Night shift in LTC/Skilled Nursing

  1. Hello, I am a relatively new grad RN with several months experience in acute care as a RN and 2.5 years experience as a CNA in memory care prior to becoming an nurse. Long story short...I took a swing at hospital nursing and found that it wasnt a good fit for me and I wasn't very happy so now I'm looking for something different.

    I've been offered a part-time night shift position in a local nursing facility that is minutes from my house and I am very much considering taking the offer. I am very nervous, though, about the high nurseatient ratios (in this case approx 1:40-42) on night shift and about the fact that I've never worked nights before either. I am kind of hoping that my experience as a CNA will help me adjust a little to LTC nursing...but I'm just not sure...

    I have a few questions for you guys who have loads more experience with this than I do:

    1) What, typically, are nursing responsibilities when working night shift and how does your shift typically run?

    2) Is this a normal nurseatient ratio for a night shift and how do you handle these high ratios? I knew it would be much higher than it is on days and evenings but I don't know if this is "normal".

    Any tips or advice would be much appreciated as well!
  2. Visit kRN0512 profile page

    About kRN0512

    Joined: Sep '12; Posts: 20; Likes: 5
    RN; from US


  3. by   kRN0512
    Darn! sorry about the emoticons...I'm not really sure why they decided to pop up.
  4. by   CapeCodMermaid
    That is a pretty standard nurse to patient ratio on an 11-7 shift unless you have a true subacute unit.
    Mostly the night nurses are responsible to keep the residents safe if they wake up and lots of paperwork. I discourage any medications or treatments on the night shift because people are supposed to sleep.
  5. by   TheCommuter
    When I worked night shift at a nursing home (10pm to 6am), I had 68 residents and cared for them with the help of three CNAs. It's not as if you're going to be doing head-to-toe assessments on them.

    You'll round on them every once in a while to ensure they're breathing, respond to requests for PRN medications, change out the tubing for the feeding tube sets, restock the med carts, pass a few scheduled medications at midnight and 6:00am, file paperwork, and complete other miscellaneous tasks.
  6. by   kRN0512
    Thank you so much for your replies! I feel like I have a better idea now of what to expect. I am actually really looking forward to getting started and "getting in the groove". I used to think during school "I'm never going to work in LTC as a nurse!" but I have to admit I've kind of missed it since I've been in the hospital the past few months
  7. by   AngelRN27
    I have been working at my current LTC facility as an RN for 6 months. I was just moved to the 11-7 shift approx. 3 weeks ago. The nurse-patient ratio you mentioned in the OP seems standard for this shift.

    Night shift "responsibilities" are pretty much as mentioned above. A few meds at 12am (usually just a couple of nebulizer treatments) and then a relatively small med pass at 6am (mostly Omeprazole and Synthroid). In between you have miscellaneous paper work as well as chart checks which require a meticulous eye and a good knowledge of your facility's protocols/procedures, which will come with time and practice. Other miscellaneous tasks include hanging new piston syringes for feeders, changing feeds as necessary, cleaning/organizing/re-stocking med carts, possibly making the morning shift's assignment (depending on your facility), checking resident appts for the following day, refilling any low meds or narcs, etc.

    You'll be fine, good luck!
  8. by   lcuster
    At my facility the above is true. However the 11-7 shift also has to do upkeep on all oxygen concentrators, clean out and maintain any resident refrigerators, and lets not forget end of month turnover on MARS and TARS. Chart checks really are the most important nightly paperwork you will do. That process catches the mistakes and oversights that may occur on other shifts. Patient orders can get pretty screwed up if thats not done right. You'll be fine. Some nights the boredom is worse than the work.
  9. by   Forever Sunshine
    11-7 you may very well be the only nurse on the unit. You said you had previous experience so you should be ok. I had only 5 mos part time experience before doing 11-7... I was fine.

    Its a nice shift .. of course there will be nights when it all falls off the walls but for the most part.. .most patients do sleep. Theres always a couple residents up late, always residents who ask for a prn tylenol, mylanta, pain pill etc.

    Theres tons of checks to do as mentioned above, plus charting. Occasionally you'll get a resident who has a change in status and needs to go to the hospital.
  10. by   amoLucia
    Y'all forgot glucometer checks, crash cart checks, refrigerator checks, etc checks. And some nite shifts do the morning fingersticks and insulin injections (it all depends on the facility).

    As a CNA, you should remember how much a nuisance those residents' safety alarms were, but you need to be ever vigilant about them, esp if there's a fall to be investigated. Alarms and siderails...

    You'lll start and end your shift with a narcotic count and if there's any one piece of advice that we 'seniors' can give newbies is to take your responsibility for that narc count absolutely SERIOUSLY. So many nurses get in trouble for poor counts just because of inattention or because you "trust" the other nurse. DO NOT accept the count unless you're positively sure the count is correct. If there's a discrepancy, it's all yours. NOBODY is going to listen when you say 'you didn't give any percosets'. It was your count and you're it!!! Also, never give your keys over to someone if you leave the floor and never ever just leave them laying on the cart.
  11. by   Blackcat99
    At my LTC facility, you can always count on the pharmacy showing up at the worst time in the mornings, usually when you are trying to do your 6am meds.
  12. by   kRN0512
    Thanks for all the replies! The way the facility is split I will be the only RN on my side which is definitely a little scary! But I'm sure I'll get into the swing of things and it will become routine. The biggest problem I have is being patient with myself when it comes to learning new things....ugh

    So what about getting used to night shift in general? How long do you guys feel it takes to get into the whole night shift mentality? I'm hoping it won't be too terrible because I'll be only part time but I honestly don't know how easy/difficult the adjustment will be for me.
  13. by   Blackcat99
    If you are the only RN, the lab will be asking you in the mornings to get the blood specimens from all of the patients who have PICC lines. Make sure you get plenty of sleep before you come to work. You may need a little benadryl 25mg when you get home to help you fall asleep. Good luck. Night shift is the best shift in LTC in my humble opinion.
  14. by   amoLucia
    Quote from Blackcat99
    If you are the only RN, the lab will be asking you in the mornings to get the blood specimens from all of the patients who have PICC lines. Make sure you get plenty of sleep before you come to work. You may need a little benadryl 25mg when you get home to help you fall asleep. Good luck. Night shift is the best shift in LTC in my humble opinion.
    Good point, Blackcat99. If OP is the only RN, she may also be called off her floor to assess/monitor any crises, particularly resident falls before they can get up.

    Also, she may be responsible for any IV needs on other units depending on IV cert status of the other nurses, esp agency nurses who may or may not be permitted to do IVs per facility policy. Pyxis access is usually prohibited for agency and nurses without privileges yet (assuming they use pyxis).

    Usually, an experienced nurse (someebody who knows who to call, who NOT to bother, when to call, etc) handles the callout phonecalls and staffing replacements, but this may fall to her also.

    To OP - another BIG TIME piece of advice. Rely on your CNAs for advice. Respect them for their input and absolutely followup on their concerns/observations. I speak from experience when I say that I know of residents' lives that were saved because the CNAs gave me critical info FAST.

    I've been working 30+ years, yet I always pick upsomething new. It's taken me all these many years to 'see the big picture' for my routines. It's always a learning process and one that changes as nec.