My facility actually has 2 transitional care units, each with 16 beds. During the day, two nurses staff each unit with a max of 8 patients while at noc, there's one nurse to the 16 residents. Now, the evening med pass is a breeze--the first SNF I worked at, I was the only nurse for 48-53 residents, so I got pretty efficient at the med passing business--16 is easy peasy. But, at night, there's little to no back-up for emergent situations, which do occur. We are getting people sooner from the hospitals, so they are sicker and more delicate. Most get stronger and go home, but there are some who experience respiratory or cardiac issues, infections, complications r/t the emergency surgeries that they went to the hospital for originally, so you have to be pretty on top of your assessments and dressing change knowledge, and be willing to actively advocate for your patient if you see something amiss. During the day, there's another nurse, the unit manager, and others around in case something occurs, while at night, you really don't have a lot of backup. Our facility requires that all the nurse managers, and all of the nursing administrators (from DON down) to take call, so you can always call them, but it's not quite the same as having another nurse in the building with you.
As far as less acuity at noc because all the patients/residents are asleep--that's kind of a running gag with noc shifters. It can be quite busy, especially since you generally have fewer people to answer lights, help people to the bathroom, deal with outbreaks of Noro-virus and other such things. I actually prefer nocs partially because there are fewer managers around, getting in the way of me doing my job, but probably at first, I'd recommend a new nurse stick with days--you'll get more exposure to the different jobs that the PT, OT, ST folks do, deal with more of the dressing changes, so you'll see more wound care (which I find fascinating), and not be alone in crises.
If your facility has an in-house hospice facility, that's worth checking out too. I'd love to do hospice, but right now with my Dad dealing with stage IV lung cancer, his chemo not working well anymore and me looking at going through hospice stuff with him, I don't think that's the place for me yet. It's a special privilege to be part of someone's last days, to help make that terrifying event less terrifying to the patient and the family, to be part of easing fears, finding solutions to difficulties as they come and finding ways to truly be a patient advocate. Sometimes that means wading into icky family dynamics, going toe-to-toe with providers, and encouraging the proper use of pain medications--which many people don't want for fear of becoming addicted. Even as they lay dying. It may not be med/surg, but it really encompasses the full range of nursing skills and is an honorable use of your days/nocs.
