What the Heck to You Do on Night Shifts?

[RedRubCatheter]

I've been asked on many occasions what we do on night shifts. I've had people (mostly those who have never been in a hospital) assume that we sit around and watch movies all night, because the patients just sleep, right? I've often thought about trying to do a fairly detailed description of a typical night shift, and decided one night about a year ago to just go for it. A wad of scrap paper in my pocket and I was all prepared to start jotting down notes about what happened.

Naturally, I should pick the worst possible night, but at least it shows very clearly that we don't all just sit around. I work full time in a float pool, so I never know where I will be working until I arrive for my shift. This shift occurred on a medical floor.

1825 - I reluctantly tear myself away from my computer and the lovely story I was reading to drag my equally reluctant backside off to work.

1840 - I look up with revulsion at the building as I pull into the parking lot and exchange my street shoes for the bio-hazardous pair that live in the trunk of my car in a tarp-like bag.

1845 - I arrive on the floor, find out where I am working and glance at my patient assignment for the night, then head downstairs to say hello to my husband (also a nurse-worked day shift). We chatted for a few and I went back upstairs.

1855 - I'm bombarded with verbal reports on people I know absolutely nothing about, seeing as how I worked downstairs on my day shifts and haven't worked up here since my days three sets ago.

1900 - I start my report. I'm warned by the day nurse that patient #5 has many IV medications all due back to back.

1903 - The husband comes upstairs and gives me a brief back massage as I write out my patient info, before he heads home.

1905 - I learned that the head nurse who decides the patient assignments for each shift forgot to provide a nurse for one whole team of nine patients. Day staff had to do some last minute adjustments to ensure everyone had a nurse.

1930 - Still in report. Many bells are ringing, but the 15-2300 nurse is on the floor and managing okay.

1945 - Finished report.

1950 - I take a quick look at all my patients. Everybody is breathing and most of them can speak. #1 asks me for pain meds.

1955 - Obtained strawberry pudding for pill administration purposes and a big glass of ice water for myself, considering the air in this place is ungodly hot and dry.

2000 - Start prepping my IV meds. I had to look up the dilution info and infusion times info for two out of the four.

2005 - Go to hang #5's first IV med, only to discover that the IV is capped, so I return to my cart to get a flush so that I can hook it up to the tubing for the infusion.

2010 - Accosted by a confused, rather barmy-looking woman in a wheelchair, asking, "where do I go?" She is not mine, but able to provide her name and I indicate which room is hers. At the same time, #1 is ringing the bell, and a coworker reports that the patient is asking for pain meds. I sent back the message that I would get there when I could.

2015 - The same woman asks the same question of another nurse. She hasn't moved from her place in the hall. #6 rings to have his door shut, but it's only open because I had to go in to answer the bell.

2017 - By now realizing I do not have time to keep noting down everything I'm doing, but don't care because this looks like a good night to document. Point form with a time only. Details added later.

2020 - #1 rings the bell again. Another co-worker got the bell for me and sure enough, #1 is asking for pain meds. I relayed my message again as I headed in with #5's IV. And there is vancomycin on my wrist watch.

2022 - Finally hang the 1st IV med.

2025 - I get the pain meds to #1. #2 has urine all over the floor by the bed and blankets are in the garbage can.

2030 - I realize that all hell is indeed breaking loose. Everyone else is running around like headless chickens and at least three bells are ringing all at once. #6 wants his already closed door closed again. I am attempting, between call bells and mini crises to administer my pills and assess the patients but I keep getting pulled away for a multitude of little things. And that woman is still asking where she's supposed to go.

2040 - #6 wants the closed door closed again. Oh, and also, wants me to empty his ileostomy. Oh joy. (If you don't know what this is, you don't want to)

2045 - Returning to pills/patient assignments. #5 wants to be unhooked from her IV to get ready for bed. I'm already running behind on the many IV meds.

2050 - Still trying to do meds/assessments when #4 rings to say that #3 threw up. Thankfully the 15-2300 nurse came to the rescue.

2050 - Bring pills and fresh blankets to #2 and discard the ones from the garbage can into the laundry. #2 takes off his pajama shirt by popping off all the buttons. Buttons fly very well. Spend some time tidying #2's messy area.

