Persistence with the Night Shift

I’m still trying to manage my life working the night shift while parenting a young child. While I wish I could engage more with my daughter, I’m grateful that she and my husband are close because of their time together without me. I wish I could give my husband more breaks from caring for our daughter solo. Unfortunately, I can’t participate in family activities like back-to-school nights or family dinners when I work. Truthfully, even when I do NOT work, I’m still exhausted from working night shifts; I can’t participate as much as I want with family activities, even on days off.

It’s a lot of effort for me to focus and maintain my clarity with sleep deprivation. When I started the night shift, I had difficulty sleeping during the day between my shifts and trouble staying alert during my shifts. I’m three months into working nights (7p-7:30a), and I can sleep about 5 hours between night shifts compared to the 3 or 4 I would get before. I am also more alert and have more stamina to last me throughout my shifts compared to three months ago. However, I now have difficulty sleeping at night on my nights off. (It was 2:30 on Monday morning when I started to write this blog post because I couldn’t sleep and wasn’t tired).

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Here is how my day(s) off went after my last shift Friday night:

8:30 a – Come home from work Saturday morning, still stressed after a rough night shift – the third of three-in-a-row.

11 a – After showering, eating, and replaying my night in my head, I finally fall asleep – and miss out on my family’s Saturday brunch outing spontaneously scheduled with a friend that morning.

3:30 p – I wake up later than my 1p target. I feel too tired and groggy to join my husband and daughter for their afternoon pool-time. 

7ish p – We have dinner delivered because I’m too tired to help prepare anything.

10 p – Husband wakes me on the couch since I fell asleep somehow. He convinces me to move to our bedroom.

2:30 a – Wake up and have trouble going back to sleep.

4:00 a – Take melatonin, hoping it will help me sleep

6:07a – The time on my clock that I remember seeing before falling asleep

7:35 a – The time I woke up when my daughter turned on all our lights and insisted on noisily searching our room for her lost unicorn.

My husband and I spent the rest of my second day off of work taking our daughter to gymnastics, having family brunch, going to church, and visiting a family friend in the afternoon and again for dinner. I briefly fell asleep sometime in the afternoon after reading with my daughter in her bedroom – before my husband woke me so we could go for the afternoon visit with a family friend. I try to enjoy days off with my family but often feel like a zombie days after I work.

When I work, I’m unable to attain the recommended 7-8 hours of sleep. I don’t think I’ve made up for the sleep debt I’ve incurred and am unsure when, if, or how I’ll make up for it. My sleep schedule is entirely abnormal, and I’m often tired. I schedule myself to sleep during certain times, but my body does not comply. I’ll fall asleep during the day between shifts hoping to sleep 6-7 hours but will often wake up after 4-5 hours. I have blackout curtains, use earplugs, play beach waves as ambient noise, spray lavender mist on my pillows and bedding, and wear a travel eye mask to help me sleep.

Travel Sleep Mask, Lavendar Spray, and Ear Plugs – standard parts of my daytime sleep routine

I don’t have television in my bedroom, and I take all phones out of the room when I sleep. I sleep for longer durations when I eat before going to bed in the morning, take melatonin, and supplement with tart cherry concentrate (which helps regulate melatonin levels). I set my alarm as late as possible before work and try not to look at my clock or phone until that alarm has gone off, even if I am awake and lying in bed for hours. I meditate or pray in bed to relax and attempt to fall asleep again if I wake up before the alarm activates. To stay awake while working, I drink caffeine but avoid it after 2a during my shifts and on days when I’m not working. 

I’m not fond of the idea of having to medicate my body to either sleep or stay alert. In reality, though, I live in a caffeinated culture. Coffee and tea helped me survive nursing school. They also helped me in my first job as a nurse working swabbing shifts before 5:30a. Many people I know consume caffeine daily to be alert or as part of their morning ritual, and they are not nurses, nor do they work night shifts. Maybe I should accept that caffeine (and melatonin) are part of my weekly routine as a night shift nurse.   

To try weaning off some of the caffeine, I’ve tried replacing some of my coffee intake with cacao. It has helped me during the early morning hours at work (when I think it’s too late to consume more caffeine), keeping me up without giving me jitters or hand tremors. My nursing school best friend turned me onto a brand, Crio Bru. According to Crio Bru:

“Brewed cacao is 99.9% caffeine free, but contains theobromine, a naturally occurring stimulant found in cacao that can be longer lasting, milder, and more pleasant than caffeine.”

