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?
As a student, I did several rotations, including my preceptorship on nights. My experiences were unrivaled by anyone in my cohort. I got to do more and see more than anyone else. I got to truly develop some time management and critical thinking skills - and had amazing preceptors. I got to watch and sort through on the fly decision making with a team of nurses. I got to soak up experiences like a sponge.
I'm a night nurse now. I wouldn't trade my night nurse autonomy for anything. Day shift has a lot to deal with - as do I. I just happen to like the naked with no leads, running down the hall, bat guano crazy, code stroke, code blue, advocate for my patient (who's assessment has changed; how do I know? I did one), call the doc for good reasons, BS that happens on nights. I enjoy the crazy and the camaraderie. I'm not a young person. Nursing was a third career. I wouldn't trade nights for anything.
I think other people have addressed the faux pas so I will let that ride.
OP - are you studying in the US? Are your past experiences with healthcare US-based? You refer to "ancillaries" - that title is a bit stiff (at least to me).
You did comment that much of your opinions are based on episodes in the distant past. Healthcare has changed so dramatically that your observations might well have been from the Crimean War and making rounds with dear Flo herself.
I just think there's more that is colouring your perspectives.
Ancillaries...of which I am one right now... easier than saying nursing assistants/ nursing aides/nurse student technicians/ etc....
And I'm not talking about the distant past. What I described a couple of posts ago is happening now...in the USA.
During my clinical rotation for critical care, I asked a nurse what is the most frustrating thing she experiences. She said nurses who, no matter what shift, doesn't think it's their job to clean up patients.
My concern here is not getting good, quality experience on night shift during my precepting. Like I said before, though, it's going to be at a hospital I don't work for...where I have completed 2 clinicals and know the staff. Those of you who didn't go ballistic and understood what I wad really saying, thank you for subsiding my perception that I won't get much experience.
Now to address the doctor issue really quickly. They don't just write new orders. I don't know where some of you work, but where I work doctors do focused assessments on patients to prevent infection and help progress patients to wellness with their treatment.
Now to address the doctor issue really quickly. They don't just write new orders. I don't know where some of you work, but where I work doctors do focused assessments on patients to prevent infection and help progress patients to wellness with their treatment.
That's not the point that was made/being addressed. Of course the docs help the PATIENTS. How do they help the nurse, as in day shift has more "help" than night shift because the doctors are there during the day vs. not being there at night?
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.
Ancillaries...of which I am one right now... easier than saying nursing assistants/ nursing aides/nurse student technicians/ etc....
And I'm not talking about the distant past. What I described a couple of posts ago is happening now...in the USA.
During my clinical rotation for critical care, I asked a nurse what is the most frustrating thing she experiences. She said nurses who, no matter what shift, doesn't think it's their job to clean up patients.
My concern here is not getting good, quality experience on night shift during my precepting. Like I said before, though, it's going to be at a hospital I don't work for...where I have completed 2 clinicals and know the staff. Those of you who didn't go ballistic and understood what I wad really saying, thank you for subsiding my perception that I won't get much experience.
Now to address the doctor issue really quickly. They don't just write new orders. I don't know where some of you work, but where I work doctors do focused assessments on patients to prevent infection and help progress patients to wellness with their treatment.
Overall, I don't think you have any realistic understanding of anything we've tried to explain.
During my clinical rotation for critical care, I asked a nurse what is the most frustrating thing she experiences. She said nurses who, no matter what shift, doesn't think it's their job to clean up patients.
You said it yourself - no matter what shift. It's not an attitude that is particular to a single shift. And it's not just avoiding cleaning up patients; you'll find everywhere, in every field, people who don't want to do some of the more boring/disgusting tasks that are part of their job.
And those days that you've walked into work and found things like dirty briefs, messy beds...what was the patient doing? Did the night shift know that the patient needed a clean brief? Was the patient up and out of bed and didn't put the covers all the way back on? There's always more to the story. It does nobody any favors to automatically assume the worst.
My concern here is not getting good, quality experience on night shift during my precepting. Like I said before, though, it's going to be at a hospital I don't work for...where I have completed 2 clinicals and know the staff. Those of you who didn't go ballistic and understood what I wad really saying, thank you for subsiding my perception that I won't get much experience.
Will you get the same experiences and opportunities as a classmate working the same unit, but on day shift? No. But they won't have the opportunities that you'll get.
It all comes down to attitude. If you go into this expecting to be with a bunch of lazy people who don't want to work, you'll find yourself miserable. If you go into this with an attitude that everybody has something to teach you, you'll find a ton of opportunities.
Specializes in Cardiology, Cardiothoracic Surgical.
Re: assessments, I have 3-4 patients on nights based on acuity. I do my own VS, I and Os, often BGs, some bathing/cleaning, assessments with my med passes. All has to be repeated around 0000 and 0400 if I have stepdown pts. Usually one is keeping me busy for most of the night with one problem or another, then there's charting the joy of charting.
