How to Maximize Efficiency During the NOC Shift

**Wendy Sutas**, BSN, RN

Healthcare is a 24/7 industry and requires overnight NOC nurses to care for patients. Nocturnal, or NOC for short, refers to the night shift. When nurses choose to work the night shift, they know it comes with its own set of challenges and rewards.

This article provides information on NOC shifts, including finances, pros and cons, and scheduling strategies to make it work for you.

Table of Contents

Overview
Night-Shift Pay
Patient Differences
Schedule for Surviving

Night-Shift Overview

The night shift, nicknamed the graveyard shift, typically goes from 7:00 pm to 7:00 am for 12-hour shifts. Some healthcare facilities still use 8-hour shifts; in that case, the 11:00 pm to 7:00 am shift qualifies as nights. In the U.S., employers commonly hire nurses for one permanent shift, while in some other countries, they schedule rotating days and nights.

NOC shifts exist anywhere with 24/7 patient care. To search available nursing jobs, including CNA and LPN positions, try company websites and online job boards, create job alerts, or network with people you know. Narrowing your search to your area will give you a better understanding of your options. Specialty night positions exist more frequently at larger medical centers than at smaller ones.

Some possibilities for NOC shift careers include:

Long-term care facilities, acute rehab, skilled nursing facilities, or nursing homes
Acute inpatient units in hospitals
Operating room nurses
Emergency department nurses
Psychiatric and inpatient behavioral health units
Rapid response teams
Nursing house supervisors
On-call hospice or home health nurses
Private duty nurses, CNAs, and LPNs
Agency, per diem, and travel nurses

How Much More Money Do You Make on the NOC Shift?

Undoubtedly, financial incentives influence many nurses to try the night shift. Pay rates vary by institution, specialty, and state, but night nurses can expect a bigger paycheck than their day-shift counterparts.

Employers commonly offer night shift differentials equal to an additional 10-20% of a registered nurse's base pay. Nurses can make significant extra money over a year when adding the possibility of weekend differentials, overtime pay, and potential sign-on bonuses.

Pros of Working the Night Shift

Potlucks are one of the unexpected benefits of working the night shift. Nurses find many reasons to celebrate with their co-workers. It is not unusual to celebrate every birthday, engagement, wedding, and birth or a simple Friday night by bringing food for each other.
Night shift nurses work closely with each other and often build strong working relationships.

Additionally, the night shift tends to provide a quieter atmosphere, leaving the hustle and bustle of the day shift behind. There are typically fewer people around at night, and you will encounter far fewer ancillary staff, doctors, occupational therapists or physiotherapists, unit clerks, administrative staff, and visitors.

You may experience more autonomy and have additional time for your patients. Fewer procedures and discharges at night mean nurses can use their downtime to catch up on charting or pursue educational activities like e-learning. Since other support staff can be minimal, tasking night nurses with emptying linen, restocking supplies, checking crash carts, or administrative duties is common.

Nurses often accept NOC shift positions to gain valuable skills and experience in a highly sought-after specialty. Other nurses find the hours work well for child care and personal obligations, while natural night owls tend to gravitate to this shift.

Cons of Working the NOC Shift

Many nurses experience ups and downs as they adjust to the night shift. Natural circadian rhythms make it biologically challenging to stay awake through the night and sleep during the day. Readjusting to standard sleep patterns on your days off can take time and effort.
This constant flip-flopping can take its toll on a nurse's physical and mental health, putting them at higher risk for the following:

Insomnia
Cardiovascular disease
Weight gain
Metabolic disorders
Diabetes
Mood changes, depression
Burnout
Increased alcohol consumption
Tiredness and fatigue
Anxiety
Drowsy driving

Having fewer people at night can also be a con. When more experienced nurses decide to transition to open day shift positions, it can leave the night shift with less experienced staff. A shortage of seasoned nurses can lead to increased errors by newer nurses and adversely affect patient outcomes. As you can expect, this can elevate the NOC nurse's anxiety, create patient safety concerns, and decrease job satisfaction.

