This story was originally published on April 9, 2012.
Night is when everything slows down. It’s peaceful, calm, quiet and everyone sleeps, right? If that’s what you think, you’ve never worked a hospital night shift.
“Sometimes I’ll look out in the lobby and there will be 25 people out there and I’ll think we’re never going to make it,” said Vicki Lyons, a staff and charge nurse at WellStar Douglas Hospital in Douglasville. “I’ll go out later, see only a couple of people and realize that three or four hours have flown by.”
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Lyons, ADN, RN, works on Friday and Saturday nights in the emergency room at a busy 100-bed hospital that serves a fast-growing community.
“Sometimes we see 125 patients in the [Emergency Department] in a 24-hour period,” she said. “On weekends, the admissions staff isn’t in the building. We’re the front door, and about 90 percent of admissions come through us. Patients come and nurses go, and my nights just fly by.”
The Emergency Department starts out the night shift at 7 p.m. with nine to 10 nurses, but because of staggered shifts, nurses sign out at 9 p.m., 1 a.m. and 3 a.m., leaving six on duty after that.
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“At 3 a.m. it should be slow, but with the ED there are no appointments and you never know who will come through the door,” Lyons said. “I’ve had patients keel over with cardiac arrest or other things as I’m admitting them. Suddenly, other nurses will be right there and we’re trying to save a life. They’ve got my back and I’ve got theirs.”
At night, Lyons has seen trauma that she never expected to deal with, and sometimes it’s hard to forget, but she’s never considered working the day shift.
“I’m a single mom and on the weekdays, a teacher,” said Lyons, who home schools her youngest son, a 15-year-old high school freshman.
She also taught her other son, who is now in college. On Sundays, she plays the piano at her church.
After four years serving in the U.S. Marines, Lyons thought she would become a paramedic, but her mother (a nurse) convinced her that nursing offered more opportunities. She earned her nursing degree in 2000 and has always worked at night.
“I love my job and I love nursing. The night shift has enabled me to do what I wanted to do, which is raise my kids. You only get one chance at that, and it goes by so fast,” she said.
Lyons, who is looking into BSN and MSN programs, plans to work more hours when her son graduates from high school.
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‘I can’t see doing it forever’
Portia Brown, RN, BSN, has worked the night shift for two-and-a-half years and values the lessons she has learned. As part of the critical care resource unit (float pool) at DeKalb Medical, she may be assigned to the intensive care unit, an intermediate recovery floor or an observational unit in the ER.
She also works nights at another hospital, so some weeks she’s on duty five nights a week and sees her significant other as they pass each other coming and going and on her days off.
“I don’t mind that my schedule is backwards for now, but I can’t see doing it forever,” Brown said. “It is more stressful because you are tired and your resources are more limited.
“But there are benefits to working at night. I can grocery shop and go to the bank when it’s not crowded, and the pay is better, which is a nice incentive.”
Depending on the number and acuity level of her patients, some nights are quiet. Not a coffee drinker, Brown has learned to keep moving and refocus to stay alert.
“I’ll go out and see if anyone else needs help, but other nights we might get eight new admissions,” she said. “It’s a misconception that things are always quiet and we’re not as busy. It’s just different.”
Brown misses the rounds of the day shift, when she could ask questions and raise concerns about her patients directly.
“At night, you get used to relying on yourself,” she said. “You learn to anticipate needs and get the information you need early in the evening, when people are awake.”
With fewer procedures and interruptions, Brown can spend more time with her patients and their families. “I can take more time answering their questions and educating them about their conditions, and that feels good.”
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‘Born-and-bred nightshifter’
As a rookie nurse, Laura Hochwalt, RN, BSN, wanted to work in the emergency department, but she needed more experience. The night shift was her way in and she ended up loving it.
“I’m a born-and-bred nightshifter,” said Hochwalt, Nurse Practice Council chair for the Emergency Department at Grady Memorial Hospital in Atlanta. “From a trauma point of view, more happens late at night after the clubs close down. The patients can be more intoxicated or combative and if it’s raining, we know we’re going to see more accident victims.”
Most emergency departments have the same patient volume at night, but smaller staffs to care for them. It makes for a challenging work environment, which Hochwalt likens to being stranded on a deserted island.
“You work closely as a team, but it’s less formal. There’s more joking and camaraderie than on the day shift,” she said.
The MRI and ultrasound departments are closed at night. “During the day, you get an order and take the patient. At night, if there’s an urgent need, you have to beep the technician on call and wait for him to arrive,” she said.
When a patient needs a splint and the orthopedic department is closed, Hochwalt has learned to borrow materials from the OR and make one herself.
“You’re always problem-solving at night,” Hochwalt said. “You have to get creative and do work-arounds. I feel like I have a little more autonomy and use more of my nursing knowledge.”
As Nurse Practice Council chair for the ED and Trauma Nurse Committee chair, Hochwalt works three days in her office and two nights on clinical shifts in the ED. Changing shifts can be challenging. On her way home from work at night, Hochwalt’s mind is still racing and it takes her a couple of hours to unwind.
“Usually, I feel good about having been there,” she said.
Hochwalt says sleep is overrated and that exercise helps her energy level.
One advantage of working on the Nurse Practice Council is the chance to be an advocate for her night owl co-workers. “I’m the voice for the night shift. I take back any issues and concerns to the council, which makes decisions about nursing practice. I figured I needed to be there to see what worked and what didn’t,” she said.
Hochwalt has addressed the shift process, morale issues, the need for more in-service training and meetings at night, and extended hours for the cafeteria.
“So many schedules focus on the day shift, but the hospital doesn’t go on auto-pilot at 7 p.m.,” she said. “Sometimes it gets even busier then.”
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