switching to night shift

[bdbrdb]

Hi guys,

I just had some questions on working night shift. I will be switching from days to go to nights next week and I am nervous. I've been working days for 2 yrs at a LTC, never worked nights. I guess the thing I'm mostly worried about is sleep, I'm not sure if i'll be able to sleep during the day. How do you manage your sleep schedule?

Also is it okay to call family members and update them on any changes, such as say a resident is going to the restroom and he trips and ends up on his knees or sits on his bottom, he's fine, no injuries, no complaints...do you need to call the family as soon as your done assessing and making sure he's okay, or is it alright to wait til the morning right before your shift is over? I only ask because I know that even during the day a lot of families seem as though you are bothering them by calling to report any changes. And I know you definetly call if they need to be sent to the ER or anything that is serious.

How do you manage your time? i'll have 3 hallways for med pass @ 8p and 6a. 6a med pass worries me, day shift comes in by 6:45a. So i'm worried I won't get meds passed and have day shift nurses waiting and upset that things aren't done. I know how the day shift nurses that I work with can be like, they often get upset when the new noc shift nurses aren't done with things.

Any suggestions would be great. I'd appreciate it :)

[MassED, BSN, RN]

I haven't worked LTC, so can't really offer real world advice for that setting, but that said...

I would start my Am med passes a lot earlier, at least an hour prior, but depending on how many residents you have, you may need more time than that. I wouldn't sweat difference from day to night people - they all have their gripes of each shift. Who cares, it has always been there and will always be there. Do your best and don't apologize if work has been left for them. That's what a 24/7 facility is all about.

I started exclusive nights 2 months ago. I was scared of how I would sleep and adjust. I have done well. I work 12 hours 7p-7a essentially. It depends on your home support and the individual time you need to sleep and then function that night for work. My best advice I can give you is to not believe too much of what you read that people post on their experience. It's like having a child, you don't know what to expect until you do it yourself. You may love it and be surprised with the adjustment. You may hate it, but give it the 'ol college try. Sleep is the priority, though, so have a good plan in place to get some uninterrupted time and save house and other stuff for another time. Good luck!

[wifeandmomoftwo]

I'm just a new grad but in our facility you don't have to call the family at night unless they are being sent out or have requested to be called for any changes. You can fax the doctor if the incident was witnessed and they didn't hit their head. If they hit their head or the incident was unwitnessed you must call the doctor.

I oriented on days for two weeks and the difference is incredible. Nights are so much quieter and laid back. Med passes are very light in comparison to days so being an experienced nurse I'm sure you'll be fine.

I'm having trouble with waking up when I should still be tired. I get off at 7, home about 8, lie down about 8:30 and wake up between 12:30 and 1:00. Then I get tired about 7pm. I'm ok though once I get to work. I did cover the windows in my bedroom to simulate night time and I run a fan for some white noise.

Good luck!

[AtomicWoman]

I haven't had any trouble sleeping during the day, thank goodness. My husband is good about tip-toe-ing around when I am sleeping. You will have to find your own rhythm. For me, the toughest day is the transition day -- I have to go work that night, but I've been living a daytime schedule on the days prior. So on that day, I get up, do some errands or chores, and then force myself to go back to bed in the afternoon and get a few more hours sleep. Otherwise, I would be too sleepy that first night. I would definitely start the 6AM med pass early. At my hospital, we start around 5 AM, and do our vitals as we pass the meds.

I only work weekend nights, BTW. I do like the night shift a lot. Much easier to get documentation done. :) But people sundown and that keeps us hopping some nights! Not to mention running every time a bed alarm goes off.

