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

[Alex_RN, BSN]

If you normally take a diuretic first thing in the morning, you will need to reschedule it when you are working NOC. You will not want to take it right before you try to sleep.

[Nurse Beth, MSN]

Great tips!

[JeanneRN83, BSN]

Nurse Beth, really, really good article and response to the question of working night shift! I have worked night shift for many years during my 33 year career. Had some daytime jobs also but only for jobs that were strictly days only, such as a research nurse coordinator and an anticoagulation RN job. Always have worked nights though for hospital bedside patient care jobs. Currently working night shift in the ED.

To Going to Nights, congratulations on your first job!

My biggest recommendation is to give yourself time to adjust and try not to be panicked if initially you feel like your body is not liking it too much. It does take a little time to adjust to the night time schedule and to discern what works best for you. All the things that Nurse Beth mentioned... for instance, is it better for you to go to bed right away after a night shift or do you need time to wind down.

My second recommendation is SLEEP. Do not short yourself on sleep which I think can be easy to do. Make sure that sleep is a priority, including having enough hours to sleep, a good sleep environment, no disruptions. The more rested you are, the easier working your night shift will be. Short yourself on sleep and you will not be happy physically or emotionally and also makes for potential for errors when you are way too tired.

For 12 hour night shifts, I try to make it a rule for myself to not being doing errands or major chores between consecutive shifts, ie, no major grocery shopping in the am after working, no trying to do laundry or getting together with friends for an early dinner before work. With consecutive night shifts, for me, it is easier to work, sleep and eat and a little time for meditation or relaxing before sleeping and that's it. I find that I can then be rested enough on nights that I am working and also rested enough on my days off to get my errands and stuff done when I am not working.

I am also one that tends to stay on a night schedule on my days off. Not always totally. If I just worked a 12 hr night, let's say Sun into Mon for example, and I am not working again Mon night, I'll go to sleep later in the am after work, around 11 am. Then wake up around 8 pm Mon eve, stay up to 2 or 3 am, go back to bed and get up around 10 am Tues am. If I am then working that night, Tues into Wed, I'll take a nap from 2 or 3 pm until 5 pm before going to work. If I am not working that Tues night, then I'll stay up until 10 pm and then go to bed. Listen to your body and when it's tired and it will tell you what to do. Initially, it may feel like you want to sleep all the time. I think that is just your body saying, "Hey, what's going on here??". So initially, you may need more sleep but after a few months, you'll settle into a routine. Everyone is different, it may take just a month, it make take 2 or 3 months or more. There are definitely a few people that just do not tolerate night shift but I think if you are able to get proper sleep, you will adjust just fine.

The other thing that I would highly recommend is absolutely do NOT keep your cell phone at the bedside or even in the bedroom. Let your family and friends know that you are now working night shifts and that you will not be keeping your cell phone at the bedside and that the ringer will be off so that you can get some decent sleep. If there is an absolute emergency that they need to wake you, tell them that they will have to come by the house and knock on the door. If you have out of town family, give them the name and phone number of a few neighbors they can contact if they need to get a hold of you emergently and your neighbors can knock on your door to wake you and notify you. I cannot stress this enough. In this age of cell phones, texting and immediate communication, we often take away the time that we need for ourselves to sleep and rest. I used to keep my cell phone at the bedside but would wake up when someone texted or called, even if the phone was on vibrate. Trust me, it's not worth it. If it is not an emergency, it can wait for people to contact you. If your employer tries to contact you and later complains that they couldn't get a hold of you, just let them know that this is what you need to do to get enough undisturbed sleep to provide the absolute best patient care.

Those are my biggest recommendations. Many more wonderful suggestions have been made by others, including making sure you are including exercise on your days off and also bringing your own food to work with enough healthy snacks to munch on throughout the night. I make sure I have at least one protein bar available in case I'm not able to get to a lunch break at the time I'd like to go to lunch. Small easy snacks, like nut mixes are good to have in your locker. Oh, and definitely invest in a covered water bottle. Most hospitals are ok with covered water bottles at the nurses station. Stay hydrated throughout the shift.

There are many, many positive benefits to working nights that have already been mentioned. I have definitely found that night shift has a more cohesive staff and generally more supportive of each other. I would not say it is necessarily a "quieter" shift but it's a different flavor when you do not have many visitors, no meals to serve and no consult doctors and ancillary services like PT/OT.

I'm very excited for you that you are starting your first job and wish you many happy years of nursing!

[NGYSUN, BSN, MSN, RN]

I had a boss who used to call me around 1300 to see if I'd be willing to come in at 1500 and work a double. She invariably would start the conversation with: "Whatcha doing?". "Sleeping", I'd say. "Must be nice to sleep all day", she'd say. Well, that got old in a hurry. I broke her of it by blowing up at her on the phone when she'd done one time too many. I used every cuss word I knew, and coming from a military family, my vocabulary is both vast and varied. She couldn't get off the phone quick enough.

