What is night shift actually like?

Kooky Korky, BSN, RN · Nov 26, 2019

You are naïve. Expect to be busy the whole shift. Be pleasantly surprised if you get a meal break, rest break, bathroom time, etc.

It depends a lot on what area you will working.

What area will you be working in?

Congrats on your first RN job!

RN in skilled nursing/long term care:

Count

get Report.

I liked to do walking rounds before the previous shift left. I needed to be sure all patients were actually present. I knew them on sight after a short while, so could also quickly make sure everyone was in the right bed. Even though the techs/aides made the majority of rounds, I figured I'd be holding the bag if someone was missing or in the wrong bed.

I also made sure all the charts were present. Sometimes they were left in a doc's office or the Sup's office.

Make sure all staff are present. If not, find out from House Sup/Nursing Office what's going on with staffing.

Everyone must be present at least a few minutes prior to shift start time and be ready to work at the stroke of 7, 11, whenever the shift starts. Not first arriving, hanging up their coats, taking off their boots, putting their food away, going to toilet. You won't be able to control anyone but yourself at first, but if you become Charge, you will want to make sure about this.

Make the assignment, unless your aides make their own, which is likely in a long-term care setting. And I worked alone, that is, I was the only RN on my ward.

Make sure floated staff get an orientation to the ward.

I made the narc sheet for the next day.

poured up my meds (very few, but I wanted to get it done; didn't open them, just had them ready)

Checked all of the charts for any orders that might have been missed (this was before EMR and we still had paper charts for a while after EMR was instituted)

Checked my email

Rounded on staff q 1 hour. Staff tend to disappear or sleep on Night shift.

Did what little charting had to be done

Read some progress notes (MD, PT, RT, ST, SW, any other disciplines that might have been involved

Pretty quiet usually until about 0430.

Read a lot, once in a while visited by phone with friends on other wards, had meal about 0300

Helped with linen changes, laundry, or whatever was going on

attended inservices as required (CPR, fire safety, policy changes, EMR training, etc.)

talked to coworkers - avoiding gossip, complaining, anything that could be turned against me or misunderstood/misinterpreted

Did required CE stuff annually

handled the occasional urgent/emergent matter on my floor, assisted in emergencies on other wards if any came up; once in a great while had to send pt to ER, so had to call doctor - something I hated doing at night, but we did not have anyone on call in-house, so had to call Attending. Oh, well, not my fault. Called Report to ER on those rare occasions.

If I needed a less urgent order, I waited til a more reasonable hour, like 0600 or so, to call a doc. Why not pass it on to Days? A Day RN once told me that since it was something that I thought was needed for the pt, I had to call. She refused to ask the Doc even though he would be arriving about 0800. House Sup agreed with her! I thought it was laziness on her part and would have been mad if I had been the Doc. But I did what the boss said to do. Doc was not mad. Oh well...

Made sure aides had cleaned the frij if it was the night for that, made sure they had emptied all trash and dirty linen, and completed their other duties because the Day nurses would really c/o if anything was reported by their techs as being undone. Boss said I was responsible for my techs. The person who trained me said give them as much independence as possible. Yes, I was caught in the middle, not fair; life in the big city.

If mine had not done everything, I either asked them to do it or did it myself just to avoid the aggravation. There wasn't that much to do, sometimes I liked to do it to keep busy.

Gave my meds.

Counted and gave Report to nurses relieving me.

Done.

Once in a while trained a new nurse.

On a med/surg floor or other acute area, you will be much busier, I'm sure.

Best wishes to you.

mi_dreamin, BSN · Nov 26, 2019

Where I work nightshift can definitely be steady but tends to be much less busy and demanding. I am primarily dayshift but like to pick up nights because it is more money and less work ?‍♀️There are actually several open day shift positions on my unit but none of the nightshift RNs will come to days because it is so much more busy and a lot more work (their words).

You have to realize, on day shift you are doing 2, 3, sometimes 4 or more med passes as the docs add orders, coordinating procedures/therapy/meals, talking to family members, planning care with social work/docs, discharge planning/teaching/coordination, in addition to the things that all shifts do - call lights, admissions, patient care, charting, etc.

Night shift can be hectic, emergencies harder to deal with, and 04:00 can feel like a nightmare, but overall it is less demanding than dayshift (on my unit anyway). It seems to me that the worst part of nightshift is the toll it takes on your body/circadian rhythm/ social-emotional health.

My aunt worked nightshift for 5(?) years and always talked about how it was still busy even though it was night and people don't sleep. Then she came to days and realized what a HUGE difference it is. Just my 0.02¢.

futurepsychrn, ADN · Nov 26, 2019

The SINGLE MOST IMPORTANT FACTOR, the team you work with!!!!!! From what I've observed, night shift teams tend to be more cohesive than day shift, probably because they have more time to get to know each other. Just my opinion but I've worked both.

inthecosmos, BSN, MSN, RN, APRN · Nov 26, 2019

It depends on the unit and your team! I think you are going to be busy until you have a routine. Once a routine is established, you'll find some downtime if the unit and patient population are good.

RNperdiem, RN · Nov 26, 2019

I found that in med-surg, night shift was tasked with a lot more of the daily tasks like changing IV tubing, hanging new tube feedings and back in the days of paper charts, auditing-type tasks. my least favorite was bowel prep and enemas till clear for patients getting colonoscopies the next day.

In med-surg, I found that many of our elderly patients, were sundowners. They became more and more disoriented at night and very much sleepless. This required more nursing time to prevent falls.

Day shift tended to discharge patients, and evenings and nights did more admissions. Admissions are time-consuming.

