURSES clean it up. On days, if a resident is returned from the hospital, one of the RN's does the assessment. On nights, when we have a hospital return (and believe me, we do get them quite often) the two night shift LPN's do the assessments in addition to all the other stuff we do nightly. I don't have a clue where you were working, but quite obviously, it was not at a facility with the census mine has. I'd be willing to say your facility is NOT the norm for a true 11-7 LTC shift.

Another thing, although I get docked for a thirty minute "lunch" break, I don't recall ever having taken one, because in order to do that, I'd have to ask the other LPN to take over responsibility for my 60 residents, in addition to the 60 she is already responsible for. So, my lunch break consists of a pack of crackers and a soda while I'm charting. In other words, I GIVE my facility 30 minutes of my time each day.

Keely-FutureRN · May 13, 2005

I used to work 7-7 (as a CNA) and it just depended on the night. I worked on a cardiac floor at the hospital with 46 beds. Usually the nurses had 8 pts each and two aides for the floor (1:23) Some days I had time to do glucometer checks, supplies, etc. between 1-2:30am but other nights I was CRAZY! Running around from room to room because you are the one that cleans up the pee on the floor, answers call lights, deal with patients that can't sleep and are frequent callers, q4 vitals, a couple q1 blood sugars, q2 turns, brief checks, complete bed changes (accidents), the post op's that you get up at 4:45 to shower, weigh, and get vitals for anesthesia at 5. Charting, I+O's (those on Lacix that don't have a foley...) Dressing changes (PICC, JP drains, MFT bag changes at 5:30, Chest tube dressings...) Blood sugars between 5:30-6, Not to mention the people that want to get up and shower at 6 when you have to hurry and finish up your Qam weights and have shift report at 7. The nurses would be running just as much for patients who needed pain meds, q2 vitals for pts with pca pumps, and they have to deal with the doctors yelling at them at 2 in the morning because they're patient is crashing and the doctor says (well I don't care if her pressure is 70/40 and she's having runs of v-tach! Leave me alone!) bla.

Every shift has it's moments. In my opinion every shift is equally hard in their own way. I don't think nights are easier at all.

Keely

Keely-FutureRN · May 13, 2005

Plus the families that stay the night and use the call light every 10 seconds to tell me that the telemetry beeped..., they're hungry can I find them something (even though the cafeteria closes at 3am), or the pts that are auto that call "can you fluff my pillow, hand me my cup an arm reach away...

Keely

rebel_red · May 25, 2005

I also work all 3 shifts, and trust me I totally agree with LPN1112005, NOCs is not a quiet shift by any means. I run just as hard on NOCs as I do on 7-3 or 3-11. And with a hell of a lot less backup than I have on the other shifts....Not to mention all the "housekeeping" chores left to NOCs...eg chart checks for the entire floor, change the batteries on the hoyer, change the batteries on bed alarms, empty the med carts for cleaning, clean up the med carts and the tx cart, stock the crash cart and the tx cart order meds for the backup boxes and house stock, change out foleys and foley bags, do the PT/INRs, make sure wheelchairs are pulled for cleaning, 6am weights (which might I add the patients just lllloooooovvveee), and of course doing all the recaps for the month for the MARs change out, and of course the regular stuff assessments, charting, med pass, assigning CNA's, handling emergent situations. Oh and I almost forgot O2 tubing and neb tubing and H2O for concentrators gets changed on NOCs also....

I am so glad I have and continue to work all 3 shifts. And hope I never get sniffy about 1 shift Doing more and NOCs not doing anything except snozing...oh that just twists my panties.....

