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October 23, 2008

Off-shift Nursing

Ivhospitalbed.72x72[1] The other day I had a conversation with a nursing supervisor about the night shift, working from 7 pm to 7 am. Our conversation became somewhat argumentative in the sense that we were both questioning if the quality of care delivered by nurses during the night shift drops significantly. It made me wonder ….

I have worked the night shift my entire nursing career. I could never return to the day shift. However, there are some issues that do occur during this shift. More often than not, I see my colleagues come in, plunk themselves down in their chairs by the nursing station and immediately focus on who is taking a break , “when, where, and how long.” At other times electronic documentation begins before even evaluating the patient. How can you assess a patient without ever seeing them? Aren’t you falsifying records or are you simply copying the previous shift’s entries? This worries me…

My shift begins the way I was taught in nursing school:  Seeing the patient, introducing myself, attending to their personal needs, performing a physical assessment, providing medications, and talking to families. Maybe this is no longer the way nursing is performed? Often my colleagues ask me to come and sit down, but there is too much to do for patients today.

Are there any evidence-based indicators to support off-shift nursing outcomes? What do you think? What differences do you see, one shift to another?

October 23, 2008 in Beka | Permalink


I wish nice time for you . if may be send your eadia abuat duration of shift after night shift.for example morning after night
akbarghods iran

Posted by: akbar ghods | Nov 23, 2010 4:02:35 AM

There will always be nurses that falsify records or cut their assessments in half, leave out bits of documentation, etc. All we can do is be the best nurses we can be, ourselves, and make sure we don't let others influence in that sense.

Posted by: NurseJoc | Sep 19, 2009 11:41:17 PM

I work D/N in a large teaching hospital. I have 30+ years exp., 12 of those years in home care. I think care at night isn't worse or better. As for being afraid of calling a doc in the middle of the night, we have 1st year residents as the 1st call. They are usually very nice and accomodating. I find a few hotshots who think they are going to behave badly, but we nurses quickly straighten them out. We can make their night rotation miserable. (kidding, we wouldn't do it unless absolutely necessary);).. I also know that it is the newer nurses who call 'for every little thing' most of the time. Personality, experience and knowledge also determines who calls and who waits until her limits are met and then calls. I don't find much of the backbiting here that I have read on this blog. We are aware that shift to shift blaming causes division, which in turn hurts pt care. It infects the entire staff, and it needs to be erradicatd.
Days here are crazy busy and we do call more often, we do in part so the residents get experience in handling problems,and the attendings WANT us to call them (R1) for everything. They get alot of calls , there are alot more nurses on days, there is alot more going on, so in turn alot more orders, alot more questions, many tests. We have to call if they have entered an order wrong or have forgotten to order something. They soon learn to get it right and be thouough. If things are not taken care of on days and eves, then yes it spills over into the night shift. We try not to call Dr's on nights, unless pt condition warrants a call. We group our calls, and try to get requests together from all nurses before we call. This has worked well and has cut down on calls . We'll do this on days too, when we are able.
Working together as a team is much better for everyone involved. Leave the blaming and backbiting to the Jr high kids is essential.

Posted by: Marci | Nov 17, 2008 3:45:11 AM

If a nurse calls a physician, regardless of whether it is day or night, it is that nurse's right to receive a (non-argumentative) call-back from that physician.
If a nurse does not check with their colleagues first and calls the physician for something unwarranted, I could understand a little attitude from the physician. I work swing-shifts, so I understand both of the difficulties. I do not, as Amy suggested in a previous post, see nurses "exploiting" their resources on days. If it takes a call to the physician because there is dispute of what is SAFE nursing practice, this is what needs to be done. I can guarantee you that none of this is being done because they feel like wasting their time (or the time of the physicians for that matter).
Amy spent her time characterizing the Day shift as needy, physician time-hungry nurses. Problem is, as I see it, on our floor, all of the orders are written on our patients during the DAY shift. That is 9 out of 10 times the reason the phone calls to physicians are warranted. New orders are often incorrectly written, not signed off, or leave questions. If day shift does not CALL the physician to find out what was intended, who will? We cannot carry out an incorrect order, or one that the pharmacy refuses to carry out because it wasn't written properly. Speaking of pharmacy, the other reason we usually call the physician on our shift is because we have to hold medications (about 90% of our meds are given on day shift).... which is also a part of the law where I practice.
Night shift does have its own distinct problems, lack of help and increasing pt:nurse ratio being one of them. But at our facility, fortunately, we get the same respect as the day shift when we call a physician in the middle of the night. One of my co-workers told me what she says to physicians who bully her when she calls in the middle of the night: "That's why you are the Doctor and I am the Nurse. I wouldn't have gone to medical school because I knew I would get calls in the middle of the night. Now, DOCTOR, what are your orders?"
If a doctor gets so tired during the day because he is simply speaking on the phone to nurses who have a query about a patient that he does not answer pages at night, he needs to find a different profession.
Nurses who fear calling the physician on any shift should re-evaluate their mindset. We are patient advocates. If we don't call a physician because we fear getting bitched out, what kind of advocate are we??

Posted by: Shona Custer | Nov 14, 2008 10:29:20 AM

I'd like to see what happens to night nurses - or any other straight night shift worker - who works night shift because they have a reversed circadian cycle, like I do. DAY shift makes me sick in every conceivable way. Yet it keeps getting recommended. Wouldn't working days do as much damage to a night person as working nights would to a day person?
As for care comparing nights to days: day shift does have all the resources - and sometimes exploits them to the detriment of off shift and weekend/holiday workers. Let me explain.
I feel that all too often, day shift nurses lean on physicians to the exclusion of their own assessments and nursing knowledge. Not all do, but sometimes, on day shift, I found myself amazed at the little things for which day shift nurses called physicians. It wasn't notification, emergent issues, or even urgent ones - not even something that warned of an imminent "crash" for a patient. They were acting as if they knew next to nothing about patient care. And if you're a night nurse on days, they get upset if you don't do the same.
But...by the time they get done paging a doctor for every little thing, apparently out of fear of getting into difficulties if something goes out of control and they have NOT called a doctor, the doctors are so tired they don't want to respond to the night shift pages. They berate the nurses, becoming at times very verbally abusive - and get even worse if they realize they should have come instead of arguing and scolding. I was stubborn enough to call anyway and soon gained a reputation of calling only when it was something for which a physician was genuinely needed. Most nurses, however, just don't have that much fight, especially in a shortage.
So...If someone's saying that care is worse on the night shift, let me ask you this: Why? Is it possible that fear of retribution for not calling on days, combined with fear of retribution for calling on nights, results in less care for patients overall? A physician who feels they're called unnecessarily soon gets socialized to ignore the pages of any nurse - especially one that wakens them at night. Care suffers as a result.
And as usual, the nurse bears all the blame.

Posted by: Amy | Oct 29, 2008 7:57:38 PM

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