-Crio Bru (https://criobru.com/pages/crio-bru-brewed-cacao)

It’s roasted cacao nibs that brew just like coffee, but there’s no caffeine. I like to make Crio Bru drink in a french press and keep it sugar-free.

I’ve also discovered a sugar-free cacao powder by ChocoVivo that doesn’t require a french press to prepare (https://chocovivo.com/collections/cacao/products/100-cacao-full-spectrum-cacao-powder). The hot chocolate from ChocoVivo has a thicker consistency since the cacao is not getting filtered out and is reminiscent of the hot chocolate I had with churros in Spain. It’s like drinking a dark chocolate bar. I sometimes like to add a little cinnamon to it.

I’ve been trying various techniques and methods to sleep or stay awake, stubbornly trying to make night shift work, because I eventually want to move out of my current position working with adults and work in a Neonatal Intensive Care Unit (NICU). I explored switching to dayshift when I met nurses from day shift in my cohort who wanted to work nights. However, I stopped pursuing dayshift with my manager when 1) the dayshift nurses changed their minds about working nights, and 2) I realized working the night shift was more aligned with my long-term goal to work in a NICU. 

Because NICU is a specialty that people do not often leave, it is rare for any new NICU nurse to start work during the dayshift. One NICU nurse shared it takes ten years to switch to dayshift in her hospital because people never leave. I have no desire to work nights for ten years, but I am willing to work a couple of years on the night shift to work and gain experience in my dream unit. I know of a hospital in the area that supposedly has their NICU nurses move to the day shift in about 2-3 years, so my goal to to work there eventually. While I’m still adapting to working the night shift, I hope to adjust and thrive in a NICU. I’m using the time in my new grad program to adjust to the night shift, so I hopefully don’t have to struggle so much by the time I land in a NICU. I am making sacrifices now in order to reach my long-term goal to become a dayshift NICU nurse. Right now, the only way I know to get to days in a NICU is to start on nights. Hence, I continue to fight and search for ways to make night shift work for me and my family.

I would love to hear about your sleep hygiene habits and any tips for sleeping. Do you have rituals for bedtime or starting your day (or night)? What are your sleep routines? How do other parents of young children manage night shifts or graveyard shifts? What do you do to ensure you have sufficient energy while you work?

Lessons Without My Preceptor

I have been working without my preceptor since the beginning of August, or for about three weeks. I’m lucky to work in a place that values teamwork and helping one another because other nurses have helped or guided me on almost every shift since I’ve been off preceptorship. One of the biggest things I’ve learned and the best advice I’ve received as a new grad is to ASK FOR HELP.

Photo by Tara Winstead on Pexels.com

I have no problem asking for help or clarification when I am unsure how to do something. However, I get flustered when asking someone to do things for me when I think I can or should do such things for myself or my patient. At some point in my shifts, I may start falling behind, or the unexpected happens; if I want to stay on track or not be completely off-schedule, I must ask for and accept help and support. Other nurses have started IVs or completed bladder scans at the end of my shift for me, so I can finish passing meds or complete tasks for my other patients. While uncomfortable for me, I’ve learned to ask for help and accept the support and generosity of others. (Note to self: Never mess with a funky IV contraption that ED set up – it’s probably the only way they got it to work. Trying to “fix” it just before shift change can mess it up and cause you to lose IV access, requiring a new IV start as you scramble to do morning meds).

I’m on an exponential learning curve and make mistakes. Each week, I discover new ways of doing things inefficiently, incorrectly, or in ways that doctors, patients, or my manager do not prefer. [Un]fortunately, I am learning through experience and by doing. I make mistakes or feel so uncomfortable or irritated with my performance that I must consider various ways to improve or avoid making mistakes in the future to feel competent and more confident about my work.

Communication

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I’m still learning how various doctors want to communicate with nurses during the night shift. Some doctors prefer secure chat, while others only want phone calls. I’ve learned preference, of course, because I’ve utilized the opposite method of communication to what some doctors wish to use. Meanwhile, my manager advised only calling doctors in an email that I didn’t read until days after sending numerous notifications to doctors via secure chat. (I now try to be more diligent about checking my work email). Ultimately, if I need to urgently communicate with a doctor about a patient condition or issue, I will use whatever method allows me to get a hold of them. I’ve also learned that it’s better for a doctor to be upset because I communicated something they thought unimportant instead of not sharing a potential issue with a doctor. Also, I need to document every attempt at trying to reach a doctor. I had a doctor upset with me for contacting him so late in the evening, even though I called his answering service multiple times, hours earlier.

