New to Night Shift - How will I survive??

[Nurse Beth]

Dear Going to Nights,

Congratulations on landing your first nursing job! So exciting and I hope you love it.

Night Shift is Different... and it Takes Time

Everyone is different as to how they respond to working nights and to an alternative sleep schedule. Sometimes it's hard to know if you're sleepy, dehydrated, or hungry, you just know you're out of sorts. Give yourself time to adjust.

I think it's safe to say you will either love it or hate it. Or you may have a love-hate relationship. But either way and while it's a major adjustment, there are some distinct advantages to working night shift. One is higher pay, which is great, and adds up! Another is not having to get up at 0500, and some night shifters throw out their alarm clocks altogether.

My hat is off to the night shifters- major props. They are a special group of nurses, and without them, hospitals would be sunk.

Night Shifters: Special Group Of Nurses

Night shift is a completely different environment than day shift. There's generally a closer sense of camaraderie among night shifters, which means support for you. It's a great time to build strong connections and bond with co-workers. Some people believe night shifters are a more laid-back, fun group of folks.

It's not as chaotic. There are fewer interruptions, which makes it easier for you to concentrate. Fewer visitors, administrative-types, doctors. Diagnostic tests often wait until morning, so fewer "road trips". No meals to serve.

You have more time to spend with patients, and you have time to read the chart. You will learn so much by reading History and Physicals, progress notes, test results, labs. It really helps when you are learning to see the big picture.

Early in your shift, check to see if you need anything from other departments that close for the night. Do you have a question for MRI about what time the procedure the next day will be, or the prep needed? Do you have all the meds you need for the whole shift, before most or all of the pharmacists go home? Do you need more tube feeding or flush bags from Nutrition or Materials Management? Call your doctors for any routine requests early, before they go to sleep, and check with your coworkers to see if they need that doctor as well at the same time.

Two am to four am can be the witching hours when your body slows down the most. You may experience drowsiness, you may be cold (bring a sweater). You may even have trouble talking properly. Plan your tasks before this time or after this time. Walk around the unit, do some squats or lunges if able, walk a flight of stairs, go outside to get a bracing breath of fresh air to get the blood circulating.

Many night shifters grab a quick nap during their thirty minute off the clock break, which can help tremendously. Set your phone alarm to wake you up and find out where there is an acceptable spot for you to do this. Night shift nurses have a risk of decreased vigilance on the job, which means you can make errors (Leman, 2012). Napping can help with alertness.

Mood

Sleep disturbances and fatigue can affect mood, especially for those who have a pre-existing mood disorder. You may experience anxiety or depression. See your doctor if symptoms persist.

Eating

It's easy to overeat on nights because you are out of routine, eating/snacking keeps you awake, and there's usually a lot of food available. You can also easily eat 4 meals (or more) a day- dinner with your family or at dinner time; meal break at work; morning breakfast; and lunch when you wake up.

Stress hormones can make it easier to gain weight. Try bringing your food from home. The key is to make healthy choices before you hardwire the bad habits. Some people do well grazing, or eating frequent, light meals with fresh vegetables, fruits, dried fruit and nuts. What you eat has a major effect on your energy levels and performance. Stay hydrated.

Sleeping Tips

The quality of sleep is just as important as the quantity. A solid four hours of sleep may be better for you than a fragmented eight hours of sleep. You will need to find the sleeping pattern that works for you. Some nurses fall asleep immediately when they get home (that was me). No preamble, just strip scrubs off while walking from front door towards the bedroom and fall in bed. (Unfortunately only to wake up in a couple of hours because my bladder was on day schedule). Other nurses need to transition, wind down, read, or practice a relaxing bedtime ritual.

Blackout curtains can be an excellent way to help trick you into staying asleep during the day. Sometimes the problem is falling asleep, and sometimes the problem is staying asleep. Uninterrupted sleep is better than trying to catch up on sleep, which rarely works.

White noise (get an old-fashioned box fan, not a silent fan) can be hypnotic, soothing and help drown out the neighbor's mower. Earplugs and a sleep mask can help as well.

Some people use Melatonin, an OTC sleeping aid, or Benadryl. Others use aromatherapy, such as lavender in a diffuser.

Avoid alcohol and caffeinated beverages close to bedtime. Keep your room temperature even and comfortable- on the cool side, with air conditioning if needed in the Summer.

Family and Friends

I can't count the number of times I was sympathetically told by a well-meaning person "Yes, I know just what it's like to work nights. Once I had a job where I didn't get off until eleven pm!!"

