Before I write this post, I want to say I am not a traditional student. I am 43 years old and switching careers. I just started as a Nurse Student Tech, and I had a rough time at first, but getting into a "smooth groove" (for lack of a better phrase) to organize my time and work.
Forgive me for my ignorance in advance, but I just got news for my placement in precepting. It is at a hospital I really enjoyed being at for 2 of my clinical rotations. The staff is really willing to teach you and allows you to spread your wings to learn.
The problem, however, is they only had night shift open. I saw a post about this on here from 2002, and I was shocked that during a poll 70% of the people believed night nurses work hard.
I understand we take what we can get when precepting. But here is my view - and please, remember I am just starting a new career and am not familiar with night shift nursing. However, I do not have a good perception of night nursing, and vowed that I would do something like work at a doctor's office before working night shift, and it is because I see night nurses never do assessments, never pass medications, never do discharges and never are involved in patient education. I had a patient complain to me once how rude night shift nurses were on my floor.
When I heard I am precepting on night shift this semester, I got frustrated, because the only experience I have with night nursing is what I mention above. My perception is they really do not do much. I am not disrespecting night nurses, I just don't know what it is they do because of this limited exposure I have with night shift. There have been several times I come on shift and people that I have gotten squeaky clean, at 7 am in the morning, smell so bad that the devil himself would run away.
The only positive experience I have had with night shift nurses was when I was pulled to Emergency. I usually show up 30 minutes before work, and when I went to Emergency, they were on top of everything.
Again, I don't mean to disrespect night shift nurses. I know that there are thousands more out there than my little corner of the world. My frustration, however, is twofold: I don't want to be labeled as a nurse that does not do anything just because I might be on night shift, and I want experience at my precepting site...not just watch or "check in" on sleeping patients once every hour. Precepting is supposed to give us experience as a nurse, and I fear I will not get that - because, as I have observed in my little corner, night nurses do not do assessments or pass medications or even clean up patients. How are we to get experience if we are on a shift where there is really nothing to do?
I know this is a large post and sorry about that. I am someone who tries to be proactive, so...after all that I have said, here is my question: How can I make the most of this placement to do well? I was hoping for day shift because I see how active the nurses are with assessments, passing medications, new admits, discharge and patient education. I really want this to be a positive experience, but how can that be when there is a perception that there is really nothing to do?
I work both day and night shifts. Both shifts are busy. Night shift runs on a slower pace, but slow does not mean a relaxing shift. Night shift does not mean I do nothing but watch my patients sleep. I am offended by your insinuations that night shift nurses are lazier when compared to their day shift counter parts.
On night shifts, I do assessments, vital signs (sometimes every 4 hours), pass meds (do you think those prn analgesics requests don't happen at night?), do dressing changes (if a coccyx dressing is soiled when I change a patient, I am not leaving it for day shift to deal with it), reposition patients, change patients, toilet patients...basically everything that you'd do for patients in the day, I also do on nights.
Not to mention admissions and transfers, and checking charts, filing labs and reports, stocking supplies, prepping patients for procedures (just who do you think ensured the patient is NPO after midnight? Who do you think complete the checklists and paperwork??), calling doctors as needed...patients don't stop being ill at night. Code Blue happens. Rapid Response gets called.
Oh and don't forget your sundowners.
Night shift do this all, and more, without the support that Day Shift has.
First step to making the most out of your preceptorship is to change your view on night staff, especially if you know nothing about them.
Eh, I think you're mistaken if think that dayshift has vastly more staff to get everything done. They typically have somewhat more staff to get vastly more done. I've done plenty of night shift work, and continue to rotate, but let's be real about the work balance, especially on floors with many discharges.
I mean, I rotate too. I guess I'm speaking for how it is where I am. Doctors and NPs and more CNA'S and tons of ancillary staff. Yeah, there are a ton more staff to help around during the day where I am.
Specializes in Cardiology, Cardiothoracic Surgical.
You opened up a hornet's nest with this one.
Night shift gets equally saddled with all the fires from day shift- answering questions for the family, patient education, finishing up post-op walks on my floor, dong the dressing changes day shift was unwilling/forgot to do, cleaning up all the lactulose/Miralax BMs that got started on day shift, etc, full assessments, 2 med passes,etc. All to be done in quick succession if you want your folks down by 2330/0000 for some sleep.
Throw in the fun of sundowning and delirium on patients, you'll see your sweet, sleep deprived patients crawl out of bed and turn into some interesting characters.
If we're lucky, we might get 4 hours of relative calm for the patients to catch up on sleep. But the fun begins all over again at 5:30/6 am with first op cases, med passes, blood draws and preparing for report.
Judging from this poster's previous threads, he truly is that ignorant about what nurses do.
Here's a little education for you, OP.
So, on my typical night at my current OBS hellhole (literally, this is a shift that happened last week):
1) Get report on 2 established patients (means they've been there more than half an hour). Run to assess them and try to chart as much as I can before I get two admissions. Find out that the reporting nurse forgot to tell me the admission paperwork hasn't been finished. Try to finish the paperwork before ED calls report.
