working graveyard shifts in LTC

Sgt_Chunk_Spelunker · Mar 25, 2005

You'll most likely be the only nurse on shift so you'll be in charge of everything! In my facility the night shift nurse gives alot of routine noc meds and PRNs, fills out lab slips, early morning glucose checks, and anything else that can't be done during the day. It can be extremely busy. Admits have been known to show up at the end of eve shift. Residents often fall during the noc shift. Staff calls off quite often on noc shift for the next morning. You may be "security" as well depending on the facility.

HannasMom · Mar 25, 2005

I have been working the night shift in LTC for almost two years. Some nights are quiet and some nights so busy I didn't have time for lunch. Last night was pretty busy...we like to blame it on the full moon. :)

I love working in LTC and I have adjusted to the night shift. It is best to stay on a night shift routine even on your days off. I do and it has worked out good, I don't get the sleepies on night shift since I decided to stay on a regular sleep pattern, not switching back and forth from day sleep to night sleep. I only sleep days now, usually from 11 am until 7 pm.

April_LPN · Mar 25, 2005

What about doing the night shift while you have kids? I have a 4 year old at home. Starting school next year.

HannasMom · Mar 25, 2005

My children are grown, so it is easier for me, than someone with little children. I will leave this question up to those who are working the night shift, and have small children. The night shift was difficult for my whole family when the boys were little, so I had to go back to days at that time.

LPN1974, LPN · Mar 25, 2005

No, I wouldn't think you would be bored.

I worked nightshift at a LTC.

Besides making q2hr rounds/checks on the patients, assessing them, charting, "on medicare you have to chart on those patients q shift, or we had to} PRN and routine meds during the night, scheduled monthly change out of meds, treatments and other wound care, glucose checks and routine meds in am to include ac breakfast and insulin meds, change out of feeding bags/tubes, incidents on any patients who decide to get up and fall during the night, patients who get sick and need to be sent to ER, oh the list goes on and on.

IF you find time for a lunch break you're blessed.

I was alot of things but NEVER was I bored.

Always something to do.

April_LPN · Mar 26, 2005

Sounds promising so far :)

LPN01112005 · Mar 26, 2005

I work 11-7 in LTC. We have two nurses on duty at night, each with approx. 60 residents to care for. We most certainly do not have time to get bored, and we never take our "lunch break". We eat at the nurses station while we are charting. Here is a typical night for me:

11-12 PM - shift change-over, initial rounds, report, narc count, making note of who has to be charted on, flushes on the tube feeders.

12-2 AM- med pass, syringe and tubing changes for tube feeders, humidification for the 02 concentrators, a couple of bolus feeds, a few of glucose checks, vital signs on those who need them.

2-4 AM- making rounds, charting on everyone who needs it, can be as few as 6 medicare residents or up to as many as 20 with declining status, falls, etc. Faxing med refills to pharmacy, accucheck controls, refrigerator temps, crash cart checks, restocking.

4AM flushes on the tube feeders. Taking a couple of feeders down prior to giving dilantin at 5 AM. Any tx/dressing changes that have to be done.

5-7 AM- med pass, glucose checks, final charting. Any incident reports, any non urgent calls to physician. Outgoing report and narc count.

Granted, there are not nearly as many meds to pass on graveyard, but don't ever let anyone tell you there are no meds to pass. This simply is not true, in addition to the PRN meds, I have quite a few scheduled meds to give, and we have quite a few tube feeders that require q4h care that is rather time consuming.

We have several residents who sleep during the day and stay up at night. One requires constant supervision, so on nights when we are short staffed (regularly, LOL) he poses quite a problem for just two nurses.

All in all, I love my job, and I've filled in on 7-3, and I'd never consider going to day shift permanently. There are days when I feel rushed, but most often, I have a steady pace that allows me to give quality care to my residents. Yet, I still have enough going on with my residents that I'm constantly learning through my assessments.

snowfreeze, BSN, RN · Mar 26, 2005

lots of stuff to do on nights, chart checks, rewrites for orders in LTC, (rewrites are done monthly or every 6 months depending on the patients status), MARs are renewed monthly so you probably check the new ones, lab work is usually done at 5 or 6am, some places the lab draws the blood most places you do and a courier picks it up, morning blood sugars are usually done by nights. Some GERD meds are given early am. Some of the continual tube feeding patients meds might have been adjusted for nights to give most of them. Checking the refrigerator temps, doing glucometer daily checks, recalibrating the b/p cuffs, checking that every opened item is labeled and dated. Checking on clean utility room and med room supplies. I also do some research on new patients with new medical stuff we haven't seen and print out useful information for staff to review.

rebel_red · Mar 30, 2005

In the 3 years I worked NOC's.....I can only remember 1 night where I had a free 45 minutes prior to final med pass. I had no idea what to do with myself.....

I loved NOC's many decisions made on the shift are unilateral. Tag you're it. Excellent opportunity to develop assessment skills. No families hanging about. Actually had time to hand hold with anxious residents. No doctors wandering around. No administration breathing down your neck.

The only real issue I have with NOCs is the way sometimes other shifts feel free to say "Oh nights doesn't do anything, they can do .......(fill in the blank)" That and often if our 7-3 nurses are running late we get calls at 4a saying to start the 7a med pass with our final med pass, so the other nurse won't be behind. This is happening with greater and greater frequency. The 7-3 nurse wanders in around 8a expecting to find all the meds passed. Last week I refused. (I don't mind the extra work, but these are timed BID meds and it is not fair to the residents to be woken up at 4a to get a 9a med...) Should be interesting to see what develops. Please I am not trying to start a "shift war" . Yet I know that if I called my facility at 7p when scheduled for 11 and said "Oh I am still so tired I can't make it till 1a, can't 3-11 stay and pass my midnights?" I would be laughed out of existance or they would have the 11-7 house sup pass the midnights. Maybe its different at our facility but NOCs stands alone often without coverage.

You really need to be indepedent, self assured, know when to call for backup and very autonomous and creative (there has been many a time when we have had to MacGuyver equipment...) to work NOC's. And lest you think I am prejudiced...I work all 3 shifts each week and have for months.

Best wishes

Tres

ibmissy · Mar 30, 2005

I work 7pm-7am Baylor weekends at my work. Depending on the residents is what decides your nights. :)

The ones with dementia tend to wander and sometimes fall which leaves about 3 hrs of paperwork to fill out.

On a normal night I print out new orders for the MAR computer backup book, any physicians orders that need signatures gets printed and put in the chart. I do treatments, meds, PRN narcs, rounds, charting on different patients, write the unit alert list each night, restock the med room, pick up other shifts messes at the nurses stations, sometimes call drs and families, etc etc. I look forward to 5am med pass..I know a good chunk of time will pass quickly then. (Usually 45-90 minutes for me to pass meds to 32 patients, depending on which unit I am on.)

I have 3 kids at home ages 4 yrs to 12 yrs and one on the way.(Am 35 wks pregnant.) The only day I have to worry about a babysitter is on Monday mornings when my other half works. The 4 yr old goes to day care on that day. You may see if you can work a baylor shift. Generally you work 24 hrs and get paid for 40. That is if you don't mind working weekends.

pumpkin92356 · Apr 7, 2005

I worked graveyard shift at a LTC facility for 7 years and I am a cna . Usually it would be myself and the LVn and one other aide. We had 2 hour rounds to make residents that would be up and about during the night because they would like the quiet time. The nurse answered lights , helped out with rounds, did the morning glucose checks , prn meds at night, weekly summaries, medicare charting ect. there was never a dull moment then. was in charge of the whole floor for the night at times.