Night shift nurse responsibilities

NurseQT · Apr 19, 2014

I have worked both days and nocs, both can be very hectic and stressful, working different shifts at different facilities made me realize that a lot of it has to do with what tasks are designated to what shift as well as the nurses that are working those shifts. My first night shift job we did a lot of the paperwork that was harder to get completed on the other shifts when the residents were awake. We did the discharge summaries, infection control tracking, and checking the MARs every month. My second NOC shift job had very little paperwork to do and some of the nurses were downright lazy, I was actually told during my orientation "we don't do charting on nocs.." What?!

I have also encountered some pretty useless nurses that work nocs (won't draw labs, won't call the family of a dying resident because they don't want to wake them up, will get abnormal vital signs at 0300 and won't f/u on it..) I'm not saying all or even most NOC nurses are lazy, or that there are no lazy nurses on days. I just think that there are some who will use the NOC shift as an excuse to not so some things they should be doing...

The OP should bring her concerns to the NOC supervisor, and do so in a way that's not accusatory towards the NOC nurses. Maybe those nurses are slacking a bit, maybe the shift is busy, maybe some tasks could be swapped around to make each shift run smoother. The best way to resolve something like this is to work together on a solution, the three shifts are all supposed to be a team and should attempt to really work as one..

BuckyBadgerRN, ASN, RN · Apr 21, 2014

My night shift is a 12 hour one--from 6p to 6a, so yes, this night shifter deals with sundowners!

Sundowning occurs literally when the sun is going down....not on the overnight shift. But, you're right....they have their share of behaviors to deal with.

BuckyBadgerRN, ASN, RN · Apr 21, 2014

Another NOC duty that has come to mind now that pharmacy has been here, NOC nurses are responsible for changing out the cycle fill. Meaning that we have to change over all of those empty med cards for the full ones that pharmacy has just dropped off. For me that is four tubs FULL of meds that all need to be verified against the MAR so they get put into the drawers in the correct order. Last month it took me over 3 hours to change out two carts. THIS month cycle fill is going to happen on my off night. I'm not sad!

MinoritySN · Sep 24, 2014

Well for me nights are extremely busy just a different kind of busy from day shift. After report its med pass, and treatments. Notifying MD of changes of change of conditions for new orders before 9 pm for patch calls, chart checks and taking off orders, and of course documentation. Then as soon as your busy pharmacy delivery stops you again. Then its all the discharge paperwork for the day nurse (writing out ALL) the meds and completing the discharge packet and making appointment packets (for follow appointment with ortho, cardio, etc). I also would complete admissions from the day shift did not. Hourly checks (people code at night) not to mention sundowing, and/or behaviors. All checks for crash cart, and medication fridge. Maintain IV etc hanging a new for the day shift was a MUST for me to help out. Glucometer highs and lows, stocking the med cart for day shift!! I can go on and on I NEVER had a break

Long Term Care Columnist / Guide · Sep 24, 2014

I remember running my rear end off on NOCs. Literally. I lost 40 pounds in the year and a half that I worked NOC shift in LTC. For some reason the RCM liked to schedule treatments for 0500, which meant waking up sleeping residents for such things as lotion to their feet and legs. I guess she didn't think I had enough to do.

I had 60 residents, 3 CNAs, and no med aide. About half of the residents got thyroid medications, Prilosec, osteoporosis drugs, and/or Tylenol at 0600. I also changed out all the tube feeding and oxygen equipment, did skin checks, got all the UAs and lab draws, made up packets for doctors' appointments, restocked carts, gave PRNs all night, dealt with falls and behaviors, did glucometer checks, restocked the med refrigerator and made sure the temperature was WNL, checked all the insulin bottles for open dates and flagged the ones that didn't have them, received nightly med deliveries, AND helped the aides with their work. Phew! Thank goodness I was a lot younger then.....I'd never be able to do that now.

MinoritySN · Sep 25, 2014

Exactly!! I also helped the CNAs giving that I use to be one. NOC's are crazy, and I don't understand why they think the shift is easier LOL!!!

TardisMom · Sep 26, 2014

We are very busy on nights at my facility, on night we are expected to:

Do 12am and 6am medpass and accuchecks.

All wound treatments on non alert and oriented residents.

