What it’s like to work as a night nurse

Nursing Our people Patient safety

As the sun sets and most are winding down their days, Encompass Health patients are cared for by night nurses committed to continuing compassionate care that sets the standard.

You cannot sleep fast.

Every hospital makes weird noises.

The sun always comes up.

Those are lessons Mary Ellen Hatch, Encompass Health’s vice president of nursing operations, learned firsthand during her years on the night shift. Mary Ellen started her career as an 11 p.m. through 7 a.m. nurse on a 46-bed telemetry unit, and still knows those three adages to be true.

Another one she shares to night nurses is to tell your stories to each other and connect with your colleagues, and know that not everyone may understand what happens at night. And, don’t be afraid to laugh, because sometimes you have to.

“Soon after I began working at a brand-new rehabilitation hospital as a night supervisor, we had a super busy night. While answering a call light, I entered a patient’s room to see what she needed,” Mary Ellen said. “As many night nurses do, I did not turn on the light because we can see in the dark, right? The patient was looking all around declaring loudly that she could not find her leg. I immediately went into therapeutic communication mode, trying to help this patient who had obviously forgotten she had experienced an above-knee amputation. She looked up at me, sighed and said, ‘No, sweetie. My leg is under the bed. I can’t reach it!’”

When the lights go off and the hustle and bustle of Encompass Health rehabilitation hospitals slows, night nurses are left standing guard, ensuring that exceptional care continues even in the dark.

“Sooner or later, the day shift will show up,” Mary Ellen said, “and you will get to go home after holding the hand of worried patients, listening to the stories told by lonely folks, returning to the same patient bed for the fifth time and the myriad of other duties performed while everyone else is asleep.”

Creativity and confidence

In his 12 year career with Encompass Health, Bobby Narkevicius has experienced both the night and day shifts. After starting on nights with Fairlawn Rehabilitation Hospital straight out of nursing school, he transitioned to days. He spent five years on the day shift before becoming a night supervisor for the last six years.

Having experience in both shifts, Bobby said he gravitates more toward the evening hours. There’s an added sense of independence that comes with working at night, as nurses are essentially the only clinicians in the hospitals.

That independence requires a nurse to be confident in their skills and knowledge, and to have a heightened sense of discernment and critical thinking.

Extra caution is always practiced in regards to patient safety, and when there is any grey area, calls to physicians or caregivers are always made. But, when a situation arises that the nursing staff can handle appropriately and confidently, caring for caregivers and preserving their rest times away from the hospital is important.

“The nights can naturally bring more challenges” Bobby said. “It’s important that we’re able to handle these challenges and learn when calls to the family are needed. A lot of new nurses can be quick to call families in the evenings, but that’s not always the best solution. You have to think of the caregivers well-being as well.”

Compassionate care and communication

At the beginning of her shift as a supervisor at Encompass Health Rehabilitation Hospital of Las Vegas, Tatiana Lafradez is greeted by incoming evening admissions.

“It may be the end of the day for most people, but it’s the start of that patient’s day at Encompass Health,” she said. “We give them a play by play of exactly what’s happening. We want to make sure they are as comfortable as possible, confident with their care plan and ready for the next day.”

As there isn’t as much activity in the evenings, Tatiana has more opportunity to talk to the patients, listen closely and answer as many questions as they may have, she said.

It’s only human nature that in the still of the night as patients find themselves alone with their thoughts, worries can grow and fears loom louder. Once visitors are no longer at the hospital, it is up to the nursing staff to be the ones at the bedside to hear a patient’s fears, concerns or other late night musings.

“What’s really important is taking that extra minute or two to let that patient speak about what’s on their mind and how they’re feeling,” Bobby said. “All patients are going through their own experience. We can get so caught up in our daily activities, but we have to remember these patients are going through their own hardships, and each story is unique.”

Collaboration and celebration

Vidette Forbes, Northeast regional CNO, learned quickly during her nursing school days that she did not adjust well to the nocturnal lifestyle. She started her career in hospice, and began working in an LTAC to gain acute experience. While she was working to obtain her RN degree, she took on the night shift at the LTAC. The experience, she said, has greatly influenced the way she leads her region.

“It was very hard; some people are night people, but I am not a night owl,” Vidette laughed. “It makes me admire night nurses even more.”

Interpersonal connections are key for a successful night shift team, Bobby said. In a quieter environment with less hustle and bustle in the halls, it can be easier to turn inwards.

That’s a trend that has to be avoided at all costs, he said. At the end of the day, there are simply just less people present in the hospital, so effective teamwork is a must.

“While we’re at work, we need to stay connected with each other,” Bobby said. “It’s easy to get in your own zone and focus on what you need to do, and get what you need done. If you are not connecting with your co-workers, it can disrupt the team environment and possibly decrease morale.”

Much as it’s important to connect, Vidette said, it’s paramount that any celebration held for day shift employees, no matter the size or scale, are replicated to honor those who stand guard at night while the world is asleep.

“We can’t forget about our dedicated team of night nurses when the lights go out,” she added.

Around the clock care

Several models are used within home health and hospice to ensure quality patient care continues 24 hours a day, seven days a week. This constant accessibility is a key part of patient satisfaction, and questions on its success are included in mandated satisfaction surveys.

A popular and effective model for delivering high quality care after the standard workday ends is the triage approach practiced in states that allow telecare assistance.

In this model, a team of registered nurses are available by phone from 5 p.m. to 8 a.m., and all weekend long. These nurses triage all calls, handling any issues they can via phone, and dispatching a nurse to the home when it’s needed.

Calls the triage team receives vary greatly, from last-minute medication refills and pain management to, in the case of hospice, the passing of a patient. When a nurse needs to be dispatched to the home, triage nurses remain in contact with a patient or caregiver until assistance arrives.

“When it’s dark out, everything seems to get a little bit worse,” said RN Patti Collett, lead triage nurse. “We can really help the patients and the families get more comfortable.”

Patti began her career in hospice nursing after her father went through hospice care. Inspired by his care, she switched gears and went to nursing school. It was her way of saying thank you for the care he received.

Though she isn’t in the home, she’s still able to make a difference with patients and their families, walking them through what is most likely the most difficult time in their lives, being a light in the dark.

“I really feel like I make a difference,” Patti said. “It’s just a different way to do it.”