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 thought night shift was going to be so chill. WRONG! For instance, I was on my feet for 11 hours last shift. I only had 1 hour of charting time.
-We don't have aides - days does.
-We draw all our labs between 10 PM - 5 AM
-We have just as many admits as days
-We do discharges sometimes during shift change/our big night pass, which is a difficult time to do so.
-We catch orders that are overlooked/missed on days. This happens a lot and it takes up a big chunk of time to get caught up.
-We do all our vital signs and ADLS on our pts
-Patients often pay more attn. to their pain at night because they are not as busy as days. We give lots of pain medications during night shift.
-We do assessments, start IVS, foleys, NG tubes, give medications, etc. All the same stuff days do.
-Sundowners. Sometimes 2 of your own patients.
A respiratory therapist once said to us, "Days is always getting lunch and the night nurses do more work than they do." I am not saying that this is true (heck, it depends on the person IMO) But, it is nice to know that someone acknowledges and actually witnesses all the hard work we do.
I think you guys are all way overreacting. Larry is just telling it like it is, after all.
I mean, look at my job. As Larry's theory applies to my specialty (L&D) in particular, everyone knows that:
1. After 1900, women are no longer pregnant. They resume their pregnancies at 0700 sharp, though some of them resume at 0600 when the day shift charge nurse rolls up, because technically, a day-shifter is present and they know it's safe. Overachievers.
2. Babies are never born at night. Fetal training during the 2nd trimester makes it very clear to all fetuses that all births shall occur between 0700-1830 on weekdays, never on weekends, never on holidays, and, my goooodness, never on nights! We night shift nurses would hardly know how to catch an overzealous baby now, would we?
3. Because of items 2 and 3, night shifters on L&D never find themselves in STAT C-sections. That would be way too much work for the laid-back environment we've come to enjoy and would probably interfere with my midnight hot chocolate break.
4. Clearly, based on item #1, patients with pre-eclampsia, GDM, PTL, PPROM, PROM, PIH, HELLP syndrome, placenta previa, and a whole slew of other antepartum conditions don't need to be assessed, so we do in fact forego all assessments on nights.
5. Night shift L&D nurses are never inundated with triage to the point where we're putting triage patients in the OR staging rooms because we're out of triage beds, and we certainly wouldn't find ourselves in this situation with no one to call in as backup in the middle of the night (manager, CNS, on-call, postpartum nurses, etc).
Yes, Larry, you should probably stick to day shift. I'm afraid on night shift, you'd... *sigh* ...just get bored!
[/sarcasm]
I myself am in awe of how a baby who is crowning @ 1855 will slide right back up the birth canal and the lady parts just closes itself until 0700 the next day. There's a lot of learning in the womb!
I myself am in awe of how a baby who is crowning @ 1855 will slide right back up the birth canal and the lady parts just closes itself until 0700 the next day. There's a lot of learning in the womb!
It really is remarkable. Those little ones know even early on they'd better not get themselves born on nights! I'm sure there's a day shifter somewhere who deserves the credit for this vital teaching.
I remember in a unit meeting when our less than loved manager made the comment that "Patients are asleep at night" I guess as a way to justify our crappy staffing.
Clearly your less-than-loved manager never worked in psych :) I'm lucky if just half of the unit is asleep!
Sorry about this comment.. As for me; I do not think it is fair at all; If you think of the night shift nurses that way in general; there are times when there will be benign periods that you won't see what you expected., but it doesn't mean it's always like that..
FYI the only difference I have observed is that you're working nights. And by that fact itself makes it hard too because, you need to stay awake for your patients. (Don't you know that it is hard to assess a person whose is asleep & who are trying to be comfortable enough; so you need to balance it; you may not be aware that the nurses on that floor had already been doing their assessments; but because they have to move fast you never saw it. If you ever doubt it was done. I suggest doing a reassessment)
Apart from the routine that you do; I do suggest that you try to do. What you think is best for your practice rather than focusing in everything every wrong that you see.
In short, It will benefit you more if
you try to do what should be done; appropriately. Goodluck!
Specializes in med-surg, IMC, school nursing, NICU.
I am not going to berate you for your obviously ill-informed opinion on night shift nurses. You truly have no idea what you are talking about and despite your intentions not to do so, I found your post offensive.
