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?
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?
Hmmm. But I do nothing...
This is an awesome post. I wish I could like it sooo many times. People really have no clue what life as a nurse is really like.
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.
No, not over interpreted. Just disagreed with. Sorry if someone not swallowing your post whole without question offends you.
At my last job there were 4 nursing staff on the floor, plus the DON and Charge Nurse during the day. There were also 15-20 support staff that could help in nursing if needed. At night it was myself and a CNA. Our census averaged 80. Do you really think I did nothing all night?
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?
I am a night nurse and while the night shift can be more calm than the day, there is still a lot going on. We still have to pass meds, do assessments, do dressings, admissions, etc. all while the patient to nurse ratio rises, we have less help, the doctor is asleep and gets angry when you call, the majority of time none of my patients sleep, etc. You have to try working as a nurse, on the night shift before you knock it. Night shift nurses change their schedules completely around and it messes with their personal lives. You are going to find lazy nurses on all shifts. But rule of thumb, patients will say things to you about other shifts all the time. When you go home they tell us night nurses "the day shift nurses never answered my call light, etc." I don't listen to it because its usually the same type of person who is manipulative to the nursing staff. Good luck to you......
I understand your concern. I think nurses on all shifts complain about how little nurses on the other shift do. Actually, I think any shift work brings that out in the workers. I worked at a facility where I worked as a CNA on day shift, then as a RN on night shift, then as RN on day shift and I can honestly tell you that everyone complains about what the other shift doesn't do and I really had no idea what every position was required to do until I was in it. As a CNA I often thought the nurse got to sit a lot, as an RN I realized how much time I had to spend documenting and checking orders.
I currently work as a rotator, meaning I can be scheduled for day or night shifts, wherever they need me. I have had nights busier than some of my days, and I have had some pretty busy days. As far as the duties of a night shift nurse vs day shift nurse, they are the same. Assessments, med passes, etc. *MOST* nights there is a point during my shift where my patients are settled and I may have some free time to do something extra like chart checks or EMR audits (or perhaps eat or pee!)
I actually found that I learned a lot more when I trained on night shift than day shift for a couple of reasons. 1. You have less resources and need to be more self sufficient. 2. I had the time! I have done more of my nursing skills and spent more time educating patients on night shift than I ever did on day shift. I had time to audit the EMR, reconcile meds, double check orders, stuff that is very important to pt care.
I understand your concern is over the staff at YOUR particular hospital. The best I can say is to give it a chance. Take everything you can from it. Do what you know to be right even if others around you are not. You Will be the nurse some student is watching one day, set a good example. If you find that you are uncomfortable with the care your colleagues are providing then maybe that hospital is not an appropriate assignment for you. And be careful about the attitude you present to your night shift colleagues. No one will want to teach you if they feel you don't respect them.
Well, I can definitely say that night shift nurses work! And work hard! Speaking as a night shift nurse myself (I work some day shifts too when my unit is in a pinch, but mostly nights), there are many tasks/responsibilities to attend to, as plenty of others have already mentioned. Depending on the unit, it can be a wee bit slower paced (not always though!) as there are typically fewer doctors, visitors, and such roaming around. Trust me, you will still have PLENTY to do and learn! Give night shift nursing a try, you just may like it! :)
And be careful about the attitude you present to your night shift colleagues. No one will want to teach you if they feel you don't respect them.
Amen.
OP's attitude is kind of backwards towards day shift learning vs. night shift learning. If night shift really is a slower shift on that unit, then the preceptor will actually have time to explain things. Don't piss off your preceptor on the first day by going in with an attitude.
My preceptorship was on a busy unit on day shift. My preceptor and I barely had time to talk. I was running around passing meds and doing assessments while she called the docs and double checked everything I did. I was not an asset to my preceptor at first and I am grateful for everything she taught me. Love you, Pam!
Someone commented that there are more codes on day shift. I did not note that to be true on my unit. Is this generally the case in the experience of the posters here?
I agree with everything @Nonyvole and everyone else said. I am not a nurse yet but I work night shift in the CCU at my Hospital and the nurses do quite alot. I am sorry if the place where you are going to be precepting has you feeling that way about night shift nurses. I urge you NOT to base your opinions on the experience you have there to the overall quality of care that other night shift nurses give to their patients... As far as I see it, the night shift nurses give the same amount of quality care to the patients as the day shift nurses. During the day, it is busy but it is NOT better than night shift by any means. I have worked with day shift and night shift nurses and I have seen both sides. Also night shift nurses ARE MORE independent because the nurse managers are not there to micro-manage and there are less doctors, resident, interns sticking their head in every few minutes.
If you decide to work nights, do it with an open mind and open heart. Do not follow others, if you do not like what is going on there then be different and try to implement change.
I'm a PRN night patient observer. I love my hours (for now..wait until the next semester begins I might change my mind, but I try not to worry about it yet) I work 11-7. I take a nap at around 7pm before I go in. Many of the nurses and staff I am privileged to be apart of don't get to take a nap right before their shifts but have been working since before I laid down for mine. The best is when a nurse asks me if I want to watch her/him and even TEACHES me..just something like "make sure you always check ___ with this" and I don't do anything out of my scope. You don't know how grateful I am to be acknowledged by a nurse at all since I feel awkward a lot still. I'm trying to work on looking more competent, I don't think all the PCA's think I'm too good yet! (I'm pretty bad making an occupied bed). This could have been a bad situation for me if I went in there thinking the night staff are lazy and I'm superior, definitely. It's good to act confident but humble I think, and not have any prior judgement, and don't insult any other floor or shift either! I overheard one girl say how she thinks oncology is so boring (I was not on oncology) and the nonverbal reaction of the 2 nurses she said that too gave said it all and they basically ignored her.
Um… from where did you get your perception of what night shifts are like? I work nights (CNA) and boy would I be happy if patients would actually sleep! I am busy all night long. The nurses are always busy too. Giving meds, doing assessments, IVs, admissions and yes, the nurses do help clean up patients too.
CBlover, BSN, RN
419 Posts
This is an awesome post. I wish I could like it sooo many times. People really have no clue what life as a nurse is really like.