Thinking about trying night shift...

Ruby Vee, BSN · Jan 5, 2008

there are many threads on adjusting to night shift -- do a search and you'll be overwhelmed with all the suggestions/ideas you find!

you've mentioned two very good reasons for switching to night shift: your family time and the increased pay. many of the moms i know wouldn't work any other shift -- they can come home from work, drop their kids at school then go home and sleep until the bus brings the kids back home. they have evenings with their families, and they save a lot on day care because their husbands are home with the kids at night while they're working.

i also found that working nights was an excellent time for learning: i had downtime some shifts to look up meds, disease processes, surgeries, etc. i could look up policies and procedures, had more time to replace that ng tube or foley that a confused little old dear pulled out and had experienced nurses around with time to answer my many questions. (now i'm the experienced nurse -- how did that ever happen?) usually night shifts are a more stable, cohesive crew. there's also less management, ancillary services and visitors -- another big plus in my book!

if you choose to go to nights, give yourself some time to adjust. it may take a few weeks or even months. in the end, i'm sure you'll find it worth it. good luck!

MelBel · Jan 5, 2008

I oriented on days, and work nights now. A lot of my coworkers have kids, and it works out really well for them.

Switching to nights was a LOT easier than I thought it would be, but maybe because I only work 3-12s, not 5-8s.

As far as having more patients goes, I was TERRIFIED at the beginning. It's not easy having 7 or 8 patients and contrary to the belief that people who have never worked nights think, they don't all sleep at night! (Maybe it has to do with the fact I work on a geriatric unit and it seems everyone always has some sundowners?)

I don't ever get much downtime...I'm usually busy from the minute I walk in until the minute I leave, but when I DO have it, people seem to be more willing to answer questions on nights than they did on days.

I would NEVER work days on my floor, maybe anywhere, again! I like when it's (relatively) quiet without visitors and doctors and social workers, etc around all day, and the night staff just have such a great bond :)

I reccomend every new nurse try nights after my experience. I've learned a LOT more, and it has caused me to be MUCH more independent.

Mommy TeleRN, RN · Jan 5, 2008

I have to ask - what are your routines on this type of floor? How frequent are VS and assessments? Do CNAs do VS?

I work tele nights and typically take 6. This keeps me busy (I'm also about 8 months in) But we do VS q 4 (nurses must do them) and assess q 8. Of course you also do the MARs on night shift which is a bit time consuming at times (esp when you find things pharmacy misses!)

I occasionally have 7 and it's really much harder - once I had 8 and I about stroked out with the stress and I was VERY behind schedule the whole shift. But if your CNAs do VS or they are less frequent than 7 could be doable.

I have worked an occasional day shift and it's just different. You do get to interact a lot more with your patients on days. And you can more easily monitor their status. For instance you give insulin and make rounds they are still up and chatting with family. On nights you give it and go back by and they are sleeping...are they sleeping or lethargic? Or you give a sedative...sleeping or oversedated? The nights when the patients are sleeping soundly scare me! lol

Overall I like it much better on nights ... just so much quieter out in the halls and I can focus better with less distractions... and it's extra $ which is always a bonus! :)

Virgo_RN, BSN, RN · Jan 5, 2008

I'm considering nights once I have my RN, and I admit, it would be for the money. I currently work eves as an LPN, so the stress is high and the money isn't great. Something that has me hesitating is, that if a patient is sleeping soundly, I'd feel terrible waking them up to do my assessment and vitals. Any noc shift nurses have any tips on how to make that part easier?

I'd also feel badly about calling the doctor in the middle of the night unless it was an emergency.

Mommy TeleRN, RN · Jan 5, 2008

You know I use to feel bad about that. Some patients do get ticked you wake them up. But let me tell ya - a couple times of a pt NOT waking up and you get over that REAL quick.

Now if they get mad I say albeit in a friendly way "I'm glad you are well enough to get mad at me. Unfortunately that's the way it is in the hospital. You need round the clock care to get ya better and get ya home!" I do assessment/VS when I first get there and then VS at midnight. By this time I can pretty well "tuck em in" as most don't have 2am anything. I will peak in on them at 2am though. Ours are monitored and as long as their HR is holding steady and they look like their breathing is steady I don't wake them at 2am. At 4 am I will gently rouse em and tell them I need to take their BP. I don't converse too much unless I question their LOC. I will do a very focused reassessment on what their primary assessment findings were prior in the shift...tell them I'll there until 7 if they need anything to feel free to ring me and I hope they have a good day (I like closure) If I think I will be back again that night I usually mention that.

Most I will peak in again around 6 to make sure all looks ok.

On our floor someone will occasionally run a few beats of Vtach or have a big HR decrease (like when the evening beta blocker kicks in) and I will wake them and usually do a VS check to make sure they are ok.