I worked full time nights for 2 years and rotating shifts for 1. Here is a small, not at all inclusive list of the things I did as a night shift nurse.
Complex dressing changes on a tunneling sacral wound, that an almighty day shift nurse decided would be adequately treated with a dry ABD pad and paper tape.
Recognized and reported a nonverbal trach patient's rapid decline into respiratory distress, suggested to the resident that he had a mucous plug and assisted in getting him bronched, effectively saving his life.
Became THE best phlebotomist on my unit.
Used my "spare time" to sit with a 35 year old woman dying of advanced metastatic ovarian cancer and take her mind off the fact that she was going to be dead by Christmas.
Prevented a sundowning old man with an adoring family from getting out of bed all night long, pulling out his PICC and falling. His daughter called me a "perfect nurse" that morning.
Helped a 500 pound man get cleaned up, applied lotion to his irritated skin and convinced him that nobody on the unit "hated him" (He thought we felt this way because of what a day shift nurse said outside of his room)
Removed a tourniquet that had been left on by the day shifter who preceded me.
I would never in one million years tick off a list of how wonderful I am. I'm not perfect and I am not one to brag. But when I hear someone with a MINUSCULE amount of experience making a generalization of an entire half of the nursing workforce, I feel the need to let them know just how wrong they are. Are there lazy people on nights? Sure. Are there lazy people on days? Sure. Are there lazy doctors, lab techs, radiology techs, managers, grocery store check out people and construction workers? Sure. But to say ALL of those people are lazy would be wrong. So why is it ok to say this about your future colleagues? I wonder.
Ok. I think some people are overreacting to what I said. The perception is there in my mind because, well, take a step into my world for a moment. I am a nurse student technician, it is my last semester of my BSN program, and since day 1 of my Foundations class and in all my clinicals, we are taught nurses are responsible for all patient care on their shift. Aides/Assistants/Technicians are nice to have around because they help out with many of the patient care aspects that give nurses time to do other patient care activities and organize their patients' treatment.
However, the first rule of nursing is tht nurses are responsible for the care of their patients. So why, when I show up on shift and have, for example, 10 patients to do vital sign on and 3 are isolation patints (and the floor has 2 assistants, yet 1 sleeps on shift):
- isolation rooms do not have gowns / masks stocked
- one of fthe patients has active MRSA and complains about being soaked in urine for 2 hours (incontinent)
- one of the patients complains about sitting in feces for an hour who has C-Diff
- patients are falling out of bed
- watere bottles compleetly empty
- rooms look like a tornado hit the hospital
I don't mind doing the work, but when showing up and assigned 10 paients to do vital sign, it should take me 30 minutes to get them done. Since none of the patint care duties are done by the nurses or the aides at night, a 30 minute task turns into 75 to 90 minutes. i cannot leave a patient soaked in uine/fece - we all know what that leads to in terms of compromising skin integrity. We could report these things to the unit manager, but then be labeled a "tattle-tale." if my wife was in the hospital and was left like that, I would tell the staff to leave it alone and bring the Unit Manager in to see it. Under no circumstances, except for a major catastrophe, should patients be left this way.
So the perception is there from me because this is what I see - all the time. Since I have started working on day shift in August, we had 3 codes - 2 RRT and 1 blue.
My question is more of this nature: What can I do to make sure that stigma does not apply to me? If you (in general) are upset / frustrated that this stigm is there, what do you do to make sure that stigma does not apply to you?
My ultimate concern is that I will not get much experience. One nurse I talked to who has been here for 20+ years started on nights and said all night nurses do are tasks, and there is really not much to learn. Patients usually are not discharged at midnight. There really is no opportunity to do patient education, because - at least where I work, 98% of new admits with a new diagnosis are on day shift. New medication orders are mostly on day shift and gives nurses opportunities for patient education. This has also been true at my clinical sites, where I have externed at 3 different hospitals.
Ok. I think some people are overreacting to what I said. The perception is there in my mind because, well, take a step into my world for a moment. I am a nurse student technician, it is my last semester of my BSN program, and since day 1 of my Foundations class and in all my clinicals, we are taught nurses are responsible for all patient care on their shift. Aides/Assistants/Technicians are nice to have around because they help out with many of the patient care aspects that give nurses time to do other patient care activities and organize their patients' treatment.
