24-hour services are essential for providing acute care. They’re essential in hospital wards, medical settings and surgical units, as well as for on-call services, trauma, and medical emergencies. 24-hour care needs to be available for some people with extra care needs living at home, and nursing care homes provide 24/7 care to some of the most vulnerable in society. Some settings can run with reduced staffing numbers overnight, whereas others need all hands on deck at all times. Whichever it is, there is no break in the need for good nursing care.
What is a day shift nurse?
24-hour care settings require shift patterns which need to be carefully thought-out to ensure that the needs of the service are met, while the needs of their staff are respected. Everyone needs to have an acceptable work-life balance, and sometimes long shifts and hours that varies from day to day can be difficult.
On a day shift, most settings are busier. In acute settings, there is usually more going on; patients receiving input from medical teams and allied healthcare professionals like physiotherapists and dietitians. Nurses need to work around mealtimes and visitors as well as respond to changing medical plans. There may be aspects of a day shift where the nursing is task-based – medication needs to be given at certain times so regular medicine rounds may be part of the working day, and nurses need to respond to decisions made on medical review rounds.
Just having more visitors around can make a huge difference to a nurse’s role on day shift, compared to a relatively visitor-free night shift. Families need to be updated or involved in decision making, and it isn’t unusual for a relative to need a substantial amount of time and nursing support to understand or come to terms with their loved one’s diagnosis, prognosis, or treatment plan. Day shifts are where specialist teams come to give input – mental health liaison, specialist nurses for wound care, palliative care, and so on.
A large part of a day shift nurse’s day is simply supporting the people they care for with their activities of daily living; making up for any self-care deficits by helping with washing, dressing, mobility and food and fluid intake. All this alongside making sure medications are given at the right time, especially some time-dependent medicines like intravenous antibiotics, fluids, and medications for diabetes and Parkinson’s. Nursing care, especially in acute settings, also includes routine essential observations, updating care records and recording every intervention, anticipating problems and responding to urgent needs and emergencies. The changeable nature of health and people’s activity means that no two days are quite the same.
What is a night shift nurse?
Many health and care facilities and providers need to have safe staffing levels 24 hours a day, 7 days a week. For emergency care settings, these staffing levels, and the nature of the role, may be very similar to a day shift. In less acute hospital or community settings, the pace on night shift may be a little slower.
One of the benefits of night shift can be the pay; many – but not all – employers offer enhanced pay for those who work unsociable hours. Nursing is a vocational career path, but that doesn’t mean that we shouldn’t expect to be fairly paid to work in a highly trained, specialised, physically and emotionally taxing job. A higher rate of pay can be very attractive.
Another potential benefit of night shifts is that it may be helpful for childcare schedules; if one parent works regular weekdays, a night-shift worker may finish work in time for the school run, sleep through the day and then be present for the demands of family life in the late afternoon and evening. Families often find that having one parent working through the day and one on night shift works very well for their schedule. Some nurses may simply find that they prefer the pace of night shift in non-acute settings; when things are a little quieter, with less staff and fewer visitors, and in hours where people require fewer nursing interventions. [i]
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What is the schedule like for night shift nurses?
Routine medicine administration in the evening is part of the role of a night nurse. This may be a regular medicine round – many medications are administered in the evening so there is likely to be a medicine round last thing in the evening. Patients or residents in a facility may also require additional medication through the night – particularly in settings where people may have additional requirements for pain management, such as in palliative care.
Some settings require a nurse to be present at all times but without significant demands on them – a care home where the residents are reasonably independent, or where they are able to make their own needs known overnight, or where staff are there to assist with regular turns for pressure area care and continence checks may have a more relaxed pace for most shifts.
If you are a night shift nurse working in home, acute, or formal care settings where people have complex care needs such as mechanical ventilation – or in acute mental health settings where patients may have delirium or cognitive impairment – you may interact more with people who have ongoing acute needs overnight. In acute settings, patients will still need regular routine obs, which nurses must be able to respond to appropriately, anticipating deterioration and managing any risk.
What kind of facilities require night shift nurses?
Any facility that provides 24-hour care, whether acute or long-term, will require an overnight nursing team. Different types of setting will require a different skill mix, and an overnight nursing team may include a mix of nursing assistants and qualified nurses. Student nurses are also usually expected to gain experience of night shifts and can be invaluable team members.[ii]
As nurses become more highly specialised, they may also be required to be part of an on-call team. They need to be prepared to come and assist with emergency procedures, but may have shifts where nothing at all happens.