The next time I saw her, I gave her my usual greeting and a smile. She said she needed to talk to me about what I said during the phone call. "What phone call?", I said, "I didn't get any phone calls. I slept all day without anybody bothering me. And I surely didn't talk to you; I'd have remembered."

I got away with it! No more daytime phone calls, either.

Hahahahahaha...... I couldn't stop laughing about this [emoji23][emoji23][emoji23][emoji23][emoji23][emoji23][emoji23]

[Dafabb, LPN]

Brilliant:roflmao:

[Dafabb, LPN]

Many of the nurses who come in sick like that will wear a mask (if you can tolerate it). If you do get to that point yo should always take off as it is your health effected....Not many people have this unnatural immune system. I have been blessed and fortunate to be that %. Gone thru entire floor getting sick for one thing or another. No allergies/cold/flu/or flu shots......It's hard when your co workers start getting sick....but it's a hospital.

[Raven Sierra, BSN, RN]

I'm naturally a night person and am rather uncivil if I have to wake before the sunrise, so I work night shift. It took trial and error to figure out the sleep schedule.

My system: If I work one night but not the next, I take a nap before my shift and then sleep about 5 hours after I get home. So I get up in the early afternoon, visit with my family, then go to bed at 10pm or so. If I'm working two or three nights in a row, I do nothing but sleep between shifts, trying to get as much sleep as possible. Then, on the last night, I do my sleep 5 hours then sleep at 10 routine. I have found that I can function well this way.

I also take vitamin C and D.

[SnuSnu82]

Anyone with young kids who work nights? I was offered a night position but don't know if I can keep up.

I have an 18 month old, been working night shift for 3 years... and am currently seeking a day position.

NIGHT SHIFT WITH A KIDDO:

the pros: I am home (sleeping) if there is a day-care emergency and can be there if needed; I don't feel guilty about missing out on too much time with my kiddo when I'm at work because he is asleep; I am able to run an errand or two, kid-free, before heading home to sleep bc he is at day care; my SO and I have opposite schedules so we only need three days a week of day care, and someone is always home in case of emergency.

cons: on my days off I am exhausted from switching from a night schedule to a day schedule in order to spend time with family- sometimes so exhausted, especially the first day after working, that i feel like i'm phoning it in with my kid and not being much of a mom; I am often rushing through the precious little time I have with my family on nights I work to be able to get ready and leave for my shift; NOBODY "gets" my schedule (especially my family! and I've been on nights for 3 years! Just reverse the times people- would you like being called at midnight? No? Don't call a nightshifter at noon then!); Holidays start and end at midnight so if you "work" Thanksgiving, you only get holiday pay from 1900-2359, nevermind you spent the whole day sleeping and missed the holiday anyway (at least this is true at my hospital- HOWEVER the reverse of this is true- work the night before Thanksgiving, get holiday pay from 0000-0700, and take a nap so you can celebrate). What I'm trying to say is, you may be required to work holidays and miss out on family time, but may not necessarily be compensated for it like a day shift person would.

Anywho, sorry for the extended post but just some things to think about, hope this helps! I love love love the rhythm of night shift- its generally more laid back and since there's a higher nurse to patient ratio and less staff, the teamwork seems to be better (maybe that's just the units I've been on though) HOWEVER with the kiddo in the mix, I am exhausted, and need the switch.

[Barbr93]

It does take time. You can do it. Caffeine at night, but I didn't usually drink any after 3am... Normally your patients are settled in and require less than day shift. With that said, all of my emergent situations usually happened right before shift change... ( why is that?! )

If you have to call a Dr at night...have everything ready and all questions/ requests down. You don't want to call a second time because you left something out. ������������

Melatonin helped with sleep during the day.

Get blackout blinds. You can find the inexpensive ones at Lowe's and Home Depot.

Let family and friends know not to call or text u during the day when you are sleeping. They forget sometimes. You will have to adjust your social schedule, and it will be harder if you have kids, but can be done.

[InScrubs_Wyoming307]

I've been working nights for 25 years now. I love it. And this article is wrong, we can't throw out our alarm clocks lol -we still have to get up for work! I only sleep 3 or 4 hours a day between my 12 hr shifts, but those 4 nights off are worth it to me. It was great working nights when my kids were growing up because at that time I was working 8's and working for an agency so I was able to make it to all my kids activities and not have to pay for daycare. Nightshifters aren't some walking anomalie, we are regular ppl in good health just living our lives who happen to be able to awake when most can't be. It's ok. I'm so happy to be able to be part of the patients 24 Care Team!