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

[Debbie_LPN]

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???

[Mister Chris, MSN, NP]

What great input! Nights as an RN in aged care is a trial of one's own patience.

120 bed unit - one RN (Me) 5 AIN's. Mostly high care residents, includes 2hrly and 4hrly turns, on-going peg feeds, bolus feeds, filing paperwork (as day staff are too busy!), cleaning, restocking, end of the month chart changes, transiderm stickers, BSL's, sub cut fluids, syringe drivers for pain control, restricted ammount of linen as the laundry is locked!, unstable diabetics, night wanderers, dressings and treatments that could not be done during the day as they were too busy, many other things to do besides answering buzzers for toiletting, prn meds, numerous "feeling unwell" calls from residents. We are as busy as the day staff if not more so, but we do not get all the politics!

As the RN I get an extra one off payment for seniority for the night $8.50.

The ammount in no way reflects the responsibility that is given.

I have worked days, but still prefer nights it works well for me.

Please, Please, Please stop the inter shift rivalry and "picking" We are all doing a great job as nurses, lets all work together-together and get the job done.

Love all you nurses (especially the aged care nurses).

Mister Chris :balloons: :Melody: :balloons:

[HannasMom]

I feel the nighshift is just as busy as other shifts, just without the added interruptions of family members, doctors, administration, etc. But, because there is the assumption that night shift isn't busy, administration has added "busy work" to my work load. I do all of day shifts skin checks, and I really hate waking up residents at 1 or 2 am, to check out their skin, or give them a scheduled Tylenol, when they are sound asleep and showing no signs of pain. And can tell you if they are in pain!!!

[aprilleverett]

I work 11-7 in a LTC and it greatly depends on which "side" i'm on.. on north side (about 16 RCF and 20 some SNF) I am bored stiff.. we have 1 nurse 1 CNA at night over there and i find myself doing mostly aide work to keep from falling asleep, on south side it's totally different ..usually about 60 snf res 1 nurse 2 aides and it's crazy... alzheimers mixed with A&O x 3.. people up and down all night.. call lights out the wazoo.. tx after tx and in the morning the med pass is like 2 hrs long on top of atleast 16 BS... i stay busy over there... and then there is all the crap that 3-11 loves to leave us.. skin assessments (at 2 in the morning, come on!), dozens of meds to put up, blood draws, urine cultures.. and the list goes ooooon

[Super_RN, BSN, RN]

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.

Thank you, well put. Couldn't have said it better myself. Obviously CapeCodMermaid hasn't had the luxury of short staffing and high acuity.

[OntCaRPN]

I've worked all three shifts too. There is a certain less political quietness on nights that I enjoy. But we certainly are not staffed for "just in case". There are two of us, me and an obstetical RN (and the RN in emerg.) (small hospital? you bet) There's paper work and checks enough to fill most of the time between pt care. But God forbid, anything should happen. We get swamped and in a hurry. The floor RN either runs to emerg and I'm alone or the Emerg RN runs to OB and I'm alone.

If someone in the unit turned sour while an OB was pushing, I'd have to hope the RNs who live in town can get dressed and run!

Quiet to the point of boredom? Very seldom. Scary .... yup.

[ktwlpn, LPN]

I don't think there is much "down time" on any shift in LTC these days.Our residents are MUCH sicker and live way longer then they used to.EACH shift has it's unique challenges -each has certain tasks that must be completed...That said-generally speaking-you will have less interruption on nocs....The noise level drops at 4 pm at our facility-the evening shift can feel the tension subside after we all leave....They have way less staff then days and have to deal with the majority of the visitors.Nocs has even less staff but again-very few interruptions.When I work nocs I can flow from point "a "to "b" to "c"....On days it's "a"...""x."..then back to " to finish up.....And the other departments and administration can suck the life force right out of you...and don't forget doctor's rounds....I think evening shift is the worst for me--I don't have the patience to deal with the sundowners.....

[kathc]

Wow..I'm amazed at how different LTC 11-7 shift is for different facilities. All trach care, tube feedings, ordering/stocking and treatments are done on the day shift. Some tube feedings are started on the evening shift. We have two nurses for 60 residents - that is if one isn't floated to another floor. They have limited meds to pass, but they had most of the BGs to do, thier own vitals for those on report and have to also do "rounds" with the aides. Personally I think all shifts have their pluses and minuses. I like days because there is a charge nurse there to take care of vitals and emergencies...I can pass my meds, do treatements, etc. I like evenings because it is quieter, more relaxed and there are less treatments - BUT if something goes wrong, you are totally off schedule. No RN to do vitals, call the doctor, etc. Now I've been told that there are floors where the 11-7 shift is boring and it is hard to keep busy, but I think that is becoming a thing of the past. As ktwlpn stated, we are getting sicker and sicker residents in long term care.

[pkeyrn]

I used to work night shift on an Alzheimer's Unit. 4o residents. On a good night maybe half of them slept in between incontinence rounds. The other half were either wandering up and down the hall, into other resident rooms, into the nurses' station or trying to exit the building - often becoming belligerant or physically abusive with any attempt at redirection. I also had to check each chart against the MAR nightly (because the other shifts didn't have the same amount of "down" time as nights), assist the 1 CNA on the Unit with the incontinence runs every 2 hours, including toileting the ambulatory ones, do the 5 - 8 MDS's that were assigned to me each week, do the skin rounds for the week, because "they are already in bed on your shift", Do a full med run at 6am (at least 30 of them got at least 1 med because they were trying to "ease the med load on days"), do fingersticks on the 23 of them who were diabetic (3 very brittle who tended to have frequent reactions throughout the night), administer insulins, go with the phlebotomist when she came in to draw because the residents were sometimes combative and she needed someown to distract them and/or hold their arms, prepare a sheet for each resident in preparation for doctors' rounds, get the MAR's, Treatment SHeets and MD orders ready for the change of month, do my regular charting, weekly behavioral notes and monthly summaries. So you can see, I had "tons" of down time.

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

[Judee Smudee, ADN, RN]

You are right, there is a misconception that night shift has nothing to do. This misconception exist only amoung people who have never worked night shift. I have also been in meetings where manager came up with new paper work and said that night shift would do it because they are not busy. Try not to choak to death when you hear something like that.

[nckdl]

I have 38 residents at noc and i ususally get my lunch if i eat it while i'm charting! Which is not so bad. I had heard that Ohio's ratio is 1/50, so it could be worse. Sometimes i get taken advantage of because I don't have that much to do, but then i kind of go off on the other shifts and they'll laugh at me because i guess i kinda go nuts then they'll back off for awhile. I mean WHEN i have extra time i do try to do extra and help out other shifts because i know their med passes are heavy but after sitting at my desk for 4 hours straight doing just paperwork between my med passes, i kind of want to quit. But then i think of how i like my job, my residents, and how i would like 1st shift someday, I keep on trucking through the nights and praying my hand doesn't fall off from all the paperwork.:chuckle