My take .. and I swear if my fundamentals teacher didn't try to drill this into my head 3 years ago when I felt bad doing a REAL assessment like making them count backwards by 3 lol and THOROUGH history (we had a 7 pg long sheet we had to fill out on our patients that semester when learning to do assessments...down to "what type of clothing do you typically wear at home?") if they didn't need round the clock care they wouldn't BE in the hospital. That is WHY they are in the hospital - nursing care! Otherwise it would all be outpatient right?

Trust me all it takes is one lethargic patient who isn't rousable and you will wanna kiss that ticked off patient who fusses at you!

Now before you all think I'm a total meanie who all the patients hate for waking them lol - I will usually tell them "this is our plan for the night...I have to do x,y,z and we will try and group such and such together" I get along beautifully with most and they know I'm just watching out for them and I often get big smiles when I walk in for the 2nd night in a row. :)

One thing I noticed on days is you have all day to get certain non urgent tasks done..on nights it's a whirlwind from 7 to midnight because you try and get all your in room tasks done so the patient can sleep.

I feel like my patients are my children. I have more knowledge on what they need to be ok and they may not understand what or why I do what I do .. why it's important to take that Lasix when your lungs are full of fluid even though you don't like it makes you pee more ... etc... and that might make you mad at me. But I have to do what's best for you because that's what moms/nurses do. We look out for your best interest! :) We will explain it of course and re-educate..but we are going to make sure you are ok!

Mommy TeleRN, RN · Jan 5, 2008

PS - about docs. I have to admit I still hate that part. I use my charge nurses judgement a lot on that - what can wait until the morning and what I need to call about now. You will get very good at troubleshooting stuff lol. I have to say the majority of things on nights can wait until the morning and you can leave a note or call in the morning (usually a note and passing it on in report suffices) There aren't too many new labs or things like that.

Mostly what I would call for is pt spiking a temp..and that's usually short and sweet call. BP I can't get down despite giving what I have available that is ordered... call for a PRN. And many times you discover things pretty early on with a good assessment that you might need to call for..pt wants a sleeping med ordered you can call on that early.

I have to call docs a LOT less often than I thought I would. Probably less than 5x a month... and this is on tele. It's great working with a lot of other nurses because you can always get another more experienced nurses opinion and advice. But if you have to call... usually it's important and they need to know - and it's part of their job. Most have someone who is on call so that is especially that person's job for the night. The tricky part is the oncall doesn't know much about the pt so you better have the chart and be prepared with info!

DudeNurseRN · Jan 7, 2008

I definately have experience when it comes to the day/night scenarios because that's what my shifts are. Nights is an interesting beast in the fact that they dump a whole bunch of pt's on you because of the theory that "well if pt's are sleeping then you can have double the amount and that shouldn't be a problem". Well that's sometimes true, but when somebody has a problem and puts on the call light or makes a whole bunch of noise it wakes more people up and then you realize that it's not as easy as it seems sometimes. But evenings tends to be more relaxed in general. Schedule takes some getting used to, and then comes the ultimate problem. To eat or not to eat, that is the question. Jury is still out in general, about 1/2 the RN's feel like eating and the other 1/2 won't and swear that you put on weight if you do. But you'll figure that out for yourself. You will have a support system of a Crosscover MD, in which case you will have to SBAR most of your pt's that have problems because this oncall MD will have no idea/information about the pt that you are taking care of otherwise. Those are the main things that I can think of off the top of my noggin.

LadyPhantom · Jan 7, 2008

Thanks for all the replies and advice! I am still seriously thinking about switching, I told my hubby I would make my decision by the end of the week, after I talk with my manager and see what shifts are available at night.

I hope I can handle the switch over, it has been YEARS since I worked nights, and I am usually in bed early

lauramae18 · Jan 8, 2008

I am a new nurse, graduated in May. :specs:I have only worked nights, and recently have started doing 7p-7a to get that extra day off a week.

I love it. I know that I will be sleeping the same time every day. My friends that I graduated with that all went to critical care are all flip-flopped around and never have a steady sleep schedule. You must be dedicated to your own sleep though. I make a committment to myself to be asleep by 10am. The only time I obviously break my rule is when I am at work late. Sometimes I have 8 patients.... the assessments take the longest, but I have it down pat. I usually get to work a few minutes early, and I go to my rooms to introduce myself and tell them I will be in soon, and apologize in advance if I have to wake them up. Since June I have only had maybe 6 people complain when I've woke them up, and they aren't people that I worry about their opinion anyway... if you know what type of patient I mean.:icon_roll

Good luck with your decision.

Dublin37 · Jan 10, 2008

I read all the replies, but I didn't see how sleeping works. So you sleep days after you've worked the night shift, I get that. What about the days you're not working? Do you sleep at night or day then?

lauramae18 · Jan 10, 2008

I usually go to sleep around 2-3 am, and sleep until 9. I take a 2 hr nap before I go to work and it does me fine. I don't know about others.