How to keep a quiet environment on the night shift

[Lobe220]

Hello everyone, so our HCAHPS score for "quietness at night" came back very low for the past couple of months on our unit. My nurse manager likes to assign different nurses to come up with plans and implement them in our unit to improve our scores and our patients' satisfaction. I was assigned to improving the quietness during the night. The only thing I have so far is a sign that pretty much says to not use cellphones in the hallway or in rooms after 9pm (something along those lines). Anyways, does anyone have any ideas, something they practice in their own unit? please let me know! Thank you!

[twinmommy+2, ADN, BSN, MSN]

I've never been tasked to solve this, but was thinking they do have something that records decibels in a room, that could be used with research as to what a more preferred noise level is.

[BecomingNursey]

We turned out the hallway lights (most of them, left enough light to see when walking) and that helped out greatly on our unit. We would shut the lights off at around 10 PM and turn them on around 6:30 AM.

[meanmaryjean, DNP, RN]

I would also suggest 'white noise' machines available to patients as well as earplugs. A certain amount of noise is going to happen just because it is a work environment and not their bedroom at home. Being proactive in addressing this, and offering noise blocking solutions would have a great impact.

[Dranger]

Of course management pawns it off to staff RNs to come up with solutions. Quietness in a hospital especially in an ICU where I work will never hit above 50-60% satisfaction level. Oh well.

[canigraduate]

1) Turn down the volume on pumps and alarms to the minimum safe level. I can't tell you how many times I've had patients be awakened by screeching alarms that day shift had turned up to the max.

2) Practice quietness during the day and night so that it gets ingrained into your unit culture. That will prevent the above from happening.

3) Turn off alarms that are not needed and set correct parameters.

4) Personal cell phones should not be in use by employees anyway except in the break room. Work cell phone conversations should be avoided unless necessary at night. Ringers should be set to the minimum safe level. When at all possible, conversations should be held in secluded areas such as a doctor's charting room, the med room, etc.

5) There should be a policy about yukking it up in the hallway. In my experience, 5/10 noise complaints are from employees being inappropriate in the hall.

6) Have a "silence the pump" rule. Anyone who passes an alarming pump needs to inform the RN immediately and get permission to silence the pump. This is a good reason to have the RN's contact info on the whiteboard. This goes for dietary, housekeeping, whoever. (PS - DO NOT touch my pump without permission. Please.)

7) Include earplugs and an eye mask in the welcome materials for an admitted patient. Sometimes people are awakened by the lights and can only complain about the noise on surveys.

8) Suggest a soundproofing initiative and bluetooth capabilities for the pumps so that they communicate directly with the nurse's desk rather than alarm at the bedside. This will never happen but will make you look good for presenting it.

[RNperdiem, RN]

There is no quick and easy fix. Some ideas do come to mind. In a monitored unit, adjusting the alarm parameters helps. When you know your patient is in afib, you can adjust the upper limit of the heart rate alarm so it does not keep alarming every time the heart rate tops 115.

Limit visitors to one at night.

Turn off the TVs for patients who are not conscious. If the patient has fallen asleep, turn it off. Why do people like blaring TVs?

Hire lots of introverts at night. Now I know this is not going to happen, but there are people who are naturally good at maintaining a quiet environment.

[canigraduate]

Turn off the TVs for patients who are not conscious. If the patient has fallen asleep, turn it off. Why do people like blaring TVs?

Ooooh, that's awesome. I hate loud TVs. I don't particularly like TV to start with, but having it shoved in my face and stabbed into my ears is torture.

[Pangea Reunited, ASN, RN]

Ambien! For everybody! Even the staff.

[canigraduate]

Pangea Reunited said:

Ambien! For everybody! Even the staff.

Except little old ladies. It turns them into:

[MendedHeart]

^^This. Hahaha.

The quiet at night scores are low across the country. We, too, are working on this. Along with all the other great responses, we are not doing Hourly rounding between the 2200-0600. Instead, we do Q2 hour rounding.

You could try and look into your units specific causes by doing a Lean project. If your employer offers this class, it's a great resource. This website below touches on it, but I would find a more in depth resource if trying to really understand how to do it. In a nutshell it is:

- Identify waste

- Make a plan to eliminate it

-Implement

-Evaluate/modify if needed

-Sustain

Lean For Dummies Cheat Sheet - For Dummies

And found this:

Lean tools and concepts reduce waste, improve efficiency - American Nurse Today

[singwithme123]

When I was in the hospital after giving birth to my son, I was initially in a room next to the nurse's station. The noise coming form hospital staff visiting with each other at the nurse's station in the middle of the night was AWFUL! (This was not noise from official business. This was laughing and talking..) I had to asked to be moved to a room away from the station. So I guess my biggest suggestion would be to keep quiet in the nurse's station!