2105 - 15-23 nurse needs my help with #3 because it's apparently "both ends" and oh so messy. I'm even further behind on the IVs and have only brought pills to two patients.

2110 - Back attempting meds. I had to go double check an order in one of the patients' charts.

2115 - #1's legs buckled in the bathroom. Turned on the bathroom bell but then turned it off when he got up on his own. Found #1 standing in the doorway, leaning against the frame with the door pulled up snugly. Got a wheelchair for #1 to sit in and we talk briefly about his pain and anxiety. Behind the curtain, #2 is having a lively conversation with nobody. Then, suddenly, #2 is standing at the end of the bed and is peeing on the floor again.

2125 - #2 is generally restless, moving around everywhere and making a huge mess.

2130 - 15-23 nurse and I get #2 into a secure chair and a pair of absorbent underpants. I bring #2 an ativan to decrease the anxiety and notice that he chewed his pills instead of swallowing them, and that the capsule from the hydromorph contin must have broken, because all those sustained-release little balls of narcotic goodness are all over his mouth. #2 doesn't understand what "touch your tongue to the roof of your mouth" means, and it's difficult to put the ativan under it when it's sticking straight out.

2135 - I am now 1 hour behind on #5's IV meds. I hang the 2nd one and then return to my cart to attempt to finish my meds.

2145 - #3 won't take pills but did get a shot of morphine.

2150 - 15-23 nurse is helping #4 get back to bed when I arrive with meds. #4 asks me, "oh, have you seen my rear end?" I say, "No, and I actually don't need to." #4 says, "Not unless you have a needle to stick in it." Thankfully, I am armed only with lipitor, cipro, and a nitro patch. We boost #4 higher in the bed and I go on my way again.

2200 - #2 is still talking to nobody from his chair in the hall. I hang IV #3 only an hour late and bring #5 the rest of the night's pills.

2205 - #3's daughter called to ask how #3's day went and proceeded to talk at length about stuff I didn't need to know. She kept me on the phone far longer than I wanted to be, and at the end said she wished somebody else who knew #3 better was the nurse tonight. Gee, thanks.

2215 - Finally in to give #6's meds. #6 is on isolation and I drop the stethoscope on the floor. I opt to eyeball the manual BP instead of risking ear contamination to listen to it. Fortunately, #6 is a very clear 130/65. I also give insulin and empty a urinal.

2220 - English co-worker's patient is crashing, and she is on the phone with doctors.

2230 - I'm finally done pills and assessments. I refill my water.

2331 - I call my husband to say goodnight.

2240 - #1 rings the bell. Co-worker gets the bell and says that #1 says he hasn't seen the med nurse (that would be me) all night. I growl when I hear this and the co-worker suggests that they try sedating me instead of my patients.

2245 - Preparing 3 more IV meds and reviewing the med book. #1 calls again to ask for meds and is reminded that he is unable to have any until after midnight.

2250 - I start helping English co-worker's nursing student because English co-worker is busy with the crashing patient.

2310 - #1 calls again to ask for meds.

2315 - Still helping the nursing student.

2330 - Everyone is still busy. Breaks are not yet started and we usually get going on those at 2300. The very stubborn 3rd IV med is finally empty and I hang the 4th med 1 ½ hours late. Oh well. The doctor is now at the bedside for the crashing patient. Still helping the student and attempting to start charts. English co-worker calls for a portable chest X-ray and I wrangle one of the ICU nurses to come take some blood gasses.

2335 - They have the good cranberry juice tonight - the actual juice, not the cool-aide or whatever the fake-tasting one is.

2355 - #1 rings for meds again while I am standing at the cart preparing them.

2400 - I have never, in my life, heard a man whine so much. EVER.

0010 - Still trying to get to my charts.

0015 - Internist sees the crashing patient and decides to send to ICU. This is a good thing.

0030 - We start breaks. I go first - 1 ½ hours later than normal. #2 is still having a conversation with nobody and has taken off all his clothes yet again. Co-worker agrees to sort him out while I go. This also coincides with my first trip to the bathroom all evening.

0035 - I sit down in the back with my notebook and write out everything from my notes.

0200 - I end my break shortened, so the others have a chance to go. We decide to do 1 ½ hours instead of 1 hour, 45 minutes. I help gather commode chairs because tonight is "potty night". English co-worker goes on break. We do our hourly round to check on the patients.