Compare and Despair


To be clear, my leadership or staff have not shamed me for my shortcomings. My leaders have been genuinely supportive and offer non-discriminatory methods of correction. I don’t feel singled out by my mistakes, and I know I’m not alone when I speak to others in my cohort. However, I measure my success by using others’ progress as my ruler. For example, one of my cohort-mates calmly activated and engaged in rapid response for one of his patients on only his fourth day without a preceptor. He received accolades from the leadership team, and our manager shared his praise with the rest of our cohort. I was so impressed and in awe by what my colleague faced and how he acted in crisis.

In comparison, during my second week, one of my patients fell. I was getting the patient’s medication in the med room when the fall occurred. Falls require an incident report and are a pretty big deal for hospitals. Thankfully, my patient did not get injured and was apologetic for the fall. I felt embarrassed and ashamed for having an incident and kept replaying the scenario and trying to understand what I could have done differently or how much worse it could have been. I have been vigilant with my patients’ bed alarms and documenting their fall education since that event.

Discovering What I Don’t Know


I have done things in less than ideal ways and made mistakes and will likely make more mistakes. However, instead of dwelling on my mistakes, I can focus on continual improvement. Am I learning from my past actions or others’ mistakes? Can I figure out how to minimize the chances for errors or prevent making the same mistakes again? Can I improve on my processes or methods? As a new nurse, I have so much room for improvement and growth. I don’t even know what I don’t know, and I keep discovering this each week.

I recently learned that I needed to administer or waste narcotics within a specific time from retrieving the medication(s) from our Omnicell. For the past three months, I dispensed and gave narcotic drugs while likely exceeding this time limit because I hadn’t known this guideline existed. I had no idea until a nurse on the floor mentioned it to me this month, and my manager emailed the team after his periodic department audit. Now that I know about this limit, I try to avoid other tasks after pulling a narcotic that may prevent me from immediately administering the medication to the patient.

From a poster in one of our break rooms

Moving Forward


As I’ve shared in previous posts, I’m still adjusting to working nights and have had difficulty sleeping. I think it’s also because I’ve developed stress-induced insomnia: I replay how my shifts went and how I could have done better. I can beat myself up about things I didn’t know or events I wished I had handled differently, or I can use these experiences as lessons and move forward.

Photo by SHVETS production on Pexels.com

I write this blog to help others and because it allows me to process my experiences as a new nurse. It’s a way to release the ideas in my head so they don’t ruminate in my mind. My blog is also a reminder to focus on neutral or positive thoughts for self-encouragement and coaching. I consider how I would talk to a friend if they were experiencing what I was experiencing.

If you are a new nurse with anxiety before/during/after your shifts or beat yourself up over your mistakes, I am with you. Without realizing it, I survived the last night shift I had without caffeine; I think my stress response kicked in, and I was running on adrenaline. (Also, a unit secretary pointed out I was having hand tremors with the amount of caffeine I was consuming, so I’ve been trying to reduce my caffeine intake). I’m still figuring out the best ways to relieve my stress and practice self-care, just as I’m learning how to be the best nurse I can be. Besides lowering my caffeine intake, I try movement (yoga or hiking), meditating, blogging/journaling, or confiding in other nurses. It doesn’t matter how old, young, experienced, or inexperienced you are – there’s always room for growth and self-discovery.

This blog chronicles my nursing journey and serves as a journal of sorts, but I share my life to support and encourage others’ success and progress, too! I would love to hear from you: How do you give yourself grace while developing and growing? How do you move forward from mistakes? How do you practice self-care? For ideas, check out the past IG post I had about the Alphabet of Coping Mechanisms: https://www.instagram.com/p/B3uuR4ynB_9/

Juggling My Nurse Residency Schedule

If you wondered what my calendar is like as a new graduate RN in a hospital residency program, this post provides some insight. I have classroom and skill sessions (didactic content) interspersed between 12-hour shifts at my hospital with a preceptor. The classroom sessions are more frequent at the beginning of the one-year residency. After the first month, there are fewer classroom and skills sessions and more shifts with a preceptor. Depending on the unit, a resident may have more or less didactic learning and preceptor shifts than other residents. For example, residents in the Emergency Department require more hours of didactic content and preceptor shifts than Med-Surge residents. I have 28 preceptor shifts for my particular unit and about 36 hours scheduled for didactic and hands-on skills sessions. The extensive orientation and formal training program are what attracted me to my hospital.