Tips for nurses working the night shift
We can’t function well without enough sleep, and nursing is one profession where the consequences of sleep-deprived staff can be catastrophic. Basic sleep hygiene can help make sure that you’re getting enough good quality sleep through the day.
Sleep hygiene tips for night shift workers
- Allow yourself time to wind down after the shift – if you’re exhausted, you might want nothing more than to get straight into bed… and this might work well for some people. For others, however, having some time to wind down can make all the difference to the quality of sleep they get, and so a bedtime routine of relaxing activities – perhaps a shower or bath, a chapter of a book, a light meal can really help.
- Limit your caffeine intake – it can be tempting when working night shifts, and especially for those workers whose schedules include a mixture of nights and days – to rely on coffee to get you through the night. Too much caffeine can be very bad for you, however, and still affects your ability to get to sleep for at least 6 hours after having it.
- Earplugs are a must! When you’re sleeping through the day, the world isn’t! You might not realise just how noisy daytimes can be until you’re trying to sleep through them. Neighbours gardening, housework, traffic and children can all contribute to a poor day’s sleep.
- Get blackout blinds – blinds or curtains with a blackout lining can help your body realise that it’s time for sleep.
- Try to spend a little time outdoors – it’s really important to get a bit of fresh air and, when possible, sunlight.
- Eat well – light meals so you don’t get that after-dinner heavy, sleepy feeling, and so you’re not kept up by a heavy meal. Make sure you’re getting the right calories and nutrients for the work you’re doing.
- Drink plenty of fluids – it’s important to stay healthy, especially when there are extra strains on your physical and mental health.
- Nap in your break – some research suggests that it’s beneficial for your health and sleep patterns if you get a little shut-eye during your breaktime on shift.[iii]
- Set an alarm – you won’t sleep well if you’re worrying about waking up in time for the next shift!
Although there are undoubted benefits to working the night shift, we can’t deny that it doesn’t fit in with most people’s natural, human, circadian rhythm. It affects your eating patterns, sleep, bowel habits, and even your health and metabolism.[iv][v] Some people prefer nights, and some may find that they can’t do them without becoming unwell, especially people with some health conditions or who need to take certain medications at set times. If you’re finding shift patterns hard to cope with, it can be worth talking to your employer to see if there any adjustments that can be made. There is lots of evidence that working night shifts, or particularly working a mix of day and night shifts, can be harmful to health, even beyond the immediate physical and mental health implications of disrupted sleep and circadian rhythm.[vi] This means that it’s especially important to do everything we can to stay healthy – and happy – as night shift workers.[vii][viii]
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[i] Vitale, S. A., Varrone-Ganesh, J., & Vu, M. (2015). Nurses working the night shift: Impact on home, family and social life. Journal of Nursing Education and Practice, 5(10), 70.
[ii] Bahramirad, F., Heshmatifar, N., & Rad, M. (2020). Students’ perception of problems and benefits of night shift nursing internship: a qualitative study. Journal of Education and Health Promotion, 9.
[iii] Silva-Costa, A., Rotenberg, L., Griep, R. H., & Fischer, F. M. (2015). Napping on the night shift among nursing staff: potential benefits for workers’ health. Escola Anna Nery, 19, 33-39.
[iv] Rogers, A. E., Hu, Y. J., Yue, Y., Wissel, E. F., Petit III, R. A., Jarrett, S., … & Read, T. D. (2021). Shiftwork, functional bowel symptoms, and the microbiome. PeerJ, 9, e11406.
[v] Bonnell, E. K., Huggins, C. E., Huggins, C. T., McCaffrey, T. A., Palermo, C., & Bonham, M. P. (2017). Influences on dietary choices during day versus night shift in shift workers: a mixed methods study. Nutrients, 9(3), 193.
[vi] Ramin C, Devore EE, Wang W, et al (2015) Night shift work at specific age ranges and chronic disease risk factors Occupational and Environmental Medicine
[vii] Wang, F., Zhang, L., Zhang, Y., Zhang, B. A., He, Y., Xie, S., … & Tse, L. A. (2014). Meta‐analysis on night shift work and risk of metabolic syndrome. Obesity reviews, 15(9), 709-720.
[viii] Ferri, G. M., Cavone, D., Intranuovo, G., & Macinagrossa, L. (2019). Healthy diet and reduction of chronic disease risks of night shift workers. Current medicinal chemistry, 26(19), 3521-3541.