Educate them, and tell friends and family you will be sleeping during the day and to not disturb you. Oddly, some people think nothing of calling you at 1400 (translate 0200). Turn your phone off if able. Post a sign on your front door saying "Day Sleeper" for UPS.

You can feel isolated or out of step from friends and family and social events in general when you work nights. You have to plan a bit more to get together, and purpose to stay connected.

Your Days Off

Some night shift nurses sleep the same every day whether they work or not, to keep their body on a consistent schedule. That means staying awake all night at home on your night off, or shopping at Walmart at 0300. That never worked for me, but I have a hunch it's healthier for your body. You will have to decide.

Take a nap before you go back to work if you've been off. Sometimes the first night on, you operate on adrenaline and actually feel OK. Then go home in the morning and sleep for as long as you can. Try taking a short nap again if you can before you go back into work.

Your Safety

Pull over immediately when driving home if you are sleepy. Tragic accidents have happened when fatigued healthcare workers drive home after a night shift. If you commute from out of town, consider getting a motel room for your stretch of nights on if feasible. If you drive, try talking (hands-free) to someone on the way home, and try chewing gum.

The National Sleep Foundation (NSF) says that if you find yourself turning the volume of the radio way up and opening the car window in an effort to combat sleepiness....you should immediately pull over. These tactics do not work effectively and are a serious warning signal that you are too fatigued to drive.

The NSF further says:

"Cognitive impairment after approximately 18 hours awake is similar to that of someone with a blood alcohol content (BAC) of 0.05 percent. Cognitive impairment after 24 hours awake is equivalent to a blood alcohol content (BAC) of 0.10 percent, which is, higher than the legal limit in the U.S."

Please be safe, and I hope you enjoy your new job! What tips do you online night shifters have for a newbie?

References:

Gaba, D. M., & Howard, S. K. (2002). Fatigue among clinicians and the safety of patients. New England Journal of Medicine, 347(16), 1249-1255.

Lerman, S. E., Eskin, E., Flower, D. J., George, E. C., Gerson, B., Hartenbaum, N., ... & Moore-Ede, M. (2012). Fatigue risk management in the workplace. Journal of Occupational and Environmental Medicine, 54(2), 231-258.

National Sleep Foundation accessed January, 2016 https://sleepfoundation.org/sites/default/files/3-Drowsy Driving Media One Sheet-CSG-FINAL.pdf

[jouRNey8]

Thank you Ellie and kbrn!

My little one is in early grade school and my husband leaves for work very early (before I would return from night shift and before the little one wakes up for school.) Hubby then returns most nights after the little one gets out of after school (5.) I was think about getting a sitter to watch her sleep in the morning and then get her ready and bring her to school. I could pick her up from after school by would need to hire someone to watch her from between when I leave to when the hubby returns.

Another concern is just feeling like a zombie even especially with t being hard to sleep on days when the little one is off of school.

Have a day offer but for a very tough unit.

[Ellie G]

Tournerviolet I think working nights definitely messes with your immune system especially at first. It's always good to practice good health habits such as healthy eating and exercise, but I believe it's even more crucial on night shift. The vending machine can look awfully tempting at 3:00 am when you hit that lag. Better to take some fruit or veggies to work with you. Sleep is also very necessary for you to stay healthy. Don't skimp on sleep. Do whatever it takes to sleep and make it a priority.

[middleagednurse]

Thank you Ellie and kbrn!

My little one is in early grade school and my husband leaves for work very early (before I would return from night shift and before the little one wakes up for school.) Hubby then returns most nights after the little one gets out of after school (5.) I was think about getting a sitter to watch her sleep in the morning and then get her ready and bring her to school. I could pick her up from after school by would need to hire someone to watch her from between when I leave to when the hubby returns

Another concern is just feeling like a zombie even especially with t being hard to sleep on days when the little one is off of school.

Have a day offer but for a very tough unit.

Sounds dangerous and illegal

[littlelimabean01, LPN]

WOW, Nurse Beth. Wow, you really hit the nail on the head with all of your advice! I too am new to the night shift as a nurse and I implore nearly everything you said, from the box fan and recognizing when you are hungry, dehydrated or just simply tired. You gave fantastic advice and it is true too that the night shift is definitely a more relaxed crowd and we do have each others back. When the day shift comes in (especially week days) they seem so p***ed off at the world and I can not wait to leave that tense environment. Thanks for the insightful advice!

[subee, MSN, CRNA]

Put dark sun glasses on when you walk into the house and don't take them off until you are going to sleep.