Tres

lovinghands · May 25, 2005

I wouldn't call it HUGE amount of down time, CapeCodMermaid. No, we don't deal with families as often, but at my facility there are a couple of resident's whose family members are there day/night! No treatments????Are you serious? What in the heck do you call trach suctioning for three trach patients, and peg tube care for over 10 tube feeders? What exactly would you call the tx's that are done to the residents who have a tx ordered with EVERY BRIEF CHANGE? What would you call the nebulizer tx for the few residents that get them q4h around the clock and those that are PRN? Or the 02 tubing/humidification change outs we do at night? No meds? What would you call the 34 finger sticks we start at 5 am? And the 3 that are done at midnight? What would you call the 15 nitroglycerine patches that are placed every morning at 6 a.m.? and What exactly would you call the bolus feeds that are given to the non-continuous feed peg tubers? What would you call all those insulin injections we give at 6:30 for the largest majority of those 34 finger sticks we did at 5 a.m.? I also have enzymes to give just before breakfast to a few residents, and a few who get atarax at 6 a.m. and a couple of dilantins to give before the resident eats. We also do the med room ordering, put away meds from the pharmacy (that came in on another shift, btw), central supply ordering, file all the new orders that have been taken on every other shift. Do full head to toe assessments on all those residents that require it. Last night, I had 14 to do. We also do the glucose monitor controls, refrigerator controls, and Crash Cart controls. ALL THIS with just two nurses and 6 CNA's (when fully staffted) in a facility with 120 residents. Add to this MAR change out on the last day of the month. No, there aren't as many meds to pass and families to contend with on nights, but there is also not 6 LPN's 4 RN's 14 CNA's, 2 Social Workers, a DON, an ADON, an Administrator, plus dietary staff and housekeeping to help with all the "confusion" on days. Give me a break. On days, if a resident is confused and pees on the floor, housekeeping cleans it up. ON nights, if a resident pees on the floor, the NURSES clean it up. On days, if a resident is returned from the hospital, one of the RN's does the assessment. On nights, when we have a hospital return (and believe me, we do get them quite often) the two night shift LPN's do the assessments in addition to all the other stuff we do nightly. I don't have a clue where you were working, but quite obviously, it was not at a facility with the census mine has. I'd be willing to say your facility is NOT the norm for a true 11-7 LTC shift.
Another thing, although I get docked for a thirty minute "lunch" break, I don't recall ever having taken one, because in order to do that, I'd have to ask the other LPN to take over responsibility for my 60 residents, in addition to the 60 she is already responsible for. So, my lunch break consists of a pack of crackers and a soda while I'm charting. In other words, I GIVE my facility 30 minutes of my time each day.

I think this is just so sad after reading this post. For years I have watched one shift berate the other and for what purpose - I do just as much or more than you so please RESPECT me or else. Bottom line, the majority of us are overworked and frazzled. Be kind to yourself as well as your co-workers - we all deserve respect for our efforts.

LPN01112005 · May 25, 2005

I think this is just so sad after reading this post. For years I have watched one shift berate the other and for what purpose - I do just as much or more than you so please RESPECT me or else. Bottom line, the majority of us are overworked and frazzled. Be kind to yourself as well as your co-workers - we all deserve respect for our efforts.

I was not berating the other shifts, lovinghands. I was responding to another poster who basically said that in her opinion, 11-7 nurses don't have that much to do. What is sad, in my opinion, is that people who work shifts other than 11-7 assume that we don't work hard because the majority of the residents are asleep. Just because we don't do exactly the same things other shifts are doing doesn't mean we have a huge amount of down time where we do nothing. It is very easy to take for granted all those things that you don't have to do on your shift, so you forget that they are actually being done. I have never worked days on a regular basis, just filled in here and there. I hated it. All I did was pass meds, and scratch out some sort of charting on the Medicare residents, which left me feeling like I wasn't using my nursing skills the way I wanted to because there was no time for me to assess my residents, and besides, there were RN's there to do that. Now, I'm sure that there are many, many 7-3 LPN's who would say they do much more than pass meds, which is why I try very hard to remember that although we are all LPN's our job descriptions and staffing ratios differ on each shift to reflect what best fills the needs of the residents and the facility. Fortunately, my facility respects the 11-7 nurses and we have received awards of excellence in nursing for our overall assessment skills. I don't think I'm regularly overworked as long as we are not short staffed, but I don't think I'm underworked either. Bottom line is that as an 11-7 nurse who has seen glimpses of 7-3, I could make the assumption that the LPN's on days only pass meds........but I'm sure that is far from the reality for those LPN's who actually work 7-3 on a daily basis, therefore,my assumption would probably be inaccurate and if I posted such an assumption, I'd be greeted with a post such as the one I initiated in response to CapeCodMermaid setting the record straight. You are right, however, we all do deserve respect for the job that we do. Fortunately for me, most of the time I get it and I hope that most of the time I give it. The intent is always there to respect any other nurse, but sometimes we fall short of our best intentions. If my post seemed disrespectful, I'm sorry....I was just looking to set the record straight for all of us 11-7 nurses who get tired of having to defend our shift.

