New PCT offered a job at a large hospital for the night shift. Any advice??

MECO28, BSN, RN · Aug 13, 2010

Hey there! First, congrats on getting offered a job in a hospital straight out of CNA school! I have been a CNA for two years, am in my second year of nursing school and have recently landed my first hospital job. I spend a lot of time feeling stupid but overall I like working in a hospital better than working in an adult family home. If you are planning on continuing your education in healthcare, the experience you'll get in a hospital will be awesome.

I will be honest, however: 12 is a crazy huge patient load and if you aren't used to third shift it may be a tough transition. A question I would ask the recruiter is: What is the ratio of nurses to patients? Some units, particularly ICUs, and some acute-care floors have a ton of nurses with very small patient loads who are responsible for the majority of their patient's care and in that case, having 12 patients would be manageable for you since you'd mainly be an extra pair of hands. Another good question would be "how long is the training process?" This is REALLY important (as I have found out) because nothing you learn in a CNA program can truly prepare you for acute care. It's a whole other ballgame! And if you don't feel comfortable after orientation, express that to your manager; if they are hiring you without experience they have to be prepared to offer adequate training.

And finally: I spent my first 6 months as a CNA working third shift and even though there were times it SUCKED (esp. around 4 am when our Circadian rhythm tells us we need to be looking at the insides of our eyelids) there are ways to make it bearable:: #1- melatonin supplements: Our bodies do not make melatonin in adequate amounts if we are mostly sleeping during the day and our sleep cycles get really f'd up, leading to weakened immune systems, general crankiness, etc. :yawn:Take melatonin and you will be happy.:) #2: Those corny-looking sleep masks are actually awesome. #3: The occasional bloody mary breakfast after a rough shift does wonders for one's outlook.

Some perks:#1- you get paid more. #2- Most of your patients will be SLEEPING! #3 You can smirk at all those chumps trotting off to their 9-5 jobs while you are heading home to sleep at 0700. :devil:

Best of luck to you!

MECO28, BSN, RN · Aug 13, 2010

Oh, and I like the surgical-telemetry unit.:redbeathe (I'm a float so I go all over). Some things to be familiar with are moving a person using sternal precautions (the patient hugs a pillow to their chest and cannot use their arms to push up off the bed), putting on telemetry leads (white to the right- clouds over green grass, smoke over fire, journey to the center of the earth- no I'm not crazy; this will make sense), and paying strict attention to vital signs and knowing what to report to the nurse (low O2 saturation, etc)

Hope this helps!

cjcsoon2bnp, MSN, RN, NP · Aug 13, 2010

First of all, congrats on the job offer but before you accept it I would consider the following.

Ask the recruiter:

1. What is the patient-to-nurse ratio on this unit?

2. What are my job responsibilities?

3. What is a typical day (or in this case night) include on this unit?

4. How long is the training for this position?

5. Who (if anyone) will be available to assist me on the nights that I am the only PCT on the unit?

Nights can be great and they can be horrible at the same time. I think that sometimes its better to be a more experienced CNA/PCT if your doing nights because you don't have as many (if any) other CNAs/PCTs to help you and you need to know how to do the stuff on your own sometimes. Just make sure you ask the questions before you quickly accept the job. You may also find that you can learn things like phlebotomy and EKGs (if your hospital allows that) which is a nice way to keep shifts interesting (especially phlebotomy on nights because you have all of those 5AM labs).

!Chris :specs:

azcna · Aug 22, 2010

@MECO28

I never heard the "journey to the center of the earth" one before, I'll have to remember that! And I'm from Michigan, so we say "snow over grass", lol.

@the OP

12 pts at night is a pretty decent patient load, 37 is not. Make sure you know if there will be other PCAs around to give you advise and answer your questions. Also make sure that you can handle working the night shift, if you never have before. It takes quite awhile for some people to transition, and it can be a real pain sometimes. I would recommend working all 3 of your days in a row if you can.

Good luck!

KaTers419 · Sep 3, 2010

I work on Tele/Med Surg as a PCT at night also. From 1900-2300 we have 8-9 pts. then from 2300-0700 we can have up to 13. Like someone said in a previous post, most of the pts do sleep; however, you do have those nights when no one sleeps and they are all crazy and pooping up a storm. Im doubting that you will be the only PCT all the time. There are times when I have been alone but I can count on one hand how many times that has happened. Its mostly because a PCT called off and we couldn't get anyone or we were low census and got slammed in the middle of the night. If you are the only one, don't stress. You can only do so much and the nurses are aware of that, most of them will jump in and help you as much as they can. Beware of the nurses out there that don't want to get their hands dirty.

sourapril · Nov 30, 2010

Hello Everyone,
3 months ago I have completed my CNA certification , and after a long search have been offered a position at a large, hospital. It is for the Surgical-Telemtry Unit, and for third shift. The recruiter told me I would be responsible for up to 12 pts on the night shift, and sometimes be the only one on the floor!! (37 bed unit). I'm worried that I would not be able to keep up with all the patients.
Any PCT's or CNA's out there that can give me any advice; I would really appreciate it! How is your day like? What unit do you work on? How is surgical-tele unit? How is third shift? ANY ADVICE is appreciated!
Thank you, very much in advanced!

Lala bee, may I ask how did you get the job? Did you have any previous experience? I got my certification in Oct and still can't find any jobs in a hospital. I had several interviews with charge nurses, but somehow couldn't get a job offer. I am really frustrated and feel like I am wasting my life...

futurernfarmer · Aug 11, 2011

I was hired two months ago on an abdominal transplant floor. I am responsible for 11 pts, 22 if I am alone. There are so many drains and assists (incontinent, bedpan, or BSC) and Q4 vitals. I am only just getting to the point where my shifts include getting to sit down occasionally and going home on time.

The best advice I can give is twofold: don't be afraid to ask for help (I'm still working on that one) and work on your time management skills.

I don't know if this is universally applicable, but here is my work-in-progress routine (there are variables such as VRE swabs on Mondays, sharps containers MWF, etc.)

7am Get PCT report, get phone and write down RN/PCT numbers on sticker to attach to phone. Write out schedule in blocks of 4 hours (separated by Q4VS.)

730-9 Take and record vitals and QID blood sugars (blood sugar is priority by 730 --the window is 630-730), checking for I&Os and updating whiteboards in pt rooms with current shift information, also stopping for urgent needs such as incontinence.

9-930 Record I&Os and collect breakfast trays.

930-11 Pass out linens (there is usually a "rounder" who does this and gets call lights and blood sugars, unless she is escorting a pt on a heart monitor, in which case I am on my own.) Set up baths and begin assists, instructing pts to call when they need help. Begin complete baths, stopping between for assists. Rarely do I actually get all baths done in this time.

11-12 QIDBS, Q6BS, Q4VS and daily weight.

At this point I have discussed lunch breaks with the other PCT(s). We get 45 min, so assume I take that sometime between 1-3.

12-1 Collect lunch trays and record I&Os.

1-3 Catch up on charting, get updated report from RNs, finish baths, collect samples.

3-4 QIDBS, Q4VS, empty linen and trash bins.

5-6 Collect dinner trays, record I&Os.

6-7 Q6BS. Finish any tasks not already completed.

7-730 Give report to oncoming PCT.

Night shift is less hectic, but there are additional responsibilities, such as restocking glucometers, recording refrigerator temps, and drawing blood for those who are trained to do so.

That schedule sounds so smooth typed up, but we all know there are so many interruptions throughout the day. Complete care patients, needy patients, needy staff, etc.

Between tasks, I typically take a breather, either get a drink or take a bathroom break, maybe even check my phone... cell phone not work phone!

sandyfeet · Aug 13, 2011

I am starting an overnight PCA position too, and am interested to read more replies! My friend who already works noc says she uses an org tool just like in nursing school. I'm not sure if you guys have to use these, but at my school we have to take a sheet of paper and break down our entire shift. There are blocks for hours where you can write in what tasks need to be completed by what time. I am a very visual person, so for me this was always helpful in NS and I hope it will transition well to being a PCT. :)