[Cactus Nurse]

Oh yea, I have only seen 2 sizes of paper shades. In my bed room they slightly over lap because I need 2 but it makes it even darker lol. I actually use the white paper shades in m living room to let in my natural light. Well kinda I'm in an apartment in a dark little area, so I don't get too much sun anyways... Sucks for when I want sun but helpful for when I need to keep it out!

[Helluvanurse]

Very difficult as single parent with kids. I lasted a few months. Got sick all the time.

[labrat2nurse]

I've been working night for 6 months since starting as a new RN. I really like it-a good environment for getting up to speed as a new nurse, and less traffic in the off hours for getting errands done.

The biggest negative for me is that there isn't much interaction with the other med teams for the patient care. Sometimes there is information that I want pass on to the med team and find that I have to rely on the dayshift nurse and/ nursing notes when I rather do it by one-on- conversation.

[vintagemother, BSN, CNA, LVN, RN]

I am naturally a morning person. However, I have successfully worked nights 2-3 shifts per week regularly as a CNA and LVN.

A major hindrance for me was the fact that I had older kids at home during the day and they just couldn't be quiet enough for me to sleep. I need complete silence to be able to sleep during the day.

One time, my ex kept the kids while i slept and I was amazed that I actually slept a good 6-8 hours.

It was then I realized that the people I live with do indeed make a huge factor in my sleep when working nocs.

After I became single and attended clinicals at 3am, I learned to use black out curtains. These made a world of difference! As other posters have mentioned, I, too used a home made version of black out curtains because the ones at the store were so expensive!

I simply hung a thick blanket over my window and secured the edges with hooks do that no light could get in.

With sufficient sleep, a few nights per week is tolerable. I'm not so sure if I could work 5X8hr shifts long term nocs, but I surely could do 2-3 nocs/week.

[Adoyoelm88]

Night shifts are more straight forward than day shifts but sleeping schedules are the main problem especially if you share the house with other family members. It is easier to organize yourselves since staff are fewer than during the day and less gossips!. The only problem I have personally experienced is the rivalry between day staff and night staff. I work at a nursing home and when we report to do a night shift, we find a lot of tasks left undone by day staff as they assume that night staff just sleep during the night! This usually causes clash between night and day staff. Personally I do manage to get at least four hours of sleep as soon as I knock off work. A good breakfast prior to settling to bed will keep you a sleep and only wake up to answer call of nature. I do night shift for convenience and not because I love it.

[bgxyrnf, MSN, RN]

A few things not mentioned:

1) Resources: Generally speaking, night shift gets the short end of the stick when it comes to resources. You are much more likely to be working without support personnel that would be available on the day shift. You are also much more likely to encounter empty blanket warmers, a dearth of nutrition options, supply carts that have been picked clean, and linen carts that are empty.

You are more likely to find yourself with reduced security services, and fewer staff members around to help with unruly patients and visitors.

2) Patient characteristics: This comes from an ED perspective but you're much more likely to encounter acutely intoxicated patients and visitors on the NOC shift so keep your personal safety in mind. NOC shift in the little rural facilities can be downright frightening when you find yourself the only person with an angry tweaker, frustrated drunk, or decompensating psych patient.

You also find yourself facing some of the patients who've been waiting for many hours, often with nebulous and low acuity complaints, who I've found to be more volatile and often angry from the moment you walk in the door.

3) Safety: On the bright side of the schedule, it's generally safe to wander outside or wander the hallways to get some energy and exercise. On the dark side, though, those can be very isolated places and you are facing risks that you might not be thinking about.

4) Health: Many studies have found that night-shift workers have lower life expectancies and higher rates of cancer and heart disease. There are myriad reasons but one of the obvious that doesn't get mentioned much is vitamin D deficiency from lack of sunshine exposure.

5) Staff: Often times, night-shift is the starting point for new hires and the staff is generally less experienced, either in their profession in general or at least in the department or facility. On the positive side, you can more quickly become a unit leader and expert resource for your colleagues but you can also find yourself without solid back-ups when you need help. Note that this phenomenon applies to docs and RTs as well.

6) Turnover: Night shift can have a higher turnover than other shifts. This is a double-edged sword... on the negative side, you get used to losing people of whom you've become very fond; on the plus side, it helps foster good relationships on the other shifts as your former teammates move on.

Personally, I favor night shift, but it comes with a unique set of problems which are often poorly understood by management and therefore generally neglected.

[ms04drip]

That's awesome!!! :)