When darkness falls on University of Colorado Hospital, most employees are at home winding down from another workday or spending some leisure time on the town. For other employees, the fading light means it’s time to go to work.
These are the people who work the night shift, indispensable to UCH’s 24/7/365 operation. Many of the night owls are nurses working 12-hour shifts that most other occupations would call “graveyard.” On an inpatient unit, the night shift is anything but that. Nurses tend to the health and well-being of patients who can go downhill just as readily at night as they do during the day. Illness doesn’t follow the clock.
The night-shift nurses keep the hospital’s patients in good hands, but helping them to stay connected to the day-to-day operations of their workplace requires effort and commitment, said Mimi Ryan, RN, director of UCH’s Magnet Program. When she worked nights as a bedside nurse, Ryan said she relished the occasional periods of quiet and a strong measure of independence. But those benefits come at a price, she added.
“Night-shift nurses are strong and autonomous, but they too often fly under the radar at the hospital,” Ryan said. “The question is how do we engage them?”
Appearances by leadership help. Associate Chief Nursing Officer Cathy Ehrenfeucht, RN, MS, and her team make early-morning breakfast for a designated unit once a month. Chief Nursing Officer Carolyn Sanders, RN, PhD, periodically joins Ehrenfeucht and others to wheel coffee carts around the units for a little pick-me-up and a chance to chat with night staff.
Still, nurses who work the day shift have greater opportunities to join committees, attend meetings, and get training, Ryan said. “We can offer these kinds of things before or after the night shift, but that means they lose time for themselves on both ends.”
Into the night
Managers, educators, and charge nurses in units across the hospital have developed and encouraged educational and team-building activities to help night-shift nurses maintain a sense of connection to their colleagues, their profession and the hospital as a whole.
For example, Krystal Chamberlain, RN, clinical nurse educator for the Neuro ICU, said an influx of new staff and training demands for new technology, such as the Alaris pump/Epic integration, increase the difficulty of maintaining contact with night staff. She counters that by offering mandatory training and continuing education classes to night staff shortly before and after shift change.
Chamberlain also worked with her ICU educator colleagues to create educational videos with information on equipment, such as rapid infusers for patients who have had massive blood loss and noninvasive cardiac monitors.
But it’s easy to take for granted the special challenges of working through the night in a high-responsibility profession. Chamberlain said that in her personal evaluation, some night staff said they’d like to see more of her.
“I told them I would take that as a compliment,” she said with a smile. “But the key is for me to help to make them cognizant of the resources that are available to them.”
Duties in the dark
Stacy Rodriguez, RN, charge nurse on the 8 West Orthopedics Unit, has worked the night shift for 10 of her 12 years at UCH. The schedule helps Rodriguez and her husband handle child-care duties for their two boys, ages 10 and 2. But she says sleep deprivation is a fact of life, and she feels at times she misses out on activities with her husband and kids.
By now, working the night shift is “second nature,” Rodriguez said. “Some people can’t do it. I can sleep during the day with a loud family.” She’s also learned to take good care of herself and exercises daily to keep her energy up and avoid fatigue.
The uninitiated might believe that night shifts are quiet, but that’s not the case, Rodriguez said. Units downsize staff at night, so nurses have more patients, many of whom don’t sleep. Night staff get fresh post-op cases, and they have to be prepared to respond with fewer resources when patients’ conditions suddenly decline.
Ashleigh Anderson, RN, charge nurse on the Medical Surgical Progressive Care Unit (MSPCU), has worked nights exclusively at UCH for almost three years. She said the evening hours can be surprisingly difficult for patients, and many of them need extra attention from their providers.
For example, she said, “Pain and anxiety go hand in hand for patients. After the hubbub of the day is gone and people aren’t coming into their rooms, patients get anxious. And when they get anxious, their pain levels go up.”
Behind the curtain
Night staff have contact with their day-time counterparts at shift change, but opportunities to interact with other hospital employees during regular working hours are limited. Chamberlain, who worked five years as a night nurse (one at UCH), said she sometimes “felt alienated,” mainly because educational opportunities were limited by the hours she worked.
“There is a feeling of separation to some extent,” Rodriguez agreed. “If there are educational opportunities or committee meetings at noon, it’s nearly impossible for a night-shift worker to attend.”
Even if the spirit is willing, absorbing information after a 12-hour shift is tough. “The brain can’t retain it,” Rodriguez said. It can add up to nurses feeling disengaged and left out of the day-to-day life of the hospital, she added.
Another complication is that individuals adjust to the rigors of a night schedule in different ways. Anderson said some nurses stick to a night routine even when they aren’t working in order to have a regular routine. That too makes attending meetings very difficult.
“When you’re used to going to bed late, it’s hard to switch over,” Anderson said.
Working the clock
But Rodriguez and Anderson – who also has two young children – have made a point of staying involved. Rodriguez joined the Kaizen Committee, which works on medication safety issues. The committee holds its monthly meetings at 7 a.m. Anderson belongs to the Pain Champions Committee. Its once-a-month meetings are Wednesdays at noon, but she said she adjusts by avoiding being scheduled to work the previous Tuesday night.
Staying connected takes that kind of planning, Rodriguez said. It’s a matter of “finding your interest and the right timing to be engaged.” Anderson developed her UEXCEL credentialing project around helping patients manage chronic pain. The work led to the development of “comfort carts” loaded with non-medicine alternatives to minimizing pain.
Anderson also started a journal club on pain management that she admits wasn’t as well attended as she would have liked. But she said the work kept her engaged with patients and her nursing colleagues and pointed the way for others on her unit.
“Credentialing and UEXCEL gives me a way to lead by example,” Anderson said. “It’s another way to encourage staff to stay involved in their profession.” Since she got her credential, many more nurses on the MSPCU are now taking the same path, she added.
Rodriguez also finds ways to help her colleagues stay connected, mentally and physically. For example, staff meetings at 7:30 a.m. can be grueling after working all night. “We all get a glazed-over look after sitting for too long,” she said. Instead, they meet at 2 a.m., when “staff are more engaged and receptive.”
Reach out in the darkness
She’s found other opportunities. When she was on light duty during her last pregnancy, Rodriguez was assigned to the telemetry “cockpit,” where staff remotely monitor patients’ heart rhythms. Rodriguez used the time as a learning experience.
“Kudos to those who work that job,” she said. “I learned a lot from them. I wasn’t comfortable when I first started. A lot of nurses feel that way working with rhythm interpretation. In Orthopedics we’re all about bones.”
After finishing her telemetry stint, Rodriguez worked with the unit’s clinical nurse educator, Michaela McCarthy, RN, to develop quizzes and copies of heart rhythm strips for nurses to interpret. She later added case studies and crossword puzzles to help build knowledge about telemetry. The materials are available in a “Cardiac Corner” Rodriguez put together in the unit’s work area.
“I’ve gotten comments from nurses that it helps them to keep the information fresh in their heads and has helped with their comfort with telemetry,” Rodriguez said. “They can come to see me with questions, and that maintains rapport.”
Anderson believes it’s important for nurses to recognize that they have an opportunity through committees, unit-based councils and other forums at UCH to blaze their own career paths regardless of the shifts they work.
“The great thing about University is that leadership listens to nurses and gives us a platform to make changes,” she said. “If you want your voice to be heard, you can get it heard.”