0205 - We can't find where they're keeping a supply of our new 24 hour nurses notes forms. Co-worker goes downstairs and brings up a handful of them.

0215 - One of the long term care patients has been continually ringing the bell and answering "I don't know what I want". This patient is ringing again.

0230 - Finally I sit down to my first chart, and I discover an order for meds for #1 that wasn't processed from the day shift. This makes me very annoyed because I could have given some of these to help his breathing earlier.

0245 - I complete the incident report for the missed orders and properly transcribe them. #1 asking again for pain meds, is told he has to wait until 0400.

0300 - #1 up in a wheelchair in the door to room. Calls out to the student to ask for meds. Co-worker goes to speak to #1. #1 says that he has meds coming now. Co-worker tells me this and I say "No, he does not. Can't have anything until 4." I mean, really! Others are doing the round, I'm still charting.

0305 - Student needs a "bag access device" for IV bags. I try to locate one in the newly renovated clean utility room. I can tell you where everything used to be.

0310 - Hang an IV med for #5. #5 is sleeping soundly.

0315 - Long term care patient rings again.

0320 - #1 is stalking me. Slowly rolled down the hall in his wheelchair and is sitting where he can watch me. I am ignoring #1 because he has already been told when the next medications are available and no amount of staring at the back of my head or looking longingly at the narc drawer on my cart will make that change.

0330 - Two charts are done, yay!

0353 - Orders not signed in #3's chart. Note left for the doctor who did this.

0354 - Three charts done.

0400 - Go get #1's meds. #1 not in room. Briefly wondering where #1 and his large wheelchair could be at this hour when #1 comes out of the sunroom. #1 had joined another of my co-workers on his break and watched a bit of TV. Hourly round completed after giving the patient the meds.

0406 - I realized I had completely forgotten to wake up English co-worker. She got 2 hours after all.

0417 - Going to leave a note in the communication book about the new MARs, and end up wrecking the book (all the pages fell out).

0425 - That long term care patient is ringing again and still wants nothing. #2 is awake again and talking to nobody.

0438 - 5 charts done!

0445 - English co-worker offers to give #2 some pain medication.

0449 - Yay, charts are done! This doesn't usually take me all night to complete.

0450 - Start my other tasks now that the charts are done. I scribble out a report on the dreaded and oh-so-hated white boards, re-order some narcotics even though it's Sunday because nobody ordered any hydromorphone 4mg tablets and I'm almost out of them and using them frequently for #1 and #2.

0510 - Re-order patient medications, stock my med cart and change the garbage bag. #1 pinched his finger in the bathroom door and wheels over for a band-aid.

0535 - We start "wet round", which is exactly what it sounds like. Patients changed and repositioned, catheters emptied, IVs totalled.

0545 - Bring in IV med to #5. Awake now and pleased that she was sleeping and didn't have to wake up for the 0300 med.

0555 - Bring meds to #1. Is eating a grape popsicle.

0600 - Vital signs on #5. Everything good this morning.

0610 - More meds to #1. Tuck #2 back into bed. Enter all my numbers into their various places and start filing yesterday's notes sheets.

0625 - #2 needs more meds-is trying to climb out of bed and pee on the floor again.

0635 - A co-worker and I start counting the narcotics. The two of us do all four carts and yay, everyone's count is correct.

0655 - Report off to the day shift RN. Have to adjust the patient assignment because #5 should be an RN patient but was allotted to an LPN on days. Talk to husband, who has arrived for his second day shift.

0705 - Co-workers and I get on the elevator and one of them says, "how can we possibly go go go for twelve hours like we just did?" Good question!

0710 - Hit the McDonald's Drive-Thru on my way home.

0715 - Decontamination cycle (aka, shower)

0730 - Mmmm, Egg McMuffin.

0740 - Sit down at the computer to finish reading the story I had been looking at before heading to work. Started typing this out.

0900 - Too tired to keep my eyes open so I go to bed.

1410 - Wake up after sleeping like the dead, with cats piled all over me.

1430 - Coffee.

1510 - And finally done typing this out.

1825: Repeat night shift PRN.