However, the first rule of nursing is tht nurses are responsible for the care of their patients. So why, when I show up on shift and have, for example, 10 patients to do vital sign on and 3 are isolation patints (and the floor has 2 assistants, yet 1 sleeps on shift):
- isolation rooms do not have gowns / masks stocked
- one of fthe patients has active MRSA and complains about being soaked in urine for 2 hours (incontinent)
- one of the patients complains about sitting in feces for an hour who has C-Diff
- patients are falling out of bed
- watere bottles compleetly empty
- rooms look like a tornado hit the hospital
I don't mind doing the work, but when showing up and assigned 10 paients to do vital sign, it should take me 30 minutes to get them done. Since none of the patint care duties are done by the nurses or the aides at night, a 30 minute task turns into 75 to 90 minutes. i cannot leave a patient soaked in uine/fece - we all know what that leads to in terms of compromising skin integrity. We could report these things to the unit manager, but then be labeled a "tattle-tale." if my wife was in the hospital and was left like that, I would tell the staff to leave it alone and bring the Unit Manager in to see it. Under no circumstances, except for a major catastrophe, should patients be left this way.
So the perception is there from me because this is what I see - all the time. Since I have started working on day shift in August, we had 3 codes - 2 RRT and 1 blue.
My question is more of this nature: What can I do to make sure that stigma does not apply to me? If you (in general) are upset / frustrated that this stigm is there, what do you do to make sure that stigma does not apply to you?
My ultimate concern is that I will not get much experience. One nurse I talked to who has been here for 20+ years started on nights and said all night nurses do are tasks, and there is really not much to learn. Patients usually are not discharged at midnight. There really is no opportunity to do patient education, because - at least where I work, 98% of new admits with a new diagnosis are on day shift. New medication orders are mostly on day shift and gives nurses opportunities for patient education. This has also been true at my clinical sites, where I have externed at 3 different hospitals.
It's not believable to me that at 3 different hospitals, the night nurses aren't working, there is nothing to learn, and there are no teaching opportunities. Your post does not ring true to anyone who has worked night shifts .
Ok. I think some people are overreacting to what I said. The perception is there in my mind because, well, take a step into my world for a moment. I am a nurse student technician, it is my last semester of my BSN program, and since day 1 of my Foundations class and in all my clinicals, we are taught nurses are responsible for all patient care on their shift. Aides/Assistants/Technicians are nice to have around because they help out with many of the patient care aspects that give nurses time to do other patient care activities and organize their patients' treatment.
However, the first rule of nursing is tht nurses are responsible for the care of their patients. So why, when I show up on shift and have, for example, 10 patients to do vital sign on and 3 are isolation patints (and the floor has 2 assistants, yet 1 sleeps on shift):
- isolation rooms do not have gowns / masks stocked
- one of fthe patients has active MRSA and complains about being soaked in urine for 2 hours (incontinent)
- one of the patients complains about sitting in feces for an hour who has C-Diff
- patients are falling out of bed
- watere bottles compleetly empty
- rooms look like a tornado hit the hospital
I don't mind doing the work, but when showing up and assigned 10 paients to do vital sign, it should take me 30 minutes to get them done.
As a tech, those are tasks that can be delegated to you by a nurse. The nurse cannot delegate assessments, dressing changes, order changes, admissions, etc. If you find someone left in a bad situation by previous shift, point it out to your nurse. Also, I have personally seen a patient changed and cleaned, then soiled head to toe less than 15 minutes later. More than once...I did the bed change, then had the patient tell me that the aid had left her like that for hours-but I knew better. Time perception during treatment becomes squewed
Ok. I think some people are overreacting to what I said. The perception is there in my mind because, well, take a step into my world for a moment. I am a nurse student technician, it is my last semester of my BSN program, and since day 1 of my Foundations class and in all my clinicals, we are taught nurses are responsible for all patient care on their shift. Aides/Assistants/Technicians are nice to have around because they help out with many of the patient care aspects that give nurses time to do other patient care activities and organize their patients' treatment.
True. But as I'm sure you've seen, what you're taught is an ideal. Reality is something completely different.
