In nursing school, I had this idea in my head that nothing happened over nightshift. I heard from some sources that nurses slept during nights! And this was confirmed when I would come early to my day shift (at one particular unnamed hospital) and see nurses asleep at the nurses’ station. Going into my first nightshift, I had no idea what to expect. Was there a lot to do? Would I feel tired? Was CHLA different than this other hospital?
Being a Pediatric Hematology/Oncology Bone Marrow Transplant nurse puts me in a PICU setting. My kiddos are extremely sick. And as everyone knows from being sick with even a head cold, it goes one of two ways: you sleep all day or you can’t sleep at all. Unfortunately, it usually goes the non-sleeping route on my unit.
My nightshift begins with getting my patient assignment and doing a quick preparation on orders and meds due within my shift. I write out what is due every hour and also include my every 4 hour (Q4H) vital sign checks, PEWS, PCA clearance, assessment, blood sugar checks, and my 0400 AM labs. I also make sure I include every hour intake and output charting. The system usually auto-populates what is going into the patient but even something like a flush or a blood draw must get charted. I/O measurements are so important with our patients. I then get hand-off from the nurse and we go into the room and I introduce myself. I first make sure my safety equipment is present, and then I check out all the patient’s lines: what is going where, what is the rate, when do the lines need to be changed, and then I clear the PCA and chart demands vs delivers. After leaving the patient’s room I scrub in. Scrubbing in for two minutes is required being amongst immunocompromised intensive care setting patients. I then wipe down my station/COW and get going with my shift.
Every night, we change lines. There are certain lines like PN and lipids that get changed everyday and others like PCA lines which only get changed every 72 hours. Checking them at the beginning of the shift helps you plan out your night, because changing lines can take time! Caps get changed every Monday night. So we plan this out as well!
It is imperative that all patients on my unit have a bath and linen change everyday. This usually happens during day shift, but if it doesn’t get done, it gets added to nightshift’s to-do list. This being said, we want to get it done before they potentially fall asleep!
These kiddos have medications due every hour. As a new grad nurse, I am trying to be very thorough in my medication administration process, and this takes time. Once I get the med that is due, I look at line compatibility. I then look at how long it is run over to plan out my other meds. Is this a safe dose for my patient? Additionally, I try to time the med finishing when I am in the room so the pumps don’t beep. This may not seem like a lot to handle but when they get over twenty meds at night with over 10 pumps connected to them, it is a lot.
Our patients have sometimes 10+ lines going into them. Beeping pumps are inevitable. Even with me doing everything in my power to avoid them beeping, they will beep. Staying close-by the patient is mandatory.
Since my patients are so sick, they can change within seconds. Frequent assessments are imperative. I kid you not, these things happen so quickly. That is why we are a PICU.
I find myself in my patient’s rooms for lengths of time. The other night I was in my patient’s room for over four hours. Additionally, full PPE is required for almost all the patients on the unit. I am busy until at least midnight…running back and forth getting things done. I then usually have time to catch up on charting around 0100. This is when I have my Pressed Juicery Almond Milk with Coffee. I don’t find myself getting tired, ever. Even on my first nightshift of three where I stay awake for 24 hours, I don’t have time to get tired. I try to take my break around 0300 because things get busy again at 0400 for lab draws. We want to make sure we draw labs as close to 0400 as possible incase they need blood. This also will require a cross and type analysis. All this takes time and we want to make sure we can start the blood before dayshift arrives.
The last tasks of the shift are giving report to charge, completing charting, and writing our end-of-shift notes. Anticipating these tasks helps me plan out my shift.
This week is my last week of nights. I then switch to days for six weeks. I am so surprised at how much I LOVE nightshift. There is something special about nightshift. I find myself feeling so close to these nurses. There is a sense of comradery amongst the nightshift nurses. We have limited resources during nights. There is only one attending on call (no Residents are allowed on our unit because of how specialized it is). Therefore, we have to help each other if something goes wrong. We are all in this together.