[KaitRN]

I worked in LTC for a year and did a few night shifts there. Now working at a hospital and am doing exclusively nights. I really enjoy nights. It can be crazy at times and there's not as many people there, but that can be a benefit as well. I find that most of the time, you are able to give yourself more time to assess your pts., etc. Sleep with an eye mask and ear plugs- it helps! As for med passing, in the hospital its not too bad, but I know from passing meds in LTC, it can take well over the alotted amt of time. I'm not saying that you should do this, its a big no-no BUT i know at my old LTC facility, most of the night nurses would pre-pour their 6am meds, write the room # on a seperate med cup and place that med cup on top of the pre poured meds, and hide them in their med carts. Also start right at 5 am passing meds. I was always nervous about pre-pouring my meds although the older nurses swore "everyone did it", so instead of pre pouring, I would arrange my meds in the med cart according to when you need to give them. If you use the big square med packs where you just pop out the meds, just arrange each pts meds in order in your cart. That way you can just go down the list in your MAR and pop each med out in order. Makes it a lot faster than filing through all the meds. (you'll have time to organize your med cart at night- a plus!) I hope this helps!!

In regards to calling families at night, I would say wait until the end of your shift to call, if its not an emergency..

Good luck! I hope you like it! I find that people on night shift are more helpful than ppl during days sometimes!

[classicdame, MSN, EdD]

When I worked nights I "trained" friends and family not to call me before 3:00 p.m., EVERY DAY. They could not keep up with my schedule, so I did not want them calling any day unless extreme emergency ( and there better be blood involved). I bought a piece of black vinyl from the fabric store and glued it around a tension rod that fit in my window. When I wanted to sleep the room was dark. Otherwise I could take it down, roll it up and store it under the bed. I tried to keep same hours even when off, unless I was off for several days in a row.

As for other questions, I have never worked LTC so cannot advise. I do think your facility should have a policy on when to call the family so you do not get caught in the crossfire when someone says you should have done-----

[Byrnowt]

I have worked with people who loved and hated nocs. I had to do them for several years but never got used to them. Developed PSVT over time, which has never returned since I stopped. Part of the problem was I would sleep at night on my off days. While it's great to have the day off, you really don't. You still need to make sleep a priority. I taped foil on my bedroom windows, wore earplugs and the phone essentially had no ring tone. You will find that the general public is not sympathetic to your schedule. You will also find the most laid back staff on nocs. None of the ivory tower or suit types around! It did annoy me when inservices/mandatory meetings would be held in the middle of the day with no consideration for our shift. Hope you enjoy it!

[tyvin, BSN, RN]

When I worked nights in LTC of course I pre-poured and started my med pass at 5am and then when that's done you do the sugars because if your facility is anything like the ones I worked in there are buku sticks to be done.

As far as sleep some can handle nights and some can't. I had my windows blacked out in my bedroom and no phone on. Also I constructed a large sign for the JW's that constantly woke me up. I can't tell you what was on the sign; it could tarnish my sterling reputaion. Anyway........I never really seemed to have a real day off because I found I needed to sleep during the day no matter how well I planned it.

[BSNBritt]

I only worked days, and used to be a morning person, but now I'm working nights full time. On my days off I typically sleep from about 0300 to about 1200. The biggest problem I've had with working nights, is feeling like I miss out on more during the day. Sleeping during the day hasn't been an issue for me. My tips are as follows:

Light blocking drapes

Cell phone setting of "alarm only"

and going to bed as soon as possible once getting off work.

Works for me, hope it works for you!

[rnto?]

I'm working M-F 11p-7a as RN supervisor in LTC/SubAcute, but I also have a 6month old that I'm breastfeeding. I have plenty of time to pump on this shift, whereas on daylight -ya right! I have a white noise CD for the baby that I use during the day, and an eye mask really does make a HUGE difference. I have to wake up to breastfeed. I occasionally do have trouble falling back to sleep. I feel like no matter how much sleep I get, I always feel tired. I've talked to other nurses who feel the same. As far as I know it is not illegal to pre-pour, as long as you can adequately maintain each individual patient's pills and not mix them up. When I worked for a special needs school that's the only way they did it to get the pills to the kids. However, at our facility each patient has their own individual slots, which makes it easier. Start at 5AM for your med pass-just be careful to stick to your hour window. Our facility changed the time of some meds so that our nurses could stay in compliance with the time frame.

As far as calling families, generally I will wait until 7AM and call right before I leave unless I'm transferring someone to the ER or something.