The night shift can also wreak havoc on your social life. Missing important events with family and friends is a common concern. Explaining to people that your day is the same as their night can be tricky. Even on days off, feeling like you are jet lagged is not uncommon.

Patient Differences on the Night Shift

Patient differences on the NOC shift largely depend on your unit, floor, and workplace environment. Although it can be quieter, there is plenty of work to keep busy. Patient care is relative to the population you are caring for, and routines will be in place to accomplish that successfully. While some patients will be sleeping and place fewer requests on their nurse, care is still necessary, including scheduled medications, monitoring of vital signs, and position changes. Critical care units can be as busy as the day shift when unstable patients require emergent surgeries, procedures, and interventions.

It is difficult to generalize what to expect of your patients on the night shift because patient population and acuity vary greatly. For example, a 3-month-old pediatric ICU patient will have vastly different needs than a home hospice patient or an elderly dementia patient in a nursing home.

Schedule for Surviving the Night Shift

Creating the perfect work schedule to survive the NOC shift often depends on the individual; it takes trial and error and changes over time. Furthermore, nurses should consider whether they work full-time, part-time, per diem or on-call shifts.

Some work environments use self-scheduling but require mandatory weekend or holiday shifts.

With all this to consider, sometimes, it is nice to ask other experienced nurses what has worked for them.

Clumping your three 12-hour shifts together gives you more days off between shifts. For some nurses, including parents, splitting shifts with one day in between might be a better option.

Naps may be your best friend when sleeping during the day. Some nurses find that taking a three to four-hour nap before they go to work helps them adjust to that first shift. Likewise, keeping yourself up and sleeping only a few hours on your first morning off can help you feel tired when going to bed at night.

For example, if you work three shifts on Monday, Tuesday, and Wednesday, you could nap Monday afternoon from 1:00 pm to 4:00 pm. On Wednesday morning, you can sleep from 9:00 am to 1:00 pm or stay awake after work and sleep from 12:00 pm to 4:00 pm. Then Wednesday night, you could go to sleep at night.

Listen to your body. Be mindful of your caffeine intake and food choices. Enjoy indulging in some self-care because adjusting to the NOC shift becomes a lifestyle. Some nurses adjust well to the night shift for years, and others may find there comes a time when their bodies and minds can no longer adapt.

Despite the challenges, the NOC shift remains a welcome opportunity for many nurses during their careers.

STAFF NOTE: Original Community Post

This article was created in response to a community post. The comments and responses have been left intact as they may be helpful. Here's the original post:

Quote

Regarding shifts, what does NOC stand for?

References

Ejebu, O. Z., Dall'Ora, C., & Griffiths, P. (2021). Nurses' experiences and preferences around shift patterns: A scoping review. PLOS one, 16(8), e0256300. https://doi.org/10.1371/journal.pone.0256300
Office of Human Resources Management. (2020, September 10). Night shift differential. U.S. Department of Commerce. https://www.commerce.gov/hr/practitioners/compensation-policies/premium-pay/federal-wage-system-fws-employees
Boivin, D. B., Boudreau, P., & Kosmadopoulos, A. (2022). Disturbance of the circadian system in shift work and its health impact. Journal of Biological Rhythms, 37(1), 3-28. https://doi.org/10.1177/07487304211064218
Kang, H., Lee, M., & Jang, S. J. (2020). The impact of social jetlag on sleep quality among nurses: A cross-sectional survey. International Journal of Environmental Research and Public Health, 18(1), 47. https://doi.org/10.3390/ijerph18010047
Chellappa, S. L., Qian, J., Vujovic, N., Morris, C. J., Nedeltcheva, A., Nguyen, H., Rahman, N., Heng, S. W., Kelly, L., Kerlin-Monteiro, K., Srivastav, S., Wang, W., Aeschbach, D., Czeisler, C. A., Shea, S. A., Adler, G. K., Garaulet, M., & Scheer, F. A. J. L. (2021). Daytime eating prevents internal circadian misalignment and glucose intolerance at night work. Science advances, 7(49), eabg9910. https://doi.org/10.1126/sciadv.abg9910