nights vs days

Altalorraine · Oct 8, 2005

Let me start by saying that I L-O-V-E my job and I absolutely love working nights, but there are some things between night and day shifts that just irk me.

I've worked both night shift and day shift, and where I work day shift is 10 times busier- more residents, more students, more families, more triages, more postings AND ... less pay.

Rain

christvs, DNP, RN, NP · Oct 8, 2005

Let me start by saying that I L-O-V-E my job and I absolutely love working nights, but there are some things between night and day shifts that just irk me. At my hospital, day shift nurses (med/surg floor) get a max load of 4 patients, on nights our max load is nine. I understand that this is not a big deal and I am ok with that. Day shift is always complaining about how many discharges/admissions they have and how much harder it is on days. On average, we get almost as many admissions as they do on days, but we do not have a ward secretary to help us with the paperwork AND we have twice the number of patients they have. We are responsible for 24 hour chart checks AND MAR checks as well. I am consistently being left new orders for 3-4 patients at the begining of my shift (some of them have been taken up to 45 minutes before day shift ends). A lot of this I can just overlook as being "just how it goes" but the kicker for me was last night when I was talking to a nurse that usually works days and we were talking about two of our more "memorable" patients from a few weeks ago. One of the patients was a 101 y/o who was a breath away from coding on me all night (yes, she was a full code). I had three major episodes with her each lasting close to an hour. I struggled with this all night long on top of caring for all of my other patients (including one who had an episode of respiratory distress). I was on the phone with her docor no less than 4 times that night. Well, as soon as 0700 came, she was on her way to the unit (before I even got off the floor). This much I knew and I was a little upset about it bc she seriously needed to be in the unit from the get-go. The other patient was a male with a hemoglobin of like 5. You may remember this from one of my earlier posts---he had just enough brain damage to be ornary and combative. He ripped out 2 IVs and smoked in the bathroom 3 times (all while getting blood). I had called the doctor a couple of times on him bc I could not get him calmed down and the only order he gave was for 1 (that's right, ONE) mg of ativan. I left work that morning quite frazzled to say the least. Well, as it turns out, day shift got an order for Haldol less than two hours in to their shift bc they just could not handle this guy. Don't get me wrong, I am not a big fan of restraints be it chemical or physical, but we really needed something for this guy. I just don't understand why day shift was able to get and order when I could not. Every one seems to think that all the patients just sleep at night so there should be no problem. In all reality, what I have found to be true is that they just get wilder as the sun goes down. Every patient on the floor is calling for pain meds as soon as the night shift nurses get to the floor. All their visitors have gone home and there is no one or nothing to distract them from their pain or boredom. Throw in all the one million other things we have to do and it makes for a very "interesting" (please note the sarcasm there) night. Does everyone else on night shift have this problem as well? If so, please give me some tips on how to get the doctors to take note when we are having a problem with a patient. I have had doctors tell me over and over that they will "deal with it in the morning." Yeah, they'll deal with it in the morning---meanwhile I am up to my elbows in it right now!

I've worked 7-3 & 3-11 but have never worked 11-7 so I can't really comment on that shift. However, I firmly believe each shift has its ups & downs, & that no one shift is "better" or "easier" or "busier" than the next. I work 3-11 PM right now & get about 2 admissions each shift, so that part can be tough when i'm trying to juggle my other patients too. But our patient load is less than the night shift nurses. I don't know how it feels to have 9 patients! I believe you when you say it can get crazy! I usually have 4 or 5, although lately I've had some pretty complex, needy patients. Anyhow, my point is, don't listen to anyone telling you that their shift is way busier than yours. It doesn't matter anyway, cuz this isn't a competition. Hopefully you are enjoying your job & are not too stressed out. That's what I try to tell myself at the end of my shift-to try to focus on positive things I've accomplished. :) I've only been a new grad RN for 3 months now, so I'm trying to stay positive from the start. :)

-Christine

wanda06211 · Oct 8, 2005

I've worked both night shift and day shift, and where I work day shift is 10 times busier- more residents, more students, more families, more triages, more postings AND ... less pay.
Rain

I've worked both nights and days at my hospital as well. On days, there is a more steady flow of patients (discharges and admissions), but there is a ward secretary and a doctor around every corner it seems. At night, (depending on which doc is in the ER) our admissions vary from day to day. One day last week, we had 4 admissions in 45 minutes (with 2 nurses on the floor). At our hospital, day shift faxes their orders down to pharmacy and pharmacy enters the meds in the computer and sends them up. On nights, nurses have to enter the meds and go find/mix them as well. On nights, we are responsible for MAR checks, 24 hour chart checks, QC checks on the glucose monitors, re-stocking all med carts, updating the worksheet, and prep any patients who are going for any surgery or procedures the next day. I'll be the first to admit that when it is slow, it is REALLY slow, but when it is busy, it is completely overwhelming---however, this is not the problem as I see it. My problem lies in the fact that it seems that doctors think that when there is a problem, it can wait until morning comes to deal with it. I can handle all the other stuff as well as 8-9 patients no problem as long as I don't have a patient "falling out" on me every couple of hours or one that is so unruly that I cannot leave his beside long enough to take proper care of the others. My problem is also in the fact that when we have these "hairy" nights, day shift comes all unglued if they have to check the glucose monitors or do a few of their own MAR checks. I understand that nursing isn't easy on any shift, but night can be as rough as days, and what I really would like to be able to do is to cut out all the competition and pettiness between our shifts and figure out how to get the doctors to take problems (and nurses) as serious at night as they do during the day. From what I can gather, though, ending world hunger would be a much easier feat! LOL! ;-)