Night shifts….

On the wards the main difference for a nurse working a night shift is doing your job around people who are sleeping.  Weird right!!!  Going about your work, in this case giving medications, writing notes, checking observations, all the while tiptoeing around the person sound asleep in the next bed.  The nurse may be settling in the new arrival from A&E and the confused elderly man in bed 10 who keeps on trying to wee in the linen basket and is convinced that the staff are out to kill him. 

There is also the matter of breaks and when to eat. It is so strange sitting around for a meal at 4am in the morning.  Your mind is tired, body aches and your both hungry and nauseous at the same time. 

In emergency care the pace remains the same, day or night. That goes with an open access 24 hours a day.  People still getting injured and having emergencies or generally feeling unwell at all times. Traumas, strokes, cardiac problems, medical emergencies and surgical complications don’t wait till a more reasonable time.   

When I first started in nursing, our rota began with 7 nights followed by 7 days off, inclusive of the morning finishing nights. Looking back, I am not sure how we did it. Working 80 hrs a week was so tough, mid week would start to feel a bit tired, by the end of the week it was a surprise we remained upright and could still see clearly to give the patient in bed 15 their IV antibiotics. The only saving grace was that back then, emergency care was seeing roughly half the patients we do today and there was a brief period overnight where a low number of patients attended the department. This enable us to clean and stock the department as well as teach students and junior nurses. 

Today, 4-5 nights are the norm, the department remains busy, regardless the time of day. There is less and less time for teaching and more likely to be tired, hungry and frustrated, all the while interacting with more and more patients, their friends and family whom are more than likely to tell you that you don’t know what you are doing and call you every rude name under the sun. All the while dealing with an increased workload and an ever shifting, under staffed work force. 

My night shifts this week consisted thus

Monday – in charge of the shift. IT issues mean more frequent board rounds, walking round the department and checking each area manually rather than virtually on the computers. Having to document site reps, admissions, breaches as well as keep track of incidents and safeguarding issues with a student tagging along who wanted to get experience of being in charge as she was on her management placement. All the while ensuring staff are coping with the downtime procedures, not too stressed and able to perform their duties as normal, ensuring I remember to go to the extra meetings overnight and have a break to eat. 

Tuesday – co-ordinating majors with a magnetic board due to ongoing IT issues which meant no computer access to medical records, blood and X-RAYS results as well as IV policies, work e-mails and local intranet. Slow patient flow due to having to register everyone manually, write assessments on paper, log patients in a book ( to keep track of patients while in the department). Walking patients around to their respective areas, relogging them in to that area and ensuring they are on the magnetic board as well as chasing the labs, who are taking a millennia in processing samples as everything is being done manually. Having to continuously remind everyone to carefully document everything as some poor soul will have to go through the notes at a later date to validate attendances, performance, breaches and admissions/discharges. 

Wednesday – Triage, assessing everyone that came in to the department buy themselves or LAS.  Still on downtime, collecting a batch of notes at a time from reception, assessing patients, writing a brief note of their encounter, finding X-RAYS request forms and ensuring they follow patients to injuries as XR’s can’t be completed without them, walking patients to their area, transferring notes and magnetic strip to each co-ordination and ensuring they are logged out of my area and in to the next one. Talking to and trying to redirect patients with primary care issues to see the out of hours GP service (or their own GP) rather than ED. 

Thursday – 12 hours back logging information on to the IT system which is finally working, all be it a small amount of functionality 😔😑. Having a quick brekkie with my team post shift. Breakfast post night shift is legendary, the only time it is socially acceptable to get a beer (or other alcoholic beverage) with a cooked breakfast. No, I wasn’t drinking as I had another shift that night 🤔

Friday – resus, really, really sick patients, 1 requiring HDU.  Multiple trauma calls brought in by LAS and other hospitals as well as patients having acute strokes, 2 of which needed thrombolysis (1 of which thromobolysed by ED as Stroke nurse performing thrombolysis on another patient) and 1 child. 

Finished nights, went home and organised to meet up with a friend whom I haven’t seen for ages. Went for short nap. Woke up at 6pm, having missed my friend and wasted a very sunny Saturday 😤.