what goes on/your floor during night shift?

CaLLaCoDe, BSN, RN · Jan 23, 2007

Things I typically see at night on telemetry:

1. Pts with sundowners/confused yelling out sometimes all night; restraints following an attempt to get out of bed or falling and adivan haldol given prn.

2. Codes can sometimes come in threes which can prove to be very taxing, since your having to deal with the code situation and not able to keep tabs on all of your patients at that time.

3. Nurses doing chart reviews; checking the MARS.

4. Some nights can be really busy with blood pressure issues, frequent pain med requests and admitting new patients to the floor with orders to be entered into the system and to be followed.

5. Concern for a patient that is crashing and moves to send the patient to ICU.

5. Not a lot of time for play...which the day shift may not understand.

catlover13 · Jan 23, 2007

Hi,

I don't have extensive experience, but this was my experience.

While a nursing student, I worked as a CNA in our hospital's rehab unit, nite shift 2300-0730.

I loved it!!! Both the unit and the shift.

Our nurses had between 5 and 7 pts. Most rehab pts are stable, post actue, although this is always subject to change.

Pt dx were many and varied, stroke, drug overdose, spinal laminectomy, guilliane barre, MS exacerbations, double knee replacement, SCI, para, quads, brain injury, too many to name.

I was able to observe and work with the nurses, my take on their abilities for this shift:

Overall if the nurse wished, there was time for total patient care, from bed bath, to meds to tx.

Usually there was enough time, if the pt had the need, for detailed unhurried discussions ranging on any and all topics that were of patient interest.

Most times charting could be completed by the end/or shortly after the shift ended.

Now, dont' get me wrong, just in the time I was there, @ 2 nites a week, we had 2 codes, although post acute, many of the pts were high risk for other probs, or repeat probs.....and of course, any sense of normalcy would be shot in these instances.

But for the most part, by the time things started hopping the floor for the day shift, replacements were in, therapists were beginning their interactions with the pts, and it was time to go home!!!

And unless it was an emergent or emergency, things that were of concern during the night were passed along to days....(major concerns were dealt with at night)

I would look for rehab as my 1st choice for placement!!!

Hope this makes sense!!!

CriticalCareLucy · Jan 23, 2007

:monkeydance: Hi! I started out in CTICU in #1 heart ctr in America 7 years ago. I too have been doing nights ever since..don't regret a thing! Yes, very difficult and LOTS to learn...but I was determined and successed very well! You do/should start out on days..most experience comes for day shift with admitting OR cases/swans/invasive line/chest tubes/etc. That way you have good knowledge of all those procedures. That way if you have to do this on night shift you will feel some comfort/knowledge about it....at least for a good 6 months or so! Stick it out and you will be glad you did!! I love nights! You will too!

JessicRN · Jan 23, 2007

Unless you are planning on staying a "baby nurse" ( not sure if that is the nursery or NICU) the rest of your carreer I do not recommend it. You need a floor that you can work with sick babies and sick adults to learn medicine. Pediatrics and especially NICU is extremely specialized pediatrics are not little adults so everything you learned about pediatrics you will have to relearn in Adults. As a new grad it would be very diffficult to transition to adults without extensive retraining.

As for night shift it depends on the unit. in the ICU the care is unchanged. In the OR there is rarely night OR except on call. Some people believe the pace is slower (not where I work) but for us night people the best part is there is more autonomy. You do not have a nurse manager breathing down your neck or medical director or attendings. I feel your assessment skills are better honed because it is usually you who sees a difference in a pt before the doctor. There is usually less staff and as the night nurse you do all the work the day shift left behind and again depending on the unit and the staff can be extensive. Nights is not for everyone, no you do not get to sleep all night. Sometimes there is more downtime and other times there is none. Staying up all night and remaining alert and sleeping all day is tough to adapt to and for some it is impossible.

Good luck in whatever unit or whichever shift you choose

AliRae · Jan 23, 2007

I do both- I'm mainly a day person, but I can get floated to nights up to half my time. I work in the PICU, and I agree that the pace is, for the most part, unchanged. The sicker the kid, the harder you'll work. The more well kids will be sleeping more, so that gives you a bit of a break.

I'd agree that starting out on days is maybe your best bet though. There are lots more people around, for one thing. If the poo hits the ceiling, there are about twice as many people around to help you scrape it off. (Figuratively speaking, one would hope...) Round are much more comprehensive during the day, with newer residents and lots of students being taught things- I learn lots during rounds. Nighttime can be a little frightening - the "When do I break down and call the doc about this?" dilemma in your head can get taxing. But I love doing both. Nights do, overall, tend to be a little quieter. It's just that, when they're not, it's worse than when days are busy.

(Also, if working nights, find a basement to sleep in. That total darkness works wonders for your system.)

meownsmile, BSN, RN · Jan 23, 2007

From what ive seen a lot of the routine care that normally goes on during the day throughout the hospital is done on nights in ICU. The patients are bathed and beds changed because of less family around. Days on ICU are spent with tests, xrays etc and family visiting in between. So i dont know that nights in an ICU would be any less stressful than days except maybe the doctors arent quite as close.

