As you all know, I’m almost exclusively a night-shift nurse and I prefer it that way. The why will have to wait for another post. Anyway, let me preface this with the fact that this post is written from the standpoint of my routine as a primarily night shift nurse.

I should also preach this that this the schedule listed below is assuming I arrive to work and I have a full load of patients on a Med-Surg  Unit where I have between 4-5 patients or a step-down unit where I have 3 patients.

For starters, I usually don’t sleep all day if it’s my first day back for the week and I was off he night preceding. If it is my first day back at work, I will usually stay up late the night before (until at least 1:30am) and wake up around 10:00 am the day I go into work.  Sometimes I may take another small 1 hour nap before work. That’s just me. I believe in the power of Naps!

After 4pm I can log on to a website to see where I will be placed for that shift. I always check at 4pm and again at 6pm, because my assignment can change sometimes. If it changes after 6pm, our office usually calls us to let us know.

I work multiple levels of care and across multiple specialties and units, such as the following.

Medical Units:

• All adult Acute (med-surg ) inpatient units

• Excluding Labor and Delivery and Postpartum (I don't play with pregnant women and babies, at least not at work as a nurse. Not if I can help it. Lol!)

• This does include inpatient oncology and Bone Marrow Transplant units

• Observation Unit/Admission Discharge unit

• All Adult Step-down/Intermediate Care Areas

• Medical Progressive Care unit

• Intermediate Surgical Care Unit

• Cardiothoracic Step-down unit

• Intermediate Cardiac Care Unit

• Critical Care Units (ICU)

• I primarily work the step-down units at my job, because I decided not to pick up the ICU grouping at this job, as I only like Cardiac Critical care and don’t care much for other types of ICUs. Lol. At my job if you pick up a grouping, like ICU, you can’t pick and choose what ICUs you will and will not float to, and I ain’t trying to kill nobody in Neuro ICU! Lol!

• I often get floated to ICUs to take step-down patients.

• Medical ICU (MICU)

• Surgical/Trauma ICU (STICU)

• Burn ICU (BICU) - the ICU i get floated to the most.

• Cardiac ICU (CICU)

• Cardiothoracic ICU (CTICU)

• At my second PRN job I work only in Cardiovascular ICU (CVICU).

• I also teach Pharmacology, online, to nursing students on a part-time basis.

My primary float pool job has a small satellite community hospital about 15 minutes away from the main campus that is about 80-100 beds and it isn’t considered a seperate hospital, but an extension of the main campus to help decompress the volume on the main facility. It is so new and up to date and easy to navigate!

If I’m assigned to the satellite hospital , we are called by 5pm so we have extra notification because the satellite campus has no cafeteria at night and no coffee shop at night. Plus it’s 15 minutes past the main campus, so it may take a little longer to get to. The satellite campus also has no 24/7 Starbucks like the main campus!

Now, let’s start the hour by hour play by play!
4:00 PM -5:15 PM:

• I usually start getting ready for work around 4:30 PM. This includes a multitude of activities such as hygienic activities, packing my lunch (which, if I’m honest, is sometimes a rare occurrence), ensuring my work back is packed and devices are charged.
  5:15 PM to 6:15 PM:

• Have a jam session on the way into work, or listen to an audiobook.

• Get to work 20-35 mins early

6:15 PM to 6:45 PM:

• Get coffee (we have a full-service 24/7 Starbucks at my job, and yes it’s awesome as it sounds).

• Sit and ponder life and mentally prepare myself to give and care for others and temporarily take on some of their problems.

  • I listen to music and audiobooks a lot. Escapism helps me a lot, and is good when you use it in a balanced way.

• I go to the floor I’m assigned and figure out the logistics, where the break room and bathroom are.

• I use the bathroom and wash my hands. Weirdly enough, I wash my hands before going to the bathroom too.

• Try to figure out my assignment. Find and empty computer and create my patient list quickly review/scan recent labs, H&P, VS, Progress and Nursing Notes and MAR.

• Ensure I’m in the unit Pyxis and assign my patients there.

6:45 PM -7:30 PM

• Do safety huddle and start bedside report and introductions. During introductions I quickly do the following;

• I ask my patients if they need me to bring them back anything while in bedside handoff and make quick lists.

• Also ensure my name is on the patient communication board and that the patient knows how to call me.

• I ensure bed alarms are actually on if the patient has been identified as needing one (learned that lesson the hard way, 😂) In handoff I’ll briefly ask about nerds for things like PRN pain meds, cups of ice water for meds, snacks, etc.... this helps minimize the number of calls for little things during the beginning of the shift, we the NA and I are busiest.

• After report I’ll try to find the NAs I’m working with to say hello and talk about our game plan for any Baths, Turns, or other ADLs.

• Will also discuss any safety concerns or potential problems.

• I will typically get the first or even more set of VS for most of my patients as I go in to assess each of them.

• I do this to help the NAs who is often running with shift change call bells for usually 10+ patients .

• I can do this because many floors at my institution have a VS machine for each, or most rooms. If that wasn’t the case, I couldn’t do this as easily and would allow my NA to get VS and I help as needed.

7:30 PM to 8:30 PM

• I will enter VS and safety/ADL checks as I go in and do my nursing assessment. I will also give PRN med requested and bring back items like ice and water requested during handoff, at this time.
  I make a list on my report sheet if I need to.

• I typically do a quick review the nights plan, reminding the patient we will be there every x amount of hours for vitals, what time meds or procedures are scheduled, and remind them about ordering food or being NPO.

• If it’s after 8:00 PM, I will sometimes take their 9:00 PM (night/bedtime meds) with me and administer them, as our hospital policy allows us to give most meds within a 1 hour before or 1 hour after prescribed time frame.

• After completing assessments, I’ll pick a station to chart at and wipe it down  with the purple cap wipes and then try to get a little charting done. Usually putting the skeleton Version my assessments in.

• I check for any new notes or orders and then I start gather meds for med pass.

8:30 PM to 10:30 PM

• Give meds, complete next ADLs and safety checks, come back and chart a little more.

10:30 PM to 12:30 AM - The Witching Hour

During this time I

• Finish up assessments and other charting.

• Review VS and I/O (input and output)

• Complete safety checks and ADLs and help with VS, as needed. Things have usually calmed a little by now and the NA May have gotten most VS. I’ll get whatever is left.

• Will give 10pm to 12am meds (if there are any, and there