Hellllllo Nurse, BSN, RN · May 25, 2005

I hate to make myself a target for irate night nurses, but there is a huge amount of down time on that shift. No families, no rehab, no appointments, no treatments, hardly any meds....I did it on the alzheimer's floor and was bored silly. I had to keep running up to the sub-acute floor to get care plans and MDS's to work on. And they nurses tell me they have plenty of down time too....compared to the craziness of days and 3-11

Well, that was YOUR situation.

Before I became and RN, I was a LTC LPN for several years.

One nurse to 65 pts- two trachs (MRSA), nine tbe-feeders and numerous wanderers, frequent fallers, "wander guards" going off all noc.

Not to mention numerous treatments and skin checks that never should be done on nocs. Don't forget all the toilets I had to unclog. As a noght nurse, I learned to plunge a toilet with a coat hanger. Remember, there is no maintainace or housekeeping on nocs. Whatever happens, the nurse has to take care of it.

I didn't get to take a lunch for over two years.

When I did days and evenings for a couple of weeks to fill in for nurses on vacation, I could not believe how much calmer it was, how much more staff there was, and how much less work there was to do. Of course, there were more politics.

Of course, this was at this particular nursing home.

As I said, every situation (and facility) is different.

Blackcat99 · May 26, 2005

I wouldn't call it HUGE amount of down time, CapeCodMermaid. No, we don't deal with families as often, but at my facility there are a couple of resident's whose family members are there day/night! No treatments????Are you serious? What in the heck do you call trach suctioning for three trach patients, and peg tube care for over 10 tube feeders? What exactly would you call the tx's that are done to the residents who have a tx ordered with EVERY BRIEF CHANGE? What would you call the nebulizer tx for the few residents that get them q4h around the clock and those that are PRN? Or the 02 tubing/humidification change outs we do at night? No meds? What would you call the 34 finger sticks we start at 5 am? And the 3 that are done at midnight? What would you call the 15 nitroglycerine patches that are placed every morning at 6 a.m.? and What exactly would you call the bolus feeds that are given to the non-continuous feed peg tubers? What would you call all those insulin injections we give at 6:30 for the largest majority of those 34 finger sticks we did at 5 a.m.? I also have enzymes to give just before breakfast to a few residents, and a few who get atarax at 6 a.m. and a couple of dilantins to give before the resident eats. We also do the med room ordering, put away meds from the pharmacy (that came in on another shift, btw), central supply ordering, file all the new orders that have been taken on every other shift. Do full head to toe assessments on all those residents that require it. Last night, I had 14 to do. We also do the glucose monitor controls, refrigerator controls, and Crash Cart controls. ALL THIS with just two nurses and 6 CNA's (when fully staffted) in a facility with 120 residents. Add to this MAR change out on the last day of the month. No, there aren't as many meds to pass and families to contend with on nights, but there is also not 6 LPN's 4 RN's 14 CNA's, 2 Social Workers, a DON, an ADON, an Administrator, plus dietary staff and housekeeping to help with all the "confusion" on days. Give me a break. On days, if a resident is confused and pees on the floor, housekeeping cleans it up. ON nights, if a resident pees on the floor, the NURSES clean it up. On days, if a resident is returned from the hospital, one of the RN's does the assessment. On nights, when we have a hospital return (and believe me, we do get them quite often) the two night shift LPN's do the assessments in addition to all the other stuff we do nightly. I don't have a clue where you were working, but quite obviously, it was not at a facility with the census mine has. I'd be willing to say your facility is NOT the norm for a true 11-7 LTC shift.
Another thing, although I get docked for a thirty minute "lunch" break, I don't recall ever having taken one, because in order to do that, I'd have to ask the other LPN to take over responsibility for my 60 residents, in addition to the 60 she is already responsible for. So, my lunch break consists of a pack of crackers and a soda while I'm charting. In other words, I GIVE my facility 30 minutes of my time each day.

Thanks LPN 01112005 for telling it like it is