ZenRN181

I've worked nights on and off for about 10 years- I have many stories from calling providers in the middle of the night, good, bad and funny. Bad story: My patient status post-GI surgery complains of chest pain at 4 am, I call the intern and no response, CP worsens so I call the rapid response team. I was yelled at for not calling the intern first and wasted rapid response time. After I persisted something was wrong I did a repeat EKG and she was having an MI. Good story: After accidentally calling an attending he laughed and said I made him feel young again! He advised me on what to do and asked I pass it along to the intern covering. Ugly: Being screamed at for calling an on-call Dr and waking up his baby... Worst: When I called to get a med order corrected, a Dr told me "how dare a nurse question a physician's orders" Here is my simple list of what to do at 3 am 1. Know who is on call. I once paged a surgical attending at 3 am instead of the intern! Luckily the attending thought it was funny and was very kind about it. 2. Have your data ready when you call: Why you are calling, last set of vitals, last labs, I/Os, etc. Don't assume the person you are waking up at 3 am is instantly going to know which patient you are talking about or if they've ever seen the patient 3. Check your orders to ensure you don't have what you already need- PRNs, labs, NPO etc 4. If you're not sure about something check with a more senior colleague, they are a wonderful resource 5. If you are not getting a response from a provider don't be afraid to go up the chain of command, it's there for a reason! 6. NEVER apologize for calling a provider; everyone is on the same team and caring for the patient, it does not matter what time you're calling with patient care concerns 7. ALWAYS repeat back what the provider says to confirm; you can hear some funny things after you woke someone up, I've even had a doctor fall asleep on the phone with me!! It's always awkward if you have to call back 10 minutes later to clarify an order. 8. SBAR- it works, use it, love it, and it cuts down on communication errors. 9. If someone is being inappropriate when you called- screaming, swearing, berating or refusing to call back; report the person to the appropriate person. This behavior should never be tolerated 10. If dealing with the person mentioned above in #9 remain calm and professional and report them to the appropriate management 11. Creativity and problem solving can go a long way on night shift and prevent the need to call anyone. If your patient is constipated and has not GI meds ordered, take them for a night time stroll, give them prune juice, etc. If your patient is anxious, sit down and talk to them for a while. Sometimes talking can go a lot further than any meds. Even if it's asking your patient about their kids or dogs or their job. Patient care and safety always come first, never be afraid to call the provider. To make everyone's job easier and for the best possible patient care. The night shift is there for a reason. Patients crash on night shift and have unexpected needs, don't feel bad, take care of your patient. From your friendly neighborhood night shift nurse practitioner

-No job is perfect, ever!! Make a list of pros and cons and think of the pros on bad days -Even if you switch jobs you could HATE your new job, the grass is not always greener on the other side -Make a five year plan and start working towards it- can you volunteer in the ED or shadow? Take ACLS, PALS etc now so when you do interview for your dream job they will be very impressed you took the time on you own to better your skills, take classes to be a paramedic? Anything to get you closer to your goal -Can you switch preceptors? - Med surg nursing is an excellent base for any specialty in nursing -Have a life outside work, only deal with work on work days -It takes at least six months to get comfortable -Nursing is very difficult- it does not matter if you're in a new grad residency

Learn something new every day, there's many ways to do the same thing!

We would only rapid response for pain meds or admission meds if the physician wasn't responding for a certain amount of time. Running to help at a code blue or rapid response if you are not assigned to is not usually helpful. Typically there are way too many people in the room and lots of confusion on roles. However as a new grad, I do recommend watching like a fly on the wall to see the flow or do something you are comfortable with like chest compressions (not recording or drawing up meds on your first code). Also keep in mind the ICU usually has a RN assigned to respond to all codes and RRTs.

My first nursing job working nights, my body was so out of whack I lost 15 pounds. I quickly gained that back and then some when I switched to days and started grad school . I have recently lost 10 pounds while working full time rotating shifts with 30 more to go and here is what works for me. -Always meal prep (work days and non work days) I usually make large portions then freeze what I don't eat so I have ready to go meals if I'm too tired to cook after work -Always bring your lunch to work (saves a lot of money and you know exactly what is in it) -On my lunch break I like to climb the stairs to get extra steps in - I use weight watchers app to track all my intake and portion sizes -The biggest help for me is finding a way to NOT be a stress eater!! I love sweets and it is my go to comfort food (and pizza). I started blogging about nursing and doing yoga- this has helped so much -Stay hydrated- I know this can be really hard as a nurse! Good luck!!

Always return their phone call! If you were receiving a call, they are interested in interviewing you. Even if the job they called about initially was filled, they could very well have another position in mind for you. Just simply return their phone call and apologize for the delay in returning the call (you don't have to give them a reason). Good luck

In order to take care of others, you need to take care of yourself! I have been in your shoes and it does get better! Take your lunch break (many places do not pay you for your lunch break, FYI), I like to walk outside if the wether is ok or do some simple yoga/stretching in the break room, read a book, meditate etc. When I'm most overwhelmed or scared, I give my self 2 seconds to feel the anxiety then take a deep breath and move forward with the task at hand. Keep up the good work

I love being a nurse and now a nurse practitioner but they are both very difficult jobs!! It will not be easy and you need to be dedicated. My advice to you is to do as much research as you possibly can- this website, nursing blogs, job shadowing, volunteering etc. I am so happy with my career but it is not for everyone. Good luck!

Vinegar for sure! Another trick that works for me is putting my deodorant on at night before I go to sleep, I sweat way less.