Clean and stock med and treatment carts and check for expired meds.

Take deliveries from the pharmacy and process all return meds.

Do 24 hr chart checks.

Do accu-check quality control checks.

Check and replace all the full sharps containers.

Skin checks and weekly nurses notes on non-skilled residents.

Skilled charting.

Quarterly MDS assessments.

Complete Admissions assessments and put in orders that weren't finished on 3-11.

Start new 24 hour charting.

Update the daily census for the unit.

Make out appointment envelopes for the next day's appts.

Clean the nurses station and med room and do the filing for the day.

Do temp checks on fridges and check the crash cart.

Help the CNA's do turns and lifts since we only have 3 for 60 residents.

Change over all the ADLS and do monthly VS and charting on the first.

At least one fall or skin incident a week as the residents tend to get confused more or have increased behaviors at night.

Make out updated report (brain) sheets to reflect any changes on the unit.

Fill out lab requisitions and call to arrange x-rays/diagnostics for the morning.

Reorder narcotics that need new scripts.

Replace all Tubefeed, IV, O2 tubing and materials.

I am sure there is more but I can't think of it right now, point is, night shift does a lot of things you may not think of but they add up. I think all nurses, regardless of shift, work very hard.

MinoritySN · Sep 26, 2014

Exactly this is why I say every shift just has a different kind of busy

Whit2389 · Sep 18, 2015

I'm still in orientation. Our night shift is 10p-6a.

When we first arrive we do narc count, clear off the med cart, receive medications from the pharmacy delivery guy & do the paperwork on those and fax them to the pharmacy. We do our 11:00 med pass anywhere from 10p-12a which mostly include sleeping meds, antianxiety meds, and pain meds. We make rounds, do the midnight census, check our wanderguards for our wanderers, etc.. Make sure our pt who get O2 at night or use cpaps are all set up. We do neurochecks if a patient has fallen and chart on them, chart on our medicare patients, chart on anyone receiving antibiotics, etc.. hang IV fluids or medications. We do a 24 hour check on all new doctor's orders (get the order, compare it to the mar, mark that it was checked and correct or mark if it needs to be clarified). Trust me, the doctor does not want a 2 AM phone call about the correct dose of simvastatin on a stable patient. So then we have gtube & peg tube feedings. Sometimes an Alzheimers or behavior patient will cause a huge ruckus and wake up half the hall so we then try to meet all those patients requests. We write lab orders into the lab book, the lab lady comes at about 4am to draw blood but we have to draw if it's from a picc. A lot of times we will also be asked to draw if the pt is combative or a hard stick. We complete any incomplete admissions paperwork or duties that show up red after midnight (which means they weren't done by other shifts). Defrost the refrigerator, check equipment (glucose machines), check refrigerator temps. Begin AM med pass between 4a-5:30a. Complete trach care. Document, prep patients who have appointments in the morning (get their charts copied, showered, dressed, etc..). Get our early risers up. If the oncoming nurse is running late then we start blood sugar checks. Every once in while there will be a wound treatment but most the time we just check the bandage and reinforce as needed. And that's just off the top of my head, I'm sure I'm missing some things..

YumCookies, BSN, RN · Oct 8, 2015

Let's see, after getting report and counting the narcs on the 11-7...going through MARS/TARS, midnight med pass, verifying orders, checking the code cart, checking the glucoscans, stocking the med/tx cart, returning discontinued meds, discharge paperwork for the next day, 0600 med pass that starts at 0500, tape recording report, counting narcs again, and charting. Oh, and not to mention a million interupptions, i.e pain, trouble sleeping, fevers, SOB, n/v, new skin issues, confused pts wandering etc etc...

There many not be as many medications/treatments on night shift than there are on days/evenings but we are responsible for more patients with far less staff/support from management. As a new grad, I've had to learn and figure how to do things on my own since I am the only nurse on my floor at night and the night supervisor isn't always around to answer every little question I have (she also has her own patients to worry about). I have worked days/evening shift and I do not believe there is a shift that is easier/harder than others, but rather each shift comes with their own challenges. There is a lot more people on days/evenings (staff and families), where there is typically more staff support but it can also create more drama/hassle to get things done. Nursing is a difficult and stressful job no matter what time of day you are working.