During the month of November I will complete my last month of the new grad program and it will be night shift. After we graduate on November 22nd half of the group will go to night shift and the other to days so the supervisor has us all working nights on our last unit in preparation for the change in the event that we go nights. Let me first start off by saying that there are many people out there that LOVE nights. Not just nurses either! I used to work in theatre and I noticed that most theatre folks don't go to bed before three am. My roommate thrives on staying up late and so does my boyfriend. I on the otherhand am NOT that kind of person. If I'm awake past ten pm it's because I took a looonnnng nap during the day. I get cranky when it gets late. I've always been this way. Also, I absolutely need a minimum of eight to ten hours of sleep every night or else I'm a walking zombie. So you can imagine how hard this transition has been for me.
So far I have only completed four of my seven night shifts. Those four shifts have been on a Progressive Care Unit that focuses on stroke/telemetry patients. Ideally, this is the unit that I want to end up on (days please!). My best friend *Darius works on this unit and the fact that this unit has a neurological focus is right up my ally. I have a B.A in Psychology and my favorite psych classes were the ones that included neurology lectures. The brain is one of the most fascinating organs that we have in our bodies. When someone has a stroke it can affect so many different aspects of a person's life. The person might need to learn how to talk again or how to get dressed in the morning due to a weakness on one side of their body. I have the amzaing talent of finding accommodations for challenges such as these. When my stroke patients have difficulty talking because of a facial droop I give them some paper and a pen to write down what their trying to say. This doesn't always work-sometimes their dominant hand is the one that is weak and writing goes out the window. In this instance we end up playing one of my favorite games-charades-in order to figure out what the patient needs.
Let's talk about the biggest changes on night shift. First of all-it's not only the patients who go to bed (although this doesn't always happen) but the hospital itself feels like it's asleep. There are no supervisors, case managers, social workers or diabetes nurse practicioners. The nutritionist, physical therapist and occupational therapist have all gone home. All that's left are the bare minimuml required staff to keep the hospital running until morning. This means that the hallways are quiet. It almost feels like a library. Most of the nurses communicate in whispers and I've become really good at seeing in the dark. Below I've listed some of my recommendations in order to survive the the world of darkness called night shift.
-The night before your night shift try to stay up until at least midnight or a littler later if possible. Then wake up between seven and nine in the morning and get in a really hard and intense workout. I go boxing. Then come home, shower, make your lunch/dinner and go back to bed. Try to sleep for at least 6-8 hours before your shift. I've only done four shifts so far but its worked for me. While everyone else is falling asleep or slapping themselves awake at 2am I on the other hand am wide awake.
-Pack a healthy lunch/dinner and multiple snacks-night shift nurses thrive on eating junk food. But it's not always the best choice. I think that some of that junk food can contribute to the exhaustion that hits around 2am. Also, as a nurse I think we have a responsibility to be healthy people.
-Buy a mini flashlight. Yes I can see really well in the dark. But I don't let that stop me from checking and assessing my patients with some light on. I had a clinical professor who once told me horror stories about nurses that did not check on their patients throughout the night and in the morning when they went to wake them up to give medications the patient was cold and dead. That fear has me checking on my patients constantly. In fact, I think I check on my patients more than I do in the day time because I have more time. Sometimes I check on my patients four times an hour. I always make sure they are breathing and then I trace any lines that are attached to the patient and make sure they are hooked up accordingly and running. I also look at the patients environment-if my patient was to wake up confused in the middle of the night with no lights on are they going to trip on anything? Is there clutter? Is the call light button close by to the patient and is there bed lowered as much as possible? I make sure to check all of these things before leaving my patients room when rounding.
-Research your patients. I've said this before. However, on night shift you have so much extra time there is no reason for not knowing your patients entire history. Read all the doctors notes, look at their labs and double check their medications. This will help you give a detailed report to the day nurse and allow you to make a list of any necessary items that need to be done before the patient gets discharged.
-Be nice to all the night time staff. I have witnessed some nurses be rude to housekeepers or transport staff. Yet on night shift you are limited to how many people you have helping you and there will come a time when you need a favor. Don't burn any bridges or it will be so much harder to find someone to help you when you need it.
-Use the extra time you have at night to practice your skills. Tell all the nurses you're working with that you're the person to call if someone pulls out an NG tube or if there's any fun procedures that need to be done. This is the best time to learn because their aren't as many interruptions.
-Get a really good eye mask and ear plugs. I got an amazing mask from REI. It makes everything pitch black. I honestly can't tell if it's day time or night time when it's on. And it doesn't crush your eyes the way others do. I know some nurses love the blackout blinds but an eye mask was so much cheaper.
-Bring a book or crossword puzzle for lunchtime. People tend to be take lunch a different times during the night shift and if you end up in the break room alone a book or puzzle will keep you awake during that short 30 minute break.
-If you find yourself getting sleepy I highly recommend stair sprints! Our lab is located on the first floor and sometimes an influenza swab or other item is needed I always volunteer to run down and get it. That rush from sprinting never fails to wake me up.
-Ease up on the caffeine. I can go an entire 12 hour shift without any caffeine but sometimes I'm exhausted and need the pick me up. On night shift however, I try not to drink it past midnight-otherwise I won't be able to sleep in the morning. Be careful-you don't want to be wide awake during the day and then have to return to the hospital for a night shift.
-On your days off try not to switch your body back to days. I do a lot during the day when I'm not working but I usually take a nap and then try to stay up late in order to keep the my body in the rhythm of night shift.
-After a night shift I get a surge of adrenaline and that's usually enough energy to get me home before I crash. However, if you find yourself exhausted after a long night shift do yourself a favor and don't drive home. Call a friend or relative to come pick you up-at worst just fall asleep in your care. You don't want to be the reason that someone else gets hurt. Drive safe and get some sleep.
Now it's time for my nap....
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