New NP feeling discouraged...

Trauma Columnist · Oct 3, 2008

Are you covering a hospitalist service? How much orientation are you getting? Do you have some nursing exp in this area to fall back on?

We have a level one trauma center in the area that is offering $10k bonus for two year night committment and they have had the ad in the paper for a long time.

Sorry you are so stressed....

Joan Z · Oct 3, 2008

I have to say, I worked nights as an RN for 8 years and never got used to them... one of the big perks of going into family practice was that nights was not an issue!

Eventually, you will adapt, in the meantime you need to take care of yourself--SLEEP when you get home, take melatonin or whatever, get some room-darkening shades, get a relaxing sound machine! Don't try to go nights to days on your off days, it will make you nuts--you don't have to stay up nights, but don't try to switch completely.

I can't imagine how it would be to have to learn the new job AND learn nights--my heart goes out to you! Just stay with it, it will happen.

christvs, DNP, RN, NP · Oct 3, 2008

Yes, it is a hospitalist position. I worked as an RN in med/surg/tele for 3 years before I became an NP. My main problem is that I feel so nervous covering ALL those 50 patients myself. Plus when the nurses call me about pt issues, I barely know anything about the pts since we just cover them at night. And I have to make decisions while not really knowing the pts. I don't think it is a good situation. My orientation was just one month. I am seriously thinking of looking elsewhere. But I am feeling so down because I really like hospital medicine...however I think if I worked days it would be completely different because not only would it be more tolerable hours, but the role of the hospitalist during the day is so different from that of night; they have 8-10 pts during the daytime and actually get to really know the pts. That is what I wish I were doing.

Trauma Columnist · Oct 3, 2008

Can you ask for more orientation? I worked nights for many years too and I agree with above poster that you need to ensure you are getting plenty of quality sleep. For me, the exhaustion clouded everything...I couldn't have made a good decision to save me. Do you have a committment to this hospital? Can you orient on days for another month so that you can at least get the flow of the patients down?

I wish you the best. Life is too short to stay miserable.

Advanced Practice Columnist / Guide · Oct 3, 2008

Yes, it is a hospitalist position. I worked as an RN in med/surg/tele for 3 years before I became an NP. My main problem is that I feel so nervous covering ALL those 50 patients myself. Plus when the nurses call me about pt issues, I barely know anything about the pts since we just cover them at night. And I have to make decisions while not really knowing the pts. I don't think it is a good situation. My orientation was just one month. I am seriously thinking of looking elsewhere. But I am feeling so down because I really like hospital medicine...however I think if I worked days it would be completely different because not only would it be more tolerable hours, but the role of the hospitalist during the day is so different from that of night; they have 8-10 pts during the daytime and actually get to really know the pts. That is what I wish I were doing.

Sorry you're having a rough time, Christine. Fifty patients sounds like a lot but it is not that unusual to have a lot of patients to cover at night. I rotate to nights from time to time where I work and we are basically cross-covering the entire cardiothoracic service in addition to our primary role in the ICU during the nighthsift. We do seem to have as much as 50 patients at night as well because the ICU alone can have up to 16 patients, add to that the cardiothoracic surgery patients in the step-down units, the consults from the ER, and the possibility of stat chest tube placements for the entire hospital. However, we make it a point to have two NP's working at night every time. One NP can be really busy with a sick patient in the ICU and if the floor calls for an emergency, it's just not possible to be in two places at one time. As part of the Department of Surgery, we also have back-up support from the senior resident covering trauma call and a senior trauma surgery attending is also available on-site throughout the night. In my opinion, it's just not safe to leave one person to cover that much of a load and it's not even an issue of how good or experienced the NP is. Patient care suffers when staffing is insufficient.

I think you need to ask if this is how it is going to be for the night NP on the service because obviously a plan needs to be in place to add more NP staff at night or establish a mechanism wherein back-up support is available if the need arises. I would also stress the importance of making sure that all the NP's on your service communicate well during shift sign-outs. There seems to be adequate NP staffing during the day where you work. It is therefore imperative that you receive accurate sign-out on each patient you are about to cover before you start your shift at night. You need to be made aware of which patient is likely to crash at night and which patients need to be closely monitored versus those who are likely to have a stable and quiet night. Never accept the beeper from the out-going shift unless you have gotten pertinent information on every single patient on your watch for the night. Also, if your hospital has a Rapid Response Team, use them as a resource as far as being the extra eye to look out for your patients. We always have good relationships with our Rapid Response RN's at night and they help us when we need things done on our floor patients right away. Finally, have you explored asking your collaborating physician to assign you on days first until you get used to the routines being that you just graduated from your NP program?

I really can't tell you much other than the above but I do want to stress to you that the most important consideration is that you are able to safely care for your patients and that each of them get the care they deserve. You need to protect yourself from being at risk of committing mistakes and giving substandard care. Good luck and I am hoping that things work out better for you. Keep us posted.

christvs, DNP, RN, NP · Oct 4, 2008

Thanks for your advice trauma and pinoy. After much thought and debating back and forth, I have decided to look for another NP position ASAP. I sent my resume to a few places and hopefully something will come of one of them. I just do not like working nights and also hate covering so many pts pretty much by myself at night. I really wish there were 2 of us NPs on each night shift, but that is unfortunately not the case. Also, I really did enjoy working days at this job when I was on orientation...but as of right now, there are only physician hospitalists working day shifts. I hate how different the job is at night vs. during the daytime. I just don't like running from one pt to the next, managing problems on the fly. I would much rather have my own little group of pts and take time to get to know them, and round on them daily...like they do during the daytime. My supervisor said he is going to start having us NPs do day/night rotation, but I think that is even worse-my body is already messed up as it is from trying to tolerate nights. So anyhow, at least I made up my mind about what I want to do. As soon as I know I have another position, I am going to give my notice. I still feel bad about leaving, but I know myself and know I will be miserable in this job no matter how much time goes by.

emtneel · Oct 4, 2008

i don't think you should have to make decisions on pts you don't know.

just a tip while you are still there.