As a night shift nurse I do a full assessment on my patient and then focused assessments. I may not be waking them up at 4am to get vitals or do an assessment if the providers say it is ok to skip and let them sleep, but I check in on them and I do an assessment every time I help get them up to the bathroom, etc. I'll tell the aide that I got it when the call bell rings just for that reason- I go in and help the patient and take advantage of them being awake and do a little assessment. I do skin checks, apply barrier creams, turn and reposition patients and anything else required to protect their skin. I also give meds as ordered- that might be midnight, 2am, 4am, etc. We might initiate NG tube feedings, we do blood transfusions when needed. I adjust heparin drips, put in nursing orders for a new PTT/INR draw, and contact the lab when needed. We collect urine, sputum, stool samples, etc. I clean the patients up as needed- change linens, personal care, new gown, etc.
I get admissions and occasionally a discharge right at shift change if I'm in at 7pm. I take every opportunity to educate my patients. It might not be as often or as in depth as day shift since they tend to be sleeping, but I do it whenever the opportunity presents itself.
I don't get to round with the providers like the day shift nurses do, but I go through each patient's chart with fine tooth comb. I read over ALL the notes- from providers, RNs, case managers, etc. to piece together the patient's story. I review all orders and ensure they are being followed. I recently discovered a patient was on a fluid restriction and there was no mention of it in my report out, no sign on the door, etc. I put the appropriate sign up and notified the morning nurse in report.
Have you ever seen a patient sundown? Talk about having your hands full, especially if you get an admission, have another unstable patient, a patient in constant pain, etc. A sundowning patient can keep you on your feet running the entire night and you don't have the support staff that the day shift does. We've had sundowners that we had to have a nurse sitting with the entire night because we didn't have a sitter available and they were getting up out of bed every few minutes. You need to make sure that patient doesn't hurt themselves, but also have to minimize the disturbance of other patients. This is when it is critical to have a supportive team that pulls together to make sure everything is done.
Edit: If I'm sitting at the computer and it looks like I'm not doing anything, it's because I'm reading over everything in the chart. Every once in a while we might get a quiet night, where the patients are good and all our work is done and we can sit around and quietly chat, but I've had a few day shifts like that too. Most of the time I'm doing stuff all night long- I actually prefer to have work at a steady pace because it helps keep me alert. Even with a full "night" (8+ hours) of sleep if you have everything done and are sitting around keeping an eye on things with the lights dimmed you CAN get sleepy (just like day shift nurses can get sleepy and might not be running on a full night of sleep).
Oh yeah, I forgot to mention. We don't have aides at night on my unit. I work cardiac ICU step down. While many of my patients are medically complex but self sufficient with some ADLs, we take a fair amount of chest pain, rule out MI, and CABG patients, not to mention elderly CHF exacerbations. Recently had a fresh heart cath patient with bilateral groin sites start sundowning before bed rest was over. What a bloody mess. Talk about putting you behind.
Oh, and insulin drips on those CABGs. One of those with hourly blood glucose checks and titration will *definitely* keep you busy, especially when your other 2 patients are ripping their leads off and freaking out. Or coding. Just sayin'. It's a 24/7 business. I think Nonyvole said it best. Sometimes I walk in to a feces fest and nothing is done, but that can happen to any nurse at anytime. Keeping a good attitude goes a long way in keeping the "shift wars" at bay.
That's not the point that was made/being addressed. Of course the docs help the PATIENTS. How do they help the nurse, as in day shift has more "help" than night shift because the doctors are there during the day vs. not being there at night?
HOW does having lots of docs around during the day shift lessen the burden of the day shift nurses in comparison with night shift nurses?
Easier to get orders. Easier to get them to assess a patient. Not having to hear "this can wait for dayshift" when it can't. I guess I'm referring to a different kind of burden that isn't just tasking.
And I do both too. I get it. Clearly my original point was over interpreted/not salient enough for the Internet.
kalycat, BSN, RN
1 Article; 553 Posts
As a student, I did several rotations, including my preceptorship on nights. My experiences were unrivaled by anyone in my cohort. I got to do more and see more than anyone else. I got to truly develop some time management and critical thinking skills - and had amazing preceptors. I got to watch and sort through on the fly decision making with a team of nurses. I got to soak up experiences like a sponge.
I'm a night nurse now. I wouldn't trade my night nurse autonomy for anything. Day shift has a lot to deal with - as do I. I just happen to like the naked with no leads, running down the hall, bat guano crazy, code stroke, code blue, advocate for my patient (who's assessment has changed; how do I know? I did one), call the doc for good reasons, BS that happens on nights. I enjoy the crazy and the camaraderie. I'm not a young person. Nursing was a third career. I wouldn't trade nights for anything.
I think other people have addressed the faux pas so I will let that ride.
Peace.