Night Shift Advice

[Neveah.]

Hi fellow nurses,

I wanted some advice. So a little background I did outpatient clinic nursing (ortho, gi, and once) for three years but didn't really provide any hands on care besides VS, wound care - removing staples/sutures. Our clinic wasn't set up for med administration at the time. Then I went into case management for another two years. I've made a decision to get my hands on and was offered a night shift position 11-730 pm at our local hospital long term care unit. I'll have 27 residents assigned to me.

I want tips in regards to what worked for you when it came to getting sleep and getting the skills down. I was told training/orienting is up to 2 weeks and can be extended as needed. I'm a just a little worried since I'll be the only RN on the unit after orientation. It wouldn't be so bad if I had another nurse with me that I could ask for help but thinking about it, it's just getting back into the skills that worries me the most. I was thinking of shadowing the nurse the first few days and then have her/him observe me afterwards, like be in control and do it all so I can get a feel and get lots of practice and ask all the questions during that, learn as much as I can and go from there. For me I don't really think of questions till I start doing something. 

Any insight would be really helpful. ? For me this will be a really big change and out of my norm/comfort zone. I always did days and always had someone to ask for help if I needed it. So as much as I'm excited to try something new, I'm also terrified. THANK YOU. 

[Davey Do]

5 hours ago, Neveah. said:

I want tips in regards to what worked for you when it came to getting sleep and getting the skills down.  

Having worked eight hour MN shifts for nearly 15 years, I can say that sticking to a MN schedule is the key. I slept from about noon to eight everyday and was generally okay with the world.

When I went to 12 hour MN shifts a few years back and attempted to flip flop back between MNs and days, things got out of whack- I didn't function as well and was felt generally uncomfortable.

For most people, staying on a MN schedule is not an easy option due to family and social responsibilities. Having no children, being a recluse whose wife worked MNs, and staying on MN schedule was relatively easy for me.

Congratulations on the job offer and good luck to you, Neveah!

[Neveah.]

Hi Davey, 

Thank you so much for the great advice. I can see how it'll be a challenge switching shifts because that'll just throw me off course. Your advice really reassured me. Thank you again!! 

[Been there,done that, ASN, RN]

 

You have three challenges facing you. The adjustment to midnights, responsibility for 27 patients, and learning medication administration. 

"a night shift position 11-730 pm". I am assuming you mean 7:30 AM.  First thing you need to do is learn the difference between AM and PM, especially when it comes to charting. Some people can adjust to midnights, I never could. Could not tell the difference between night and day sometimes. I lasted 9 months and made a LOT of mistakes.

I also did LTC, briefly. The main responsibility is medication administration. I was already experienced in that area and could not keep up with the med passes for that many patients. You cannot possibly know that many patients history, how it affects each and every pill you must push, and the biological action of all those meds, in a two week orientation.

 I fear you have bitten off more than anybody could chew.  I am concerned about the facility that would hire a nurse with only clinic background... to be responsible for 27 residents. A BIG RED FLAG.

[Neveah.]

Hi! 

Thank you for your input I really appreciate it. Everyone's experiences are different and we'll see where this takes me. The manager is supportive and is willing to provide me additional training and support to succeed. They have a few nurses who only had clinic experience prior to going into it and have been there for 5 years and are happy with where they are. 

The hospital outpatient clinic I worked in we saw 20-30 patients per day with only a clerk and 1 medical assistants and I had to manage three specialties on my own. It was a lot of triaging, paperwork, multitasking, and the doctors I supported were so busy focused on clinic that they expected me to do everything else which I enjoyed. I mean a lung cancer pt would come in with dyspnea expecting to see the doc w/o an appt but I'd do a thorough assessment and versus sending him through the ED since it's so busy I'd contact radiology directly to have them do an ultrasound guided thoracentesis. For all those times I did that, I was right and would have liters of fluid drained from their lung with immediate relief. Of course I'd notify the oncologist prior to sending pts on their way and they'd  agree with my judgment and are grateful I saved their time. It all depended on the situation of course and judgment. I also had my own patients to see in clinic for chemotherapy clearance. When I went into case management it's a much slower pace managing 90 patients since Im not doing any running around than what I did at the clinic and I just really missed being busy, I missed the fast pace, and that's what brought me to my decision of leaving something comfortable.

You're absolutely right I will be faced with three challenges and I'm ready to face them head on since it'll help me grow. I am worried but excited at the same time. Per the nurses working there, it gets to the point where I do the same thing everyday repetitively for the same residents that I'll just learn to get used to it and they recommended the night shift to start. As they all did and when they transitioned to days or mid shift they felt the pressure but because they warmed up on nights it was easier to transition. They told me there's a nursing supervisor avail for assistance if I need it. I'm young and I don't have kids so I figured I'd do this now than later. 

Again thank you for your input and concern. Patient safety is priority and I'll be taking everything into perspective and like you said med admin is the biggest so I'll freshen up on those skills. I will be planning on studying up and leaning on to my colleagues for support. Other skills such as foleys, g tubes, etc I'll freshen up on those too. Shifting my CEUs to be focused on Geriatric and LTC nursing to get the most out of it. I'm pretty determined and will do whatever it takes to ensure I'm providing safe care. I had to take care of my mom and sister who were both dying of cancer. They passed on but they're one of my biggest motivators at always giving it my best. 

Thank you again and have a beautiful day!