Night shifts…. some people love them, some people hate them. Personally I quite like them – it’s a welcome break from all the busyness of the daytime. The wards are a lot more of the Q word ending with T (which you are banned from ever saying on a hospital ward – we’re a superstitious lot!) and so you have more time to spend with patients and are not as rushed as usual. Although having said that, some night shifts I’ve done have been extremely busy with deteriorating patients and admissions to attend to.
The downside for me is the immense tiredness. The most nights I have done in a row are 3 and I am certainly tired by night 3. I usually find that the 1st night is quite hard, the 2nd is not bad at all and is probably my peak and then by the 3rd night I start to really feel tired. I’ve only ever had hospital placements so cannot say what it’s like in a nursing home or other healthcare settings but this is the routine for a student nurse on a medical ward (from my experience).
7.45 – Arrive on shift, get a general idea of how the day shift has been from the atmosphere on the ward. Get my handover printed if it hasn’t already been done.
8.00 – Handover begins.
8.15/8.30 – Handover finishes. The day staff start to leave.
8.30 – We introduce ourselves to the patients – the ward is split into two with 2 nurses and me on. One nurse has 3 bays, the other has 2 and all the side rooms. I am usually assigned my own bay of patients to care for. Start doing my patient’s observations. Work out when the next observations will be due for each patient. HCA’s team up and assist patients to bed and with personal care.
9.30 – Medication round begins. Some medication is time specific such as epilepsy medication and so may be taken slightly later or earlier. I do the round with the nurse observing me.
10.15 – IVs are done last unless there are any which urgently needed doing. It’s a good chance for me to practice my medication calculations.
10.45 – We are free to help with any turns and toileting the patients may need help with.
12.00 – 03.00 – Go through the patients’ notes and see what doctors/nurse specialists have decided is the plan of action for each patient. Update the handover sheets if need be. Do any observations which are due. Make sure the drug trolleys are tidy and stocked up – a good opportunity for me to test my pharmacology knowledge. Assist with patients’ personal care – turns, assisting patients to the toilet/to use a bedpan/ if a patient needs their pad changing. Go through the crash trolley checklist and check that everything is there and all in date! Make sure B M (blood monitoring) machines have been checked and are ready for use later on.
03.00- 04.00 – BREAK TIME 🙂 I like to go around this time as this is when I feel the most tired and usually by this time I’m up-to-date with all my jobs. I’ve also got some observations to do around 4 and so this is good timing.
04.00 – Do any observations due.
04.45 – Prepare my handover – add on anything important that has happened overnight for example – a patient has had chest pain and so I did an ECG and beeped the doctor or critical outreach nurse. What the doctor/nurse said and what action was taken. How the patient has been the rest of the night. Or it can be something less exciting such as a patient had an episode of loose stools, the day staff need to know where on the Bristol Stool Chart the stool was and whether I’ve managed to send off a sample yet. Write my patient’s notes – if anything major happened such as the chest pain example, I will already have written in the notes at the time so I don’t miss anything important out.
06.15 – Do any more observations due, check patient blood sugars. Assist health care assistants to meet patient’s personal care needs. It usually gets busy around this time and you’re rushing around!
06.45 – Day staff start arriving. Make sure handovers are printed out.
07.00 – Handover time! I handover my patients to all the day staff. The nice nurses usually let me go 1st so I can leave 1st. The joys of being a student nurse!
07.15 – Finish!
Think I’ve managed to include everything! My top tips for doing a night shift are:
1. Keep busy! If you’re sitting around, time tends to move very slowly. Take some reading with you in case you get a bit of down-time during the shift to keep you occupied.
2. Try and go to bed a bit later than usual the night before you start night-shifts and lie in if you can. If you don’t think you can do this have a nap in the afternoon before your night-shift (I can never do this for some reason!).
3. Take healthy(ish) food to your night-shift. I usually take soup, a small chocolate bar, a banana and a diet fizzy drink. The most tiring night-shift I did was when a nurse brought in loads of junk food; crisps, cakes, chocolate which I binged on. The sugar-low in the morning was awful!
4. Make sure you have somewhere quiet and dark to sleep during the day. You need darkness for your body to produce melatonin (essential for your sleep/wake cycle) – suppressed melatonin has been linked with various cancers, heart disease, impaired immunity…the list goes on. I live with my partner but when I’m on nights I sleep at my mums because it’s much quieter in the day-time where she lives.
5. Try to go to sleep as soon as you get in from a night-shift. If you wake up a few hours later, try to go back to sleep or just rest in bed. Some people get a “second wind” and feel like they’ll be fine getting up but then feel exhausted by the time they start their night-shift. I try get at least 6 hours sleep in the day, 7 ideally.
6. Do not drink alcohol the night before a night shift! I haven’t done this before (promise!) but know people who have and say they feel a lot more tired than usual. Obviously a couple of drinks are fine but not a night-out’s worth of drinks!
So these are my thoughts on night-shifts. They can be a really good learning experience as caring for deteriorating patients at night when there are less doctors and other healthcare professionals around is big learning opportunity. You and the nurses you’re working with have to make decisions without a big team around you – obviously there are always doctors and specialist nurses around, but when they’re on-call for all the wards in the hospital you need to be able to make judgments about your patient and make sure you communicate effectively and so that the patient doesn’t deteriorate any further. Hope you don’t find your night-shifts too bad or maybe you like them! 🙂
Student Nurse Yorkshire 
Another fascinating blog! But what are these wards beginning with Q and ending with E – queue?
It’s word – quiet! Ending in T 🙂
Really enjoying your posts! I will share! a friend across the pond 🙂
Thankyou! Haven’t written anything in a while, will have to start it up again 🙂