After the first 1.5 months, it seems the didactic portions take place about once or twice a month. My hospital hired me to work the night shift, and my preceptor works the night shift. During preceptorship, the resident’s schedule matches that of their preceptor. Some of my cohort-mates were hired into the night shift but have had day shift preceptors. It has been a new challenge for me, balancing working the night shift while trying to sleep and meet other obligations during the day, like spending time with my family or attending my daytime didactic sessions.

A pic of me during my online classroom session from home this past Tuesday. Pre-pandemic, I’m told classroom sessions were in-person. I attend online classroom in my daughter’s room while my husband works in another part of the house (still working from home, thanks to the pandemic). Even though I’m not at the hospital, I still have to wear scrubs and prepare to be on camera for my online sessions! And of course, gotta have my coffee – looks like I’m due for a refill!

As a resident still on preceptorship, we’re not allowed to work overtime or during the holidays. This past week, I was unable to work Monday due to the Memorial Day holiday. However, I had work scheduled Tuesday through Friday morning and Saturday through Tuesday in addition to homework and exams I needed to finish. Sprinkled in my calendar are preschool pickups or drop-offs, grocery shopping, family outings, and other life events like my dear friend’s funeral. My schedule was as follows:

Sunday: complete homework/assignments
Monday: Memorial Day holiday (not allowed to work)
Tuesday: 8a-2:30p daytime classroom session (online)
Wednesday: [7p-7:30a] night shift with preceptor A
Thursday: night shift with preceptor A
Friday: 10a – funeral/celebration of life mass
Saturday: 4a-8a phlebotomy shadow
Sunday: night shift with preceptor B
Monday: night shift with preceptor B
Tuesday: night shift with preceptor B

I mentioned my friend’s memorial mass to my preceptor Wednesday night only to ask where I might be able to shower or nap since the mass was at a church just down the street from the hospital. It wouldn’t be worth it to go home after my Thursday night shift and turn back around during rush hour traffic to attend my friend’s mass. After hearing my schedule, she offered to have me take Thursday off and reschedule that shift with her for another time. Initially, I refused, thinking it would reflect poorly on me not to work my total hours. Plus, I like my preceptor and did not want to reduce my shifts with her in the “shadowing” stage of my preceptorship. Yet, altering the rest of my schedule was impossible. I was determined to attend my friend’s mass in person Friday morning. I could not reschedule my Saturday shift since work already rescheduled it from the prior month due to the phlebotomist’s schedule. If I wanted to work the week of June 6, preceptor B was the only one available since my regular preceptor (preceptor A) would be on vacation that week for a family wedding.

As I sat there re-considering my preceptor’s offer to reschedule our Thursday shift together, I realized her offer was grace not often granted. As a resident tied to my preceptor, I’m not really on the schedule yet. My assigned preceptor is the only nurse listed on the roster for our shifts. Once I start working independently, it won’t be easy to take time off, especially since I’m only in my first year and have little paid time off accrued. I knew if I worked Thursday night, I would be drained and unable to rest Friday morning, which would add to me being an emotional wreck during my friend’s memorial mass. I returned to my preceptor and let her know I would take her up on her offer. I took Thursday night off.

I was grateful to be able to be present at my friend’s celebration of life mass. It was a blessing to be surrounded by those who loved her on Friday and remember her together. Unfortunately, not all those who lost loved ones during the pandemic had such an opportunity to gather in person. I was lucky that the pandemic death rate has slowed in our area, and churches loosened restrictions.

Part of the reason I became a nurse was to spend more time with my loved ones. I already worked 10-12 hour days in my previous job, but I worked five days a week. This past week’s events reminded me of how much I valued my loved ones and allowed me to create space for them and my well-being. I appreciate being a nurse, but I do not want work to come before loved ones (or my health) in my life.

It is Sunday afternoon. I need to be sleeping for my first three-sequential-night-shifts block, but I cannot sleep because I slept last night and have difficulty sleeping again during the day after a whole night’s sleep. I’m still figuring out a sleep schedule that works with my body. I’ve tried laying in bed, meditation, and prayer so I’ve given up sleeping today and figured I’d finish this blog post. I have never worked three shifts in a row before, let alone with the assigned preceptor (preceptor B) for the next three nights. I am nervous but excited to get a better sense of what it will be like to work three shifts per week as an independent nurse.

Wish me luck!