2) ED calls for report while I'm trying to fix the IV that's alarming. The other ED nurse calls on the second line while I'm getting report. Get two admissions from the ED at the same time, one of whom is usually unstable, and maybe a downgrade from the Med-Surg or Tele floor. Stabilize the unstable patient. Maybe call a rapid response if I can't get them straightened out. Sometimes, they try to send me someone who is completely inappropriate for our unit and I have to fight with case management. I usually have to take the patient because the charge and the house sup have no balls and threaten to write me up and have me fired.
3) Rush through the 30 minute admission process while trying to pass my 2100 meds. During this, have to call pharmacy 2-3 times to get the meds I don't have.
4) Give pain meds to my acute appy's, gallbladders, whatevers. Run to chart as much as I can before somebody crumps.
5) Call the pharmacy to verify the meds that my new patients are taking, because they don't know the names or dosages. They just know they take 6 pills in the morning, 2 in the afternoon, and three at night. Some of them are white, one is pink, one is a purple capsule. Hopefully they go to one of the pharmacies that has a 24 hour phone line. Find out patient takes around 15-20 meds. Have pharmacy fax me the particulars. Take 10 or so minutes to put in the computer. Call the hospitalist to let them know the meds are updated. Hospitalist wants me to put the orders in. We fight. I have to put the orders in because my charge and house sup have no balls and they threaten to write me up. Takes 10 more minutes to put the 15-20 med orders in.
6) Run to give all the missing meds that pharmacy has sent up.
7) By now, it's at least 2230. Hopefully my med pass is done. Sit down and chart all the things that aren't important to patient care but that administration wants.
8) Go see why my patient is screaming - oh, my suicidal patient who's withdrawing from heroin (soooo appropriate for OBS, eh?) has decided that she likes thrashing on the floor and is pitching a fit to get her way. Verbal deescalation attempted, not successful in the slightest. Learn that 19 year olds know some really nasty words and have good aim. Call security, get behavioral restraints because she thinks I look like a good punching bag, and get her back on the bed and tied down. Call the doc and the charge and sometimes the house sup to take care of the legal details.
9) Now it's 0130. I run to make sure my other patients are breathing. Yay! Everybody's alive. Do my 0000 assessments while there.
10) Try to chart as much as I can before I do my nightly chart checks. You know, to catch any orders that slipped through the cracks because day shift is so busy. Find out one of my established patients is supposed to be on tele. Wake the patient up while putting them on a remote monitor and get cussed out. Luckily, the rhythm is OK.
11) If I don't already have five, I get my fifth patient at this point usually, because, hey, nights are slower. Try to get admission paperwork done, IVF started, meds given. Find some orders that make me think the hospitalist got patients confused. Call the hospitalist. Hospitalist wants me to change the orders, we have a fight because I want him to do his job and put the orders in correctly, I end up changing the orders because my charge and house sup have no balls.
12) Start at 0500 and run to pass 0600 meds and do my 0400 assessment while there, pull catheters, remove packing, etc.
13) Sit down to chart at 0640. Do my best to catch up I&Os, check to make sure all the t's are crossed and i's are dotted.
14) Keep charting and notice that day shift hasn't come to get report at 0715. Find out day shift nurse is no-call no-show. Stick around and check my email, which has backed up for a couple of weeks, while I wait for someone to relieve me. Pass the 0730 meds and give some pain meds. Day nurse finally shows up, wants to know the color of the patient's backteeth. Give SBAR report for 30 minutes. Finally get to leave around 0815.
15) Get a call from management @ 1100 complaining about overtime. I can't believe they woke me up for that ****.
Did you see any lunch breaks or pee breaks in there? No?
Bravo for reaching out for clarity and not being close minded by your limited experience. I have worked many different hospitals, all night shift, all same basic work processes. Night shift on all acute units assess patients, pass meds, teach, and sometimes even discharge. I encourage you to take advantage of this opportunity. Night shift presents a different tempo, but most importantly, environment. Night shift puts patient care almost entirely on nursing, save a respiratory therapist if the pt. has that need. I get the ownership of a day shift nurse who has had a pt. for a few days, the interactions are more numerous, but night shift is intimately responsible for that pt., no one else is overseeing their care, it is up to me and me alone to make sure they are safe. Night shift nurses have an independence that just isn't there on days, one of the huge reasons I am concerned when new nurses are put on night shift right out of school. I am in no way knocking day shift, I am constantly telling administration that all things being equal, day shift needs the extra staff. I would not be able to endure what day shift goes through, I respect what they are asked to achieve and succeed. Try nights, I think you will change your view.
I actually cut my post down a lot because it was too long.Someone asked where I get the impression I do. I realize that there arethousands of night nurses out there who work hard, but my little corner of the world hasgiven me a negative impression of night nursing. My wife has a friend who was a night nurse for 20+ years and he did well, but he also told me the other nurses did absolutely nothing.
