Do Day Nurses Really Feel that Night Nurses Do Nothing All Night? - page 7

Having worked the 12 hour night shift in many hospitals I find the same things. Day shift nurses leave us so much work to do that we're playing catch up all night. We start off 2 hours behind... Read More

  1. by   traumajunkiegirl
    ok where i work this is what goes down....

    Rural Hospital 20 beds, ob and l/d, er

    3 RNs
    1 LPN
    2 CNAs
    1 Ward Clerk
    Office staff to sign papers and register admits and paperwork
    Dr. rounds once....
    Non-emergent ERs are routed to the clinic

    1 RN
    1 LPN
    1 CNA

    same patients...and ER goes nutz after the clinic closes at 5pm
    Dr. rounds in the evening.
    all the blood infusions never seem to get done and are left for us
    phone rings like hell
    I alone am in charge of the entire floor and ER.
    we get to make out dayshifts paperwork for them and check charts to make sure they noted thier orders correctly, and make out new mar's
    we have more meds, more orders to note, and more er's
    but amazingly ....less staff ????
    Guess what else...major trauma/code comes in, its all on me, a lpn, and the doc on call...i dont have a team of 4 nurses to help out!
    Not only do you have to be independant and skilled at ER you gotta be good enough that you can handle a code/trauma alone.
  2. by   End Game RN
    O.K. I am not speaking for any other unit or floor or service in our facility. Just the neuroscience where I have been forever, actually I am, along with just one other critical care RN (a brillant former mentor of mine) are the most senior staff members in our unit.

    I have watched a hundred or more nurses and other staff members move on, move out of the profession or move up in other areas of nursing such as arnp or nurse anesthetist, administration, business management, nursing education, etc...

    I have also worked some oddly structured shifts early in my carreer in this facility..i.e. 11 am to 7 pm, 11 pm 7 am 12 noon to 12mn, 12 mn to 12 pm, 3 pm to 11 pm, 7 am to 11 pm, 3am to 3 pm, 3 pm to 3 am. This was during a traditional 8 hour shifts with the exception of a couple of twelve hour shifts thrown in. The problem was to balance this with a covering nurse to work the other side of the odd hour shifts.

    I eventually went to modified Baylor weekends. Every Friday, Saturday, Sunday, 7am to 7 pm. The rest of the week at this time I took care of my parents who were very ill, arranged for friends and family to assist with this and was able to get a home health care RN and CNA, but this was the exception, not the rule. I also continued practicing Judo (stress relief for having no social life), total years in Judo, 20...with the early part of my participation in this sport spent in extensive training, six days/week and competition, State and National and International.

    Because of having the experience of working all 24 hour possible shift schedules I can honestly say that no one shift, I don't care who you busier than the other.We are solely responisble for what we do at work. There is the professional side, the side that knows what is right from wrong, the side that knows what needs to be done and does it, triaging the most important nursing care, the side, more importantly, that understands that nursing is 24 hours and does not have time to ***** about what another nurse does or does not do.

    This is an issue between nurses reporting off, when you are receiving oral report with the patient's chart and the flowsheet, checking the last orders towards the end of your shift to see that they are taken off per your units P & Ps and discussed between the two nurses. Questions regarding the documentation, performance or pending performance of the last orders should be dealt with.
    Then "round" with the off going nurse and check lines, dressings, any infusing medications, mix of drips and check labels. Review ventilator settings and pending changes and/or labs for ABG or other labs and when they are due. Discuss known or potential complications of patient's and interventions to be performed or have been performed. Check all wound dressings and wounds uncovered and have sutures or staples. Discuss psychosocial issues as a heads up to the oncomming nurse if issues with family/friends.

    Report time is the time to discuss concerns you have with what has been done or not done for the patient and/or family in a calm and professional matter. This is not a personal issue, this is not a time to fight over what should or should not have been done.:angryfire

    The above is our typical report for each patient in our unit. We check our neighbors to keep us on tract as a unit. Yes we will fight, but shift wars are not tolerated, this being a strict, unwritten law that we can not violate without compromising our professionalism and our personal relationshipsl. Our unit is unique in so many ways. We will fight like family, but God forbid if a stranger comes between us or decides to intervene in an issue between nurses.

    Our unit is on 12 hours shifts, nights and days with no other shift options at this time. The outstanding thing about our unit is that we know each other so well, we integrate new staff as soon as possible.
    For example, I rewarded one of my excellent orientees when she not only passed the ICU clinical program at our facility with outstanding performance and grades, but actually got through my orientation with a minimal of growing pains, I invited her to one of our farms and she rode my mare, the mother of the gelding who threw me on my ass this past June) After she rode, took pictures with other horses, I took her to Shorty's Bar B Q and told her she deserved recognition and I told her I knew she would go far in this profession..I took this time to counsel her to return to school and decide what she wants to do in nursing. This "away" time from the hospital environment is what I choose to do for outstanding orientees. It is casual and non-threatening.
    This is one way to develop the "young ones" and NO, we do not permit the young to be eaten by others. There have been a few difficult transitions for new staff when working either shift, we have found a way to make transitions easier by "adopting" and "nurturing" the new staff. To make them "ours"

    Individual conflicts between staff members from either shift are encouraged by the "group" to be resolved between the persons involved. More commonly, senior staff may advise and assist with restoring communication. Other staff, perhaps with less experience but possesing a good dose of common sense, compassion and good people skills are also important in assisting with potentially toxic intershift relations. Administrative action would only be taken for issues that persist and potentially become destructive to the group as a whole.

