My 12 Hours as a Night Shift Nurse

I’ve been blogging mostly about my travels and personal life but never really touched much about my work. Well aside from HIPAA* laws that prevent us from revealing and divulging our patients’ private health information, I haven’t really found the urge to write about it (my work, not my patient’s private health information, I don’t want to get fired, thank you!) until now.

Welcome to my boring nurse life!

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1600 – My alarm goes off. Time to wake up!

1630 – Done showering and changing into half my scrubs.

1630-1700 – Dinner with the hubby.

1700-1730 – Finishing up, getting ready for work. Top scrubs donned, after brushing my teeth (of course I do not want my top to be smeared with food or toothpaste).

1730-1745 – Getting my lunch food/snacks ready, and my hubby’s too, if he is also working. Playing around with Facebook, WordPress and/or emails while waiting.

1746-1835 – Off to work. It takes about 45 mins to get there, more with traffic (God forbid there are no accidents on the highway). I work about 23 miles away. The drive isn’t bad as it is mostly along the river. Pretty views, nice houses.

1835 – I clock in, more or less.

1836-1900 – Supposed to get report from day RN*. That depends on how busy the nurse was during the shift. I patiently wait until they are ready to give report by looking up labs, patient’s history, checking the chart, or going into my patient’s room and introduce myself while writing my name on the white board (in no particular order). Check bed alarms.

1900-1930 – After shift change report while doing walking rounds with the off going nurse, I TRY to get organized. Try being the operative word here because you can get stuck in a patient’s room easily during change of shift. A lot of things need to be done, for some reason, everyone wants something at the same time at the change of shift. Pain meds, ice water, potty, questions about their care…bed alarms.

1930-2000 – After answering all needs at that given moment (one at a time of course, and if it can be delegated, with my CNA’s* help), I sit down look at my papers, review my patients’ plan of care, make a note of their medication times and check their charts for new/missed orders.

2000-2100 – Assess my patients. But, take note, when I first rounded on them earlier, I was already doing a quick mental assessment. Is my patient alert, awake and oriented to name, place and time? Is my patient in pain? How are they breathing? If my patient needed to urinate, can he/she stand up on their own and walk to the bathroom or do they need help getting up or do they need a urinal/bedpan? If they need the bedpan, as the patient is turning to their side, I am already checking out their behinds and note any skin breakdowns or pressure ulcers. Also while the blankets are off, I am already noting for any edema, ecchymotic areas, skin tears elsewhere, IVs* in place, dressings if any. Do they have a foley catheter, what is the urine color? While they are drinking water, are they able to hold the cup on their own? Any problems swallowing? What are their IV fluids, IV drips? Are the rates correct? Last bowel movements? All these noted while I am talking or assisting them with their needs. By the way, make sure that bed alarm is on!

So the more detailed assessment involves, checking for their neuro* status if the patient is lethargic or unresponsive, listening to their lung sounds, heart beat and bowel sounds, feeling for pulses. Before I leave the room, bed alarm.

2100-2300 – I start preparing my meds in the med room. Night time meds are usually timed at 2200 in most of the facilities I’ve worked at. We have an allowance of 30 minutes before and 30 minutes after that to administer them. Anything before 2130 is too early and anything after 2230 is too late. That is assuming your night goes well. You know, with no interruptions from doctors, phone calls, family members and patients. But this is the real world.

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In between all that, as you pass your meds, of course, one patient wants more water, or an evening snack (and your CNA is nowhere to be found, either busy with another patient or who knows..). Another patient told you that she has pooped and needs changing (of course, you don’t let the patient wait there laying in her dirty diapers, you do it yourself). Then while you are in the midst of cleaning up a diarrhea explosion with your gloved hands buried deep in s–t, the “clock-watcher” calls that it is time for their Dilaudid …. and if they can have their Phenergan too…

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Okay, let me finish this clean up first. 15 minutes later, you go in bring them their drugs of choice and they are mad at you for being late. Why can’t another nurse bring them their pain meds if I was busy with another patient? Uhh, that nurse is busy passing meds too… So, I give them their meds and you hear a bed alarm go off, excuse me, I have to go check on that bed alarm.

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It is your elderly 80 something year old who wants to go to the bathroom. You help them get up, make sure their red socks are on, get them their walker and off to the bathroom you go. You either wait till they’re done or ask them to pull on that cord when they’re done. If I don’t trust you, I will wait until you’re done unless a CNA comes in to take over.

No one falls under my watch. 

And this is a good night. It is not even midnight yet. On a bad night, oh, you don’t even want to know. That might be another post for another day…

2300-0000 – Finally, done with meds. Having tucked all our patients in bed, wrapped them warmly in their blankets, SCDs* are attached, most importantly, bed alarms are on, I sit down and start to chart.

CNAs do their midnight vitals so naturally, wakes the patient up. Call lights go off. Patient in 201 wants his sleeping pill. Patient 202 wants her pain med. Patient 203 wants to potty. And the cycle goes on until they go back to sleep again. IF they go to sleep at all.

0000-0400 – Quiet time. We aren’t really supposed to say the Q word because that is considered a jinx. I’ve been in nursing long enough to believe in superstitious beliefs such as the Q word and full moons.

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While our patients are restfully healing in their sleep, we faithfully do our hourly rounding alternating between CNA and RN. In between that, we take our 30 minute mandated lunch breaks. Yes, we night shifters have lunch at 2 am! We are weird that way.

By the way, have I mentioned that this nurse needs to go to a potty break too? In the madness earlier, I forgot to pee. A nurse averages going to the bathroom 1-2 times during a 12 hour shift, on a normal day/night, if they’re lucky, sometimes none at all. Most times, they get affected with the “F2P syndrome “.

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We also do our 24 hour chart checks. This is to ensure nothing has been missed during the day, no order has been left un-noted and not done, that all treatments and labs are put in the computer where they are supposed to be, that the MARs* are up to date and correct. Nursing is a 24 hour job.

Charge Nurse calls. You are getting an admission. Uh-oh. I am halfway done with my charting and my chart checks. Regardless like a real trooper, you call ER* for report and receive the patient (with open arms?) with a welcoming smile and do your orientation and admission spiel. Your shift could end well and early if you get a “good” admission. If your admit is a train wreck, good luck!!!

0500 – It’s almost time. Phlebotomist/lab tech comes in and wakes everybody up with lab draws. Call bells and bed alarms go off. The cycle continues.

0600 – Time to pass that Synthroid and Protonix. Wake everybody up again. You sit down to finish your charting.

0620 – Patient in 202 wants her pain med. Patient in 201 pulled out her IV and is bleeding profusely. Bed alarm in 203. Really.

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0635 – All fires are put out. Pain med given, new IV access inserted, patient back in bed with bed alarm on. Where is that day shift RN?

I go home just around 0730 tired and exhausted, more so if it’s my 3rd night. I drive back home trying to stay awake and the minute my head hits my pillow (after a small breakfast and a quick shower), I fall asleep dreaming of bed alarms and call bells.

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And the cycle goes on…

Here’s to nurses and all caregivers!!!

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Glossary:
1. HIPAA – Health Insurance Portability and Accountability Act
2. RN – registered nurse
3. CNA – certified nurse assistant
4. IV – intravenous
5. neuro – neurological
6. SCD – sequential compression device
7. MAR – medication administration record
8. ER – emergency room