Waiting for Retirement · Nov 26, 2019

I think it's been pretty much said already, but I have a little time to kill so I'll add my two cents!

My experience when I worked night shift was that I had as much work as daytime nurses did but often had different work/tasks/details to attend to.

Differences I found included:

Bowel preps and other preps for morning procedures were done at night, not during the day.

Dementia patients do not become less demented at night, and those who seemed perfectly fine ("A&Ox3, I swear!") sundowned or had that as a side-effect of their nighttime sleep meds.

Medication reconciliations were done at night, orders for the previous 24 hrs were reviewed and mistakes/omissions/missed orders caught.

Nights had higher/heavier patient assignments than Days, so even when the patient needed the same things at night the nurse could expect to have another few patients that also needed nighttime care. The thinking was that some of your patients would sleep "most" of the time, but that really doesn't make up for an increased patient count.

Sleeping patients are great but the ones that sleep all day (making the daytime nurse's job easier!) were up all night, on the call bell, needing/wanting things.

Patients who had been waiting in ED for several hours during the day and were finally assigned a bed in the later afternoon or early evening were settled in and STARTED to get set up for orders, meds, etc. But frequently night shift is finishing up those admissions plus getting more overnight. It about took an act of Congress to get someone who had been in the ED during the night to hold off until Days came in for that bed assignment, even if they had only been there a couple of hours.

Patients who had surgery on Days and were in need of little while the anesthesia was wearing off became much more aware of their pain late into/through the night. If you're on a surgical step-down or med-surg unit you should expect a significant amount of pain management.

Even though the mantra was "this unit is 24 hours so it's a 24 hour job not a one-shift job" the reality is that whatever didn't get done those previous 24 hours (and needed to get done 'that day') would fall on the nighttime person. If XX wasn't done by the time Doc came by in the morning they will look to the person who had that patient the last 8 hours, not the 16 before that.

With all of that said I liked working nights ?

Workitinurfava, BSN, RN · Nov 27, 2019

It's not as busy as days. Honestly I like it better. You don't pass as much medication. There will be times that you can sit down. That is impossible to do if you work the dayshift, plus management wants you to look busy. Your manager won't be there at night to micro-manage you. You will use this phrase, "that will have to wait untill tommorrow during the dayshift". That phrase can you get you yelled at but most patients understand. There are downsides but I feel working at night is less of everything. You will still work hard though. I was asked to come off of night shift for days and I said, no way. O yea, you should get paid more money which is a bonus. I should not forget to tell you that the patients go to bed, unlike days (most of them). You will become an admission expert.

Newishnurse1995 · Nov 28, 2019

I have some nights where my patients are all self sufficient (once every couple of months) and other nights where they are all completes and really sick. Just depends. Day shift would usually discharge and nights would admit. Expect a lot of admissions if you are a general med surg floor and you have a busy ER.

Typical night

Get report for 30 mins

Chart on my patients and look up their meds and orders

Get an admission (usually 2-3 per night depending on how many patients you have. On my floor we are allowed to care for 6 patients).

Try to give meds to my patients. I try to cater to all of their needs when I do my med pass and complete any orders (Wound care, Foley care, colostomy care, turning, IV start, lab draws etc.)

Get a call from the ER about my admission during my med pass.

If I have a good tech that night I will tell them about my admission and they will set up the room. If it’s a bad tech I’ll just set up the room.

My admission arrives. I do their admission. Document their home medications. Call the doctor to get any orders they may need (which is a lot. Most of the time they do not come up with any orders). If they do come up with orders it’s usually lab draws that were not done in the ER. I make sure they are comfortable and then tend to my other patients.

Later in the night I do another med pass (usually heparin or an antibiotic) and a finally one at 0600.

This may seem easy but throughout the night we usually have a lot of hurdles. Getting orders at night is tough because we only have one doctor who does admissions and then we have one on the phone who does triage. We don’t have transport at night so if a doctor orders a STAT diagnostic test we have to take them down if the tech is busy. We have a lot of RRTs. A lot of sick patients. A lot of demented patients. A lot of care needs to be done. We also just done have the resources that day shift has. We all have to work together to get though the night. You’ll see once you start. Can’t really describe what happens.

Editorial Team / Moderator · Nov 28, 2019

Just flip am with pm or vice versa, that's what you'll be doing. It's like dayshift except dark outside with marginally fewer visits from physicians and PT/OT/SLP. ?

Lynker, LPN · Nov 28, 2019

My nights are usually really quiet. We get the overnight duties done, and we're free to do whatever we want, unless patients need CNA care and nursing care. I'm using my time lately for studying for my TEAS test to get into my ADN program.

Taylor ce · Nov 28, 2019

I’m in cardio surg floor unit. Nights are way better. Not as noisy as dayshifts. Less staff, less drama. We don’t have any admissions at night, unless another unit doesn’t have free beds so we lend them a couple. Basically I come, go greet all of the patients and give them their evening meds. Then look at all of the assignments, IV’s and stuff. Make a list of them so I can cross them out once I’ve done them. Then after dinner I change bandages on their surgical wounds. Then take their BP. Then prepare patients for tomorrows surgery (shaving, showering, changing bed sheets). Then couple more meds and by 11pm that’s all. And it’s usually quiet all night until 5am when we start to draw blood and give their morning meds. That’s all. Unless of course an emergency like code happens or someone gets admitted from another unit. The only downside is lack of sleep and your body feels super imbalanced on everything. I tend to gain some weight on nighsthifts. But once I’m on a dayshift it all normalizes again. Good luck!