    Being human, none of us are perfect. Mutual respect, understanding the people you work with, the level of experience, the age of the "new" nurse and that individual's life experiences (we are nosy, we learn a lot about each other, this is a big plus when helping staff to integrate into the group). Never refering to the oncomming staff in a way that defines them as different from us, but as friends and colleagues. Looking objectively, despite how you feel how an assignment has been left for you to "clean up".. Learn first from report what has happened, maybe the patient just came from the OR or from another proceedure, or just admitted, regardless of what the time is. Maybe its a fresh trauma with tremendous challenges to support the patient requiring multiple staff to jump in a help and yet much more must be done for the patient as the new shift walks in.

    Now, if you find a nurse hanging around the nurses station or computer checking out the latest Pottery Barn catalog...Well...Communication has to begin somewhere, but not with public display of anger, disgust, and repeating over and over to sympathetic staff how you were screwed. Sooooo COUNTERPRODUCTIVE.

    No matter how you feel , get the staff member aside to discuss your concerns, especially if end of shift orders were not recognized, or recognized but ignored for the "other" shift. Perhaps last 7 am hourly vital signs still need to be documented, or the urine bag is bursting because it was not emptied and measured regularly..just a lot of **** you find and want to blow up, but don't! Missed medication at the end of the shift, especially if there are no emergencies, CTs, admissions of trauma or transfers for example, is unacceptable, after all, don't we take pride in our profession?

    In our unit, I am day shift, 7 am - 7 pm, I can objectively state night shift gets a majority of trauma, brain and spinal cord, usually, depending on when the patient was completely worked up in Resus and cleared to be transported to the unit, sometimes early evening or maybe around 2,3 6 am. There is a great deal that needs to be done for this type of patient admission, as you know. I have seen days when night shift staff not only received trauma and transfers late at night, but also at the start of their shift receive scheduled post op patients, many with 8 or 10 or 14+ hours of surgery, many with profound medical issues, sketchy medical historys or with no know pre-existing medical history, or develop complications of diagnosis and/or surgery requiring aggressive multi-ICU nurse availability to support the nurse and the patient he/she is admitting/caring for.

    And yes, there are also many days, though not usually back to back..where the unit is status quo..Admissions, Discharges, Trauma and Transfer admissions just seem to flow smoothly through each receiving shft.:spin:

    Any of the above sceanarios can occur during any shift. The trick is to realize that there is no unit conspiracy to deliberately sabotage either shift by any one person. No one is that powerful. **** happens 24 hours a day.

    End of my epistle....

    Have fun..End Game RN
  3. by   jelorde37
    ive worked pms and nocs. when i worked pms i found out that i was running most of the things that the am shift didnt get to finish. when i work noc, i would run the things that the pms didnt finish as well as getting things ready for the ams.
  4. by   Sean 91
    At my previous employment at an HCA facility as a 12-hr nightshift nurse we had an ave. 8-10 patients at night (several times 12 pts) on a Med-Surg tele floor (and the night where I floated to Trauma with 11 pts) (that's HCA for you), sometimes with only 1-2 aides for a 36-pt unit, and I did so much walking I developed constant burning aching feet. I worked my tail off. (Always a few who seem to be down at the nursing station much of the time.) Often didn't get a break.