I get floated to ICU occasionally from med/surg. I like med/surg because i like patients who are a bit less "critical" and are more able to communicate. Frequently we get patients as they progress and are moved out of ICU anyway. If they keep a surgical floor truely a surgical floor and use extra beds for medical overflow it isnt to bad. But i do agree that sometimes if the surgery schedule is low you tend to get some patients that really dont need to be on that floor.

kcalohagirl · Jan 24, 2007

I think by "baby nurse" she meant as a new grad. I know that's what we were affectionatley (I hope) called by the DON during nursing orientation.

I love night shift, and I work on a surgical tele floor at a big university medical center. Because of the nature of my unit (we see mainly s/p CABG, valve replacements, thoracotomies) we rarely see admits at night unless it is an emergency and there are no other beds anywhere else in the hospital. We've had 2 so far tonight. We do chart checks, audits, MAR checks, the kind of paperwork you don't see done as often during the day. I also think we stretch our critical thinking skills a bit, since we don't have as many people to rely on for help/answers. Our medical staff isn't in-house at night, so we try to call them for only true "emergencies." Although staff is fabulous, and has never even been the least bit huffy w/ me when they get the 2 am phone call. Our attendings are awesome!

Occasionally things can go completely and utterly to heck. That's when you thank god for your co-workers, the rapid response team, the IV team, etc.

I'm really fortunate it where I work!

htrn · Jan 24, 2007

I love night shift!!! I was hired right out of college to OB/PP/NBN on a day/noc rotation in a 500 delivery a year hospital. I did my first 6 months of orientation on day shift only. There were more people around, more opportunities to see things, talk to doctors, get help if and when I needed it, etc... I did the last six months (yes, we have a full year of orientation for new grads) on nocs, my request to go to straight nocs.

There are many nocs that we are very slow, but there are many nocs that we don't even have time to pee. You have to have good assessment skills, know when to call the doc and when it is OK to let things ride. You learn to develop a good repor with ancillary staff (RT/lab/radiology/nsg supervisor) and learn what a God send a good CNA is. Lots of autonomy, but with good back-up in my situation.

Takes a bit of finnegaling to get the sleeping thing down. Ear plugs, unplugged phones, eye masks or light blocking shades, etc... Try to sleep to a schedule, all that other good stuff.

What ever you do, good luck and enjoy!!!

ICU_floater · Jan 24, 2007

night shift for a new grad, in my opinion is the best and worst,

best- decreased stimuli, not acuity, I'm an ICU nurse, their sick 24/7, nothing changes except less people vying for your pt. less visitation so you've more time to fine hone your skills and not be pulled in so many directions. my facility is all attendings, non teaching... this is different in a teaching hospital. There you have inexpeienced MD's who need constant monitoring themselves and as a new grad,you lack the brass ones to stand up, and the knowledge to know when and where to stand. Non teaching, no one wants to be called at night, but you do anyway, are refused, call back, argue for the pt. call, treat... call... diplomacy and the concicse way of telling your story is a must. Pt. bathed, check the chart and med record.... much paperwork, labs, transfers and admissions.

Day-more meds given during the day and more docs, visitors, PT, OT, social work, swallowing eval. ect. you can't get to your chart! Family is in all the time, plus or minus, you can extend teaching or just do service recovery and spend more time treating the family than the patient..... hippa more volitile here as the neighbors show up with their sick kids and your learning customer service talking your patient out of that one, while not saying a word. Line changes , CT scans, MRI's... this is not cool, you just keep transporting the pt. from test to test and pray they don't code.

Night shift is the same as days, only you have quieter times, but spend more time critically thinking what are we missing and formulate your wish list for days to accaomplish.

I feel after almost 12 years in ICU that all new nurses need 1 year on days, then, when you have you lack of resources, your experienced and don't need a doc t the bedside to guide you.

Elvish, BSN, DNP, RN, NP · Jan 24, 2007

I work nights. I started out nights, went to days, and now (at a different job) am back to nights. As a new nurse, I felt that nights were right for me to get my head together (I started out on a gen. surgery floor). There weren't as many docs, family, lab, PT, OT, etc. etc. pulling me every which way. I could figure out what I was doing at a little slower pace.

That said, it seems to me that if patients are going to crump, they choose to do it on nights. What's good about nights is also bad about nights. You don't have as much backup. I personally think a little of both is good for a new grad; it helps you get an idea of what each shift does.

Wishing you all the best!

TAPANGA · Jan 26, 2007

I work nights 7p-7a on a LTC pedi floor, I have 14-16 kids, they all have a

g-tube or j-tube, some bolus or some continous.......most have trachs. some nights go pretty smooth other nights you don't have time to go to the bathroom ( forget about eating). We do have a supervisor in house most nights if you need an extra hand if you have more than one kid go bad . I love nights. I have been doing 12hour shifts (Baylor) for 2 years now and wouldn't change a thing. Good luck in what ever you choose.