[SWS RN, ASN, RN]

Dear Red-or do you prefer catheter?

HAHAHAHAHAHAHAHAHAHAAAAAAAAAAAAA!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

OK! I began reading this and less than half way thru I had to get up and change my sheets and nightgown b/c I spit my coffee all over the place! also almost wet myself-but ran fast enuf

I think I have worked at your facility before

Actually, being a dyed in the wool 7p-7a shifter (I wouldn't have it any other way) I can so relate to everything you wrote.

Loved the part about looking at the building in revulsion... I still do that!

I would love to work with you-your sense of humor is so like mine-and if people can't laugh at this stuff-they need to be in a different profession.

Having worked nights for the better part of the last 17 years, I really get annoyed when people make the "what do you do all night" comment! I can't count the shifts when the only time I sat down was to pee and many times I charted while I did that! (multi-tasking)

It does not matter if you work LTC with 20 pts or ICU with 2-nights can be brutal. How many times has that "stable" pt waited all day to crash on your night shift!

I have been working for the past 4 months as a Case Manager for an Insurance Co. Talk about shock! I actually have to work when its daylight and I have to do it 5 days a week! I hate it! I SO miss those 3 12 hour nights!

Thanks for making my night!

s

[abbaking]

Not saying you shift isn't hard - but an 1.5 hour break? You have it made.

Try 30 minutes for a meal break - if your lucky

[Penelope_Pitstop, BSN, RN]

Not saying you shift isn't hard - but an 1.5 hour break? You have it made.

Try 30 minutes for a meal break - if your lucky

I agree, I had to reread that part a few times!

I have NEVER left the floor for a break, and I've worked 7P-7A for a couple of years. There simply isn't the staffing to do that. I've eaten in the break room before, but never taken longer than twenty minutes. And I'm still on the unit then.

But either way...people who don't work midnights need to LEARN what we deal with on a daily (nightly?) basis. I have a friend who is a day shift nurse and has never ever worked a midnight shift, who honestly believes that all of the patients sleep all night. Hahahaha.

[franciscangypsy]

Add an admit or two and having to trend tele for up to 6 patients (I'm not up to the full 7 pt load yet -- we'll see how I do in May, when I've been off orientation for 6 months) and that would be one of my nights lately! Some nights I'm lucky if I can eat for half an hour, let alone pee before 0400.

Wow, written out like that, we really do a lot. It's a nice reminder. Especially on nights where I'm running behind by the time dayshift comes and am barely coherent giving report.

Heaven forbid you have a couple post caths still on checks (groin, groin, groin, down the hall. lol), have an insulin gtt (or any gtt like amiodarone, heparin, or dopamine), or have to start blood. Or someone has CP.

[RosesrReder, BSN, MSN, RN]

Great post. Been there and done that minus the breaks (no minutes at all in a 12 hr shift).

Also, no med cart. You have to run across the way to the med room to get each and every med (usually a wait because other nurses are lined up too).

I recently started working float pool and it is nuts.....lol

[MissyF_RN]

Really 1 and 1/2 hour break! I wish. Last night it was eat and run for us. 15 minutes tops!

[iNurseUK, RN]

I just KNOW I'm going to get hated for this.....Nights erm let's see. Well we change chemo infusions, answer the odd call bell. Do the 22.00 drug round then mostly sit in the doctor's office shooting the breeze, reading or surfing the net on the Trust's computers. We get 2 hour breaks

I know I'm English....

[franciscangypsy]

I just KNOW I'm going to get hated for this.....Nights erm let's see. Well we change chemo infusions, answer the odd call bell. Do the 22.00 drug round then mostly sit in the doctor's office shooting the breeze, reading or surfing the net on the Trust's computers. We get 2 hour breaks

I know I'm English....

HAAAAATTTEEEE. lol

Man, so jealous. Are you actually in Britain? I lived there a few years....

[iNurseUK, RN]

Sorry Fransicangypsy but yes I am both English and work in the UK. I'm proud to work for the UK's most respected cancer specialist hospital but I blush to admit nights are a cinch on my ward.

[cicatrixx15]

Going back and looking, the people that get too short of breaks are working in the U.S. The OP has a Canadian flag next to the name.

[Up2nogood RN, RN]

We play shuffleboard every morning at 2am.