    Now working at a different facility as a dayshift nurse with 4-6 patients often with total care pts it seems just as busy. But I'd like to try nightshift here because they get no more than 6 pts each, which might be breeze compared to 8-10 ave. before.
  5. by   chibear55
    We Rotate Every 2 Weeks Between Nights And Days. No One Can Grip That Way.
  6. by   akcarmean
    I have worked both day and noc shifts
    I prefer nocs b/c you don't have to deal with the politics to much
    but I do and have worked very hard at night
    i worked in a LTC facility there were 2 nurses and 2 cna for 174 pts. talk about being busy!! you had your work to do plus help the cna with there work. I never got out of work on time and was always getting in trouble for that but what can you do. This LTC facility always put the full weekly skin assessments on the noc nurses.
  7. by   BearyPrivate
    I have worked noc shift for the past 15 years. I agree that each shift has their own duties. However, noc shift is the shift with less staff, more paper work, and Residents up all hours. I have worked at LTC facilities through all my career. Noc shift is left to basically CLEAN UP the crap that the shifts before couldn't get done. Our facility just did away with all med techs. So now day shift has 4 lpn's, 4 rn's, and 6 cna's for the 79 patients we have. Evening shift has 4 lpn's, 6 cna's. Noc shift gets 1 lpn (me) and 3-4 cna's if no one calls in. If they do call in most generally the evening shift lpn's (4 of them) just simply didn't have time to pick up a phone and call anyone. Now you tell me who is going to want to come in after 10 pm. The lpn's on days pass meds on the hall that rn's are in charge of, evening shift lpn's have to pass their own meds, charge their own floor do their own tx's and chart..
    Noc shift has to pass all meds ( scheduled and prn), charge the whole building, make sure cna's are doing what their suppose to do, fill out census sheets, calibrate accu check machine, perform any tx evening shift couldn't get to, flushing 5 g-tubes, bolus feed 3 of the 5, perform 2 trach cares, suction as many as 5-6 times on each trach, and this is just an average noc.
    Then day shift comes in and c/o having to do all this with just 4 rn's, 4 lpns and 6 cna's on the floor. It makes me sick. Sorry to all you rn's out there but just like lpn's there are the bad apples in the bunch and I think they all have jobs at the facility I work at.:chuckle
  8. by   newdawn_45
    Always get a chuckle when I hear the day shift talk about the night shift not doing anything. Speaking as a Charge for the ER we both work equally hard. We come in and usually have to hit the floor running. As the night progresses we lose all but one of the techs and a nurse or two. By morning we are worn out and have the ER down to a few rooms filled.. if my nurses are standing around when day shift comes rolling in, its because they have earned it.
  9. by   jessPICURN
    I'm not a big commentor, but I had to throw my $.02 in on this one.

    I work in a 20-bed pediatric ICU. we get everything you can imagine, and stuff you'd probably rather not. In the beginning of my career, I worked straight nights (7p-7.30a), But for the last eight months or so, I've been working a rotating shift (2 mo's days, 2mo's nights). I can honestly say, it's about the same. There are lots more people around on days, and lots of rearranging, but nights sees the "trainwreck" admits and is more frequently short staffed. On days, you can get by with asking docs and pa's- and you are much, MUCH more likely to sit in the break room for a 30-min lunch. On nights, you have your brain, your charge nurse, and your neighbor. On nights, your extremely unstable pt in multi-system organ failure is ALL YOURS. When something goes wrong, yeah, you can call the resident over to the bedside, but more frequently than not, they'll look at you like "now what do i do?" And yes, there's a fellow in-house... except he's sound asleep and really needs some caffeine to get that brain going.

    I guess what I'm saying is that days has a lot more hustle and bustle, but nights is what separates the mice from the men. it's all about finding your niche in the mix.
  10. by   NeoNurseTX
    I'm on nights and I rarely get to sit down..I'm a new nurse, but it's still very busy because we do additional stuff at night.
  11. by   SteveNNP
    Having worked both days and nights, ("Bi-shiftual") I honestly believe that at least in critical care, days and nights has equal amounts of work, it's just that on days you have rounds, many new orders, families, meals, etc taking you away from your patients. On nights you have less distractions from your work, but have less staff, less experience, rarely have NAs or secretaries. Pharmacy and Lab are running on barebones staff, the kitchen's closed, and the equipment depot is cleaned out of equipment.

    Same work, different resources.

    This topic has been discussed to death. It all comes down to nurses realizing that nursing is a 24-hour job, and that sometimes, no matter how good a shift we had, stuff didn't get done.
  12. by   Brita01
    Quote from SteveRN21
    This topic has been discussed to death. It all comes down to nurses realizing that nursing is a 24-hour job, and that sometimes, no matter how good a shift we had, stuff didn't get done.

    It's hard to believe that this thread was started way back in 2002 and people are still finding it. Not much has changed in six years, it seems.
  13. by   BayouLPN
    Quote from Brita01
    It's hard to believe that this thread was started way back in 2002 and people are still finding it. Not much has changed in six years, it seems.
    I didn't know it started that long ago. I have worked 6a-6p for a long time. I found it chaotic and grueling. Never enough time to get done what needs to be done. Now I work nights 7p-7a or 11p-7a. I like it so much better.

    Nights are not less busy. NOT in the least. Staffing is cut and alot of tasks are added because of the perceived "less work". But, it feels less chaotic to me. No back to back scheduled surgeries and sections. No md's buzzing around your head like flies. Fewer family members (esp. those with the darling children who run relays up and down the halls while squealing at the top of their lungs) and emptying the pantry and making request for themselves (you think you could get me bag of chips and a soda?, I have to be up at 5 in the morning, will you make sure I am up?) and let's not forget the students who are asking questions and looking for procedures.

    Students: Don't take offense, you are doing what you are suppose to do. Just for me personally, more people equals more noise and chaos. I wish I had a few students at night.....

    I believe each shift has it pros and cons. I, also, believe that EVERYONE should be on a team. Having worked both shifts...I know both are busy. I just find nights are less chaotic.