I worked at a teaching hosp. as a RN and the resident that was a "hospitalist" as you say who covered nights had like 10 pagers and got called for ALL the services. i just checked it is a 500 bed hospital, level 1 trauma.

Whenever we would call, the resident would say, okay i can't make any decision but i will let the covering team know in the morning.

they wouldn't let us d/c foleys, or stop/start any meds.

The only thing they would really do is give us meds if we really needed them such as nausea, pain meds, or possibly anxiety.

They wouldn't let us make any changes, like advancing diet etc, just for the fact that they did NOT know the patients.

just something to consider.

The world won't go under if you don't write orders or manage pts you don't know.

Maybe you are trying to do more than the job actually requires?? Could this be?

christvs, DNP, RN, NP · Oct 4, 2008

i don't think you should have to make decisions on pts you don't know.
just a tip while you are still there.
I worked at a teaching hosp. as a RN and the resident that was a "hospitalist" as you say who covered nights had like 10 pagers and got called for ALL the services. i just checked it is a 500 bed hospital, level 1 trauma.
Whenever we would call, the resident would say, okay i can't make any decision but i will let the covering team know in the morning.
they wouldn't let us d/c foleys, or stop/start any meds.
The only thing they would really do is give us meds if we really needed them such as nausea, pain meds, or possibly anxiety.
They wouldn't let us make any changes, like advancing diet etc, just for the fact that they did NOT know the patients.
just something to consider.
The world won't go under if you don't write orders or manage pts you don't know.
Maybe you are trying to do more than the job actually requires?? Could this be?

Hi. I totally hear what you are saying. However, what I'm talking about is that not only do I cover hospital medicine patients (that is what I was hired for), but at night we also have to cover urology surgery and neurosurgery patients as well. It's those 2 services that are especially making me nervous, since I know next to nothing about them and also was blown off twice by the urology team (who work only in the AM) who was supposed to give me some training...since I know nothing about urology. The other night I had a really sick patient who needed to be transferred to the ICU, and he was a urology pt, I tried calling the uro surgeon 3 times at home and got no answer from him...I told this to my supervisor who said he will try to talk to him, but apparently, no one can seem to ever get in touch with the urologists, even during an emergency like I had the other night. I know nothing about trouble-shooting urological issues (other than basics) and that night I had 2 uro issues...and no urologist available...so not right. I also had 2 pts in active chest pain at the same time that I was having the 2 uro issues (one of which was going to the SICU) all at the same time. That is why I don't like this job-there is only one NP on each night for all these pts, and just like that night, I know many emergencies can happen at the same time...and it is very overwhelming trying to manage them all...esp when I have not received urology training and we cover those pts...and I won't even get into how little I know about neurosurg...I don't want to be covering services I know nothing about, and in which serious issues may occur overnight. That is why I want to switch jobs. It really has nothing to do with what you were saying. Plus, I am a total zombie working nights!

carachel2 · Oct 4, 2008

Still a student here, but I could *never* work nights. I get physically ill when I stay up that late, no matter how much sleep I've had. I hope you find something that works better for you!

christvs, DNP, RN, NP · Oct 6, 2008

Still a student here, but I could *never* work nights. I get physically ill when I stay up that late, no matter how much sleep I've had. I hope you find something that works better for you!

I'm so happy someone else understands what I am saying! :) I try to sleep as much as I possible can during the day, but no matter how dark and quiet my room is, I still keep waking up because I am so not used to sleeping during the daytime. And so now I am already sleepy at 12:30 AM...with 7 more hours to go in my shift...ugh....I asked my supervisor if I can switch to working just the day shift. I figure it doesn't hurt to ask; the worst he can say is no...and I am already looking for other NP positions. It is just not worth it to me if I am constantly tired, cranky, and depressed about my situation.

ANPFNPGNP · Oct 7, 2008

I'm so happy someone else understands what I am saying! :) I try to sleep as much as I possible can during the day, but no matter how dark and quiet my room is, I still keep waking up because I am so not used to sleeping during the daytime. And so now I am already sleepy at 12:30 AM...with 7 more hours to go in my shift...ugh....I asked my supervisor if I can switch to working just the day shift. I figure it doesn't hurt to ask; the worst he can say is no...and I am already looking for other NP positions. It is just not worth it to me if I am constantly tired, cranky, and depressed about my situation.

I used to work nights and at first I had to use a sleep aid to fall asleep. I used melatonin and it worked well for me. After I got used to working at night and sleeping during the day I didn't have a problem. I would prefer to work at night anytime. Usually the night shift is much more laid back and you get paid more...at least I hope that's the case with you.

Something else, even on my days off I maintained the same sleep schedule.