However, the first rule of nursing is tht nurses are responsible for the care of their patients. So why, when I show up on shift and have, for example, 10 patients to do vital sign on and 3 are isolation patints (and the floor has 2 assistants, yet 1 sleeps on shift):
- isolation rooms do not have gowns / masks stocked
- one of fthe patients has active MRSA and complains about being soaked in urine for 2 hours (incontinent)
- one of the patients complains about sitting in feces for an hour who has C-Diff
- patients are falling out of bed
- watere bottles compleetly empty
- rooms look like a tornado hit the hospital
Who is responsible for stocking? Making sure water bottles are filled? Making sure the room is nice and tidy? Everybody. And yes, I hold physicians in that group - I may have a different attitude towards them, but they can certainly refill a water bottle for a patient.
I don't mind doing the work, but when showing up and assigned 10 paients to do vital sign, it should take me 30 minutes to get them done. Since none of the patint care duties are done by the nurses or the aides at night, a 30 minute task turns into 75 to 90 minutes. i cannot leave a patient soaked in uine/fece - we all know what that leads to in terms of compromising skin integrity. We could report these things to the unit manager, but then be labeled a "tattle-tale." if my wife was in the hospital and was left like that, I would tell the staff to leave it alone and bring the Unit Manager in to see it. Under no circumstances, except for a major catastrophe, should patients be left this way.
So the perception is there from me because this is what I see - all the time. Since I have started working on day shift in August, we had 3 codes - 2 RRT and 1 blue.
Everybody has a different idea as to what a major catastrophe is. For me, a code doesn't count. But then again, I'm just a night shift nurse in an ED...so obviously I'm sitting around with my thumb up my butt, not doing my job. Codes are easy. Now, two different patients that are actively crashing? That's something that gets a little challenging to work around.
Or, things like stocking are everybody's responsibility. What is a red flag here, though, is that one assistant is sleeping on shift. That's poor management on the part of the unit manager and the charge nurse.
My question is more of this nature: What can I do to make sure that stigma does not apply to me? If you (in general) are upset / frustrated that this stigm is there, what do you do to make sure that stigma does not apply to you?
I do the best damn job that I can do. Simple as that.
My ultimate concern is that I will not get much experience. One nurse I talked to who has been here for 20+ years started on nights and said all night nurses do are tasks, and there is really not much to learn. Patients usually are not discharged at midnight. There really is no opportunity to do patient education, because - at least where I work, 98% of new admits with a new diagnosis are on day shift. New medication orders are mostly on day shift and gives nurses opportunities for patient education. This has also been true at my clinical sites, where I have externed at 3 different hospitals.
Since when was patient education done only on admission or discharge? When you're in a room with a patient, do you stay completely silent, or do you talk with them? Questions arise at every minute of every day, and the patient may not feel confident enough to just ask them out of the blue. "Do you have any questions/concerns for me?" is part of my assessment and something that I ask every single time I see a patient. And suddenly yes, they have a question because they were looking up this thing online and it said this...
From what you've written here, you are damning yourself before you begin. Hiring managers don't care what shifts you worked, they care that you know your stuff.
Everything can be qualified as a task. It's a nursing task to teach patients ways to manage their diabetes. It's a nursing task to sit there and hold the hand of a parent who was just told that their baby died. It's a nursing task to critically evaluate all of their patients and prioritize various and sundry things before going and doing the tasks of doing them. Delegation? Yep, that's a task, too.
Scarlettz, BSN, RN
258 Posts
I thought night shift was going to be so chill. WRONG! For instance, I was on my feet for 11 hours last shift. I only had 1 hour of charting time.
-We don't have aides - days does.
-We draw all our labs between 10 PM - 5 AM
-We have just as many admits as days
-We do discharges sometimes during shift change/our big night pass, which is a difficult time to do so.
-We catch orders that are overlooked/missed on days. This happens a lot and it takes up a big chunk of time to get caught up.
-We do all our vital signs and ADLS on our pts
-Patients often pay more attn. to their pain at night because they are not as busy as days. We give lots of pain medications during night shift.
-We do assessments, start IVS, foleys, NG tubes, give medications, etc. All the same stuff days do.
-Sundowners. Sometimes 2 of your own patients.
A respiratory therapist once said to us, "Days is always getting lunch and the night nurses do more work than they do." I am not saying that this is true (heck, it depends on the person IMO) But, it is nice to know that someone acknowledges and actually witnesses all the hard work we do.