When I trained on night shift as an ancillary, I chose to do it to see what thedifference was between night shift and day shift. Recently, I have been working as an ancillaryfrom 7 am to 7 pm on a med surg floor. Most of the patients are asleep by 7 to8 pm. When I trained on night shift, the person that was training me fellasleep all the time during the shift. I prepared for the shift by gettingproper amount of sleep and went into it with a positive attitude. Recently, Ihad to sit with a patient who kept pulling the IV out of their hand. Thepatient tried several times on my shift and I prevented it. The other ancillaryI relieved from night shift, who trained me on that shift, told me she pulledher IV out again…this happened three days in a row on his night shift
I was told that at the end of each shift, ancillaries andnurses are responsible to ensure patients are comfortable, have fresh water,are clean (especially if the patient is incontinent), and so forth. Most of thetime when I show up for my shift at 7 am, water bottles are empty, my patient assignments are leaning on the edge of their beds, covers are all over theplace, and some of them are sitting in urine or feces. If I had a family memberthat was left like this at night and came in to see them at 7 am, I would tellthe staff to get the unit manager here immediately and let them know this ishow patients are left. No matter how busy people are, no patient should be leftthat way…ever. If I walked in on my relative laying that way at 7 am, I would tell the staff to leave them that way and bring the unit manager in here immediately to see this...and if nothing was done, go to the nursing supervisor. The only exception to a patient being left this way is if a code was called.
When I trained on night shift, I took my meal break at 3 am.We were pulled to another floor that day. I went to get my stuff on my floor,and nurses were playing on ipads, flipping rubber bands at each other,wheelchair races, etc. It really was a carnival that night.
So that is where I get this impression. Again, it's only one place and it'sonly one little corner of the world – and it is our school's policy that wecannot precept where we work. This is where the impression comes from.
Another impression too was when my grandmother several years ago was in thehospital for a staph infection. My mom and her sister would ask nurses on 7pmto 7 am shift questions and were basically ignored.
So I know there are night nurses who work hard. Thanks to those who replied to my overall question about how I can make the most of this opportunity and not taking what I said as offensive. Obviously there are night nurses who do their job well, I just have seen night nurses not really that busy or doing much where I work, and I was wanting day shift because I feel that is where precepts get most experience at patient care. Some of you have provided good advice that answered my question and I really thank you for doing so.
I'm hopefully going to be starting a pct job here soon. They asked me if I wanted days or nights and I chose nights. I did this for several reasons.
I think getting my feet wet on nights will be perfect. The nurses on night shift will be better apt to teach me only for two reasons. Not because they have less to do, I think they have the same amount of patient care, but because for the most part, patients are aslee and there is not a whole lot of family to contend with.
There are still meds to pass, patients to clean, treatments to take care of, all of those things which will be great training for me. Patients still do wake up at 3am and need assistance.
You are very misguided in your perception of what night nurses do. You are being given an excellent opportunity and you should take it.
I mean, I rotate too. I guess I'm speaking for how it is where I am. Doctors and NPs and more CNA'S and tons of ancillary staff. Yeah, there are a ton more staff to help around during the day where I am.
How do doctors "help"? Seems to me that all too often what the doctors do when they come around is write new orders. They aren't helping the nurses, they are creating new tasks for the nurses.
OP, I'm really at a loss as to why you don't think night nurses do med passes. How could you not know that meds are scheduled 24/7?
Every nurse has to chart a full assessment on every patient in acute care. I don't believe for one minute that all the nurses at your facility are falsifying their charting.
What kind of facility are you basing your judgments on? It doesn't sound like a hospital.
My wife has a friend who was a night nurse for 20+ years and he did well, but he also told me the other nurses did absolutely nothing.
Well, of course HE "did well" while all the other nurses "did nothing." Super nurse!
Don't ever base an opinion on a large group of people on what one random person tells you, especially when their version elevates their own role while denigrating that of EVERYONE else. That should go without saying, but apparently not...
MPKH, BSN, RN
449 Posts
I work both day and night shifts. Both shifts are busy. Night shift runs on a slower pace, but slow does not mean a relaxing shift. Night shift does not mean I do nothing but watch my patients sleep. I am offended by your insinuations that night shift nurses are lazier when compared to their day shift counter parts.
On night shifts, I do assessments, vital signs (sometimes every 4 hours), pass meds (do you think those prn analgesics requests don't happen at night?), do dressing changes (if a coccyx dressing is soiled when I change a patient, I am not leaving it for day shift to deal with it), reposition patients, change patients, toilet patients...basically everything that you'd do for patients in the day, I also do on nights.
Not to mention admissions and transfers, and checking charts, filing labs and reports, stocking supplies, prepping patients for procedures (just who do you think ensured the patient is NPO after midnight? Who do you think complete the checklists and paperwork??), calling doctors as needed...patients don't stop being ill at night. Code Blue happens. Rapid Response gets called.
Oh and don't forget your sundowners.
Night shift do this all, and more, without the support that Day Shift has.
First step to making the most out of your preceptorship is to change your view on night staff, especially if you know nothing about them.