Do NNPs on Rotating Shifts Get to Sleep on Night Shift?

[thaifood122]

Hey guys! I'm curious for those of you who work with NNPs on your unit doing rotating 12 hour shifts. I know NNPs working 24 hour shifts get a call room and time to sleep. What about for NNPs working rotating shifts? When they are assigned a 12 hour night shift at your hospital, do any use some of the shift to sleep in the call room or is it more like a nursing night shift where they are up and active all night long?

[babyNP., APRN]

It depends on the hospital, but I would say that most if not all facilities will have a call room for the NNP even if they do 12 hour shifts.

It's not a good use of productivity for the NNP to stay up all night for no reason. Most NNPs will do some brief night rounds to check in with all the nurses and then go to bed. This helps with patient safety because a well-rested provider will make better medical decisions.

Of course- there are nights where we are up all night, but that's just luck of the draw. I usually got a few hours of sleep even when I worked at a Level IV children's hospital as a NNP (I mostly work community Level II/III now).

[thaifood122]

Thanks babyNP! That’s really helpful to know! I’m really interested in pursuing this field but all the jobs calling for rotating shifts have made me nervous about the long term effects on my own health, especially since I’ve never had to work nights before.

[GlitterSparkles, BSN]

In my facility, NNPs do not do 12 hour night shifts. We have 2 NNPs during day shift, a 12 hour and a 24 hour. The one working a 12 leaves and the 24 hour stays so we only have one NNP on night shift. The 24 hour NNP tries to sleep during day shift a little as well in case they have a busy night and dont get to.

[Leader25, ASN, BSN, RN]

On 10/4/2019 at 4:02 PM, thaifood122 said:

When they are assigned a 12 hour night shift at your hospital, do any use some of the shift to sleep in the call room or is it more like a nursing night shift where they are up and active all night long?

surely you jest

[thaifood122]

Nope I don't jest. Almost all the job entries for NNPs I'm seeing say "rotating 12 hour shifts" so I'm wondering how exactly that works since rotating shifts are pretty universally accepted to be incredibly unhealthy and lead to burnout quickly. But I heard that some providers on night shift just use call rooms to nap. I guess the providers are all awake through the night on your floor @Leader25?

[Nunya, BSN]

This will be hospital dependent. In a big NICU I wouldn't count on sleeping. I worked in St Louis several years ago and they didn't sleep, but the night NNPs worked straight nights, no 24 hour shifts. In a smaller unit/level 2 you may be able to get some sleep. During interviews I would ask what the rotating schedule looks like; a month or 6 weeks of nights/days is totally different from working both shifts in a one or two week period.

[adventure_rn, MSN, NP]

9 hours ago, Elaine M said:

This will be hospital dependent. In a big NICU I wouldn't count on sleeping. I worked in St Louis several years ago and they didn't sleep, but the night NNPs worked straight nights, no 24 hour shifts. In a smaller unit/level 2 you may be able to get some sleep. During interviews I would ask what the rotating schedule looks like; a month or 6 weeks of nights/days is totally different from working both shifts in a one or two week period.

I agree with @Elaine M. I feel like the 24s where the providers sleep all night are more common, but there are definitely facilities (especially large academic centers) where providers who work 12-hour nights are expected to be up all night. If you work in a place where residents and fellows are expected to be up for a full 12 overnight, the NNPs may have to be up, too.

As a nurse, I personally really appreciate when the providers are awake and accessible all night. I'm sure it's a pain as a provider, but I've seen instances where patient interventions were delayed because the nurse was afraid to wake up a cranky provider. It's easy when the kid is critically ill and it's obvious the provider needs to be woken up, but it's trickier when you're on the fence about whether or not it can wait (and frankly, that decision shouldn't be up the nurse anyway since it's out of our scope). Different providers have such different tolerance for what they want to be woken up for (i.e. 'wake me up for everything' vs. 'don't wake me up unless somebody is dying'), and it can put the nurse in a real bind.

[babyNP., APRN]

On 10/25/2019 at 7:52 PM, adventure_rn said:

I agree with @Elaine M. I feel like the 24s where the providers sleep all night are more common, but there are definitely facilities (especially large academic centers) where providers who work 12-hour nights are expected to be up all night. If you work in a place where residents and fellows are expected to be up for a full 12 overnight, the NNPs may have to be up, too.

As a nurse, I personally really appreciate when the providers are awake and accessible all night. I'm sure it's a pain as a provider, but I've seen instances where patient interventions were delayed because the nurse was afraid to wake up a cranky provider. It's easy when the kid is critically ill and it's obvious the provider needs to be woken up, but it's trickier when you're on the fence about whether or not it can wait (and frankly, that decision shouldn't be up the nurse anyway since it's out of our scope). Different providers have such different tolerance for what they want to be woken up for (i.e. 'wake me up for everything' vs. 'don't wake me up unless somebody is dying'), and it can put the nurse in a real bind.

This is a bit of a tangent to the original post, but something I have a passion for- communication & patient safety.

I think it sucks that you have experience with "cranky" providers. That should not happen and should always warrant an apology from them. Chain of command (nurse manager) is there for a reason if you get someone who is rude. But...respectfully, the nurse is still responsible for contacting the provider when there are concerns despite the risk of a person's potential crankiness no matter what time it is. It's an interesting phenomenon to me because it never crossed my mind as a bedside nurse about should I/shouldn't I? for calling someone. I might have asked the charge nurse for their advice, but I always called if I thought they needed to be called. This was when I worked in on the east coast in a Level IV 60 bed unit and the residents & NNPs/fellows did go to call rooms after night rounds.

On the other hand now that I work in a community setting in a different region of the US, it is a bizarre experience to see this hesitance. I always say to every nurse when I do night rounds, "please call me for any concerns" and I am unfailingly polite on the phone (even when I have a situation when a nurse who called me in 15 minute intervals with normal lab results at 0430, after the third time, I said, "These sound normal, do you have a specific concern?" "No" "Okay, we will review them on rounds but you don't have to call me with the results unless you have a concern, thanks"). I am unfailingly polite no matter how tired I feel because 1. being a good person and all that 2. I don't want to give the nurse any reason to have any hesitation to call me when it could be a serious concern.

There is a 2 way street here- I can't address concerns that I am not told about. I cannot read minds... although I have changed my practice over the years to also include something like "do you feel comfortable with this plan?" verbally so I put their feet to the fire if they have concerns.

On another tangent, there is a communication program called TeamSTEPPs which focuses on learning communication skills between the provider, nurse, other team members. Using "CUS"- buzz words like "I am concerned" "I am uncomfortable" "This is a safety issue." This is awesome and I definitely recommend nurses use these words because by it should grab any provider's attention immediately. While the provider generally see the bigger picture for the patients the nurse knows that patient's nuances better than the provider could because they are with that patient for 12 hours continuously. They see things that we don't.

[NICUmiiki, DNP, NP]

On 10/4/2019 at 3:26 PM, babyNP. said:

It depends on the hospital, but I would say that most if not all facilities will have a call room for the NNP even if they do 12 hour shifts.

It's not a good use of productivity for the NNP to stay up all night for no reason. Most NNPs will do some brief night rounds to check in with all the nurses and then go to bed. This helps with patient safety because a well-rested provider will make better medical decisions.

Of course- there are nights where we are up all night, but that's just luck of the draw. I usually got a few hours of sleep even when I worked at a Level IV children's hospital as a NNP (I mostly work community Level II/III now).

This makes me feel better about possibly working night shifts again. I hate them! Moved to days as quick as I could. The NNPs where I work either work call (24 hours) or come in for an 8 hour day shift, and I'm ok with that. I think I'd prefer 24 hours, but 12 hour nights don't seem so bad if I can get some sleep. Just more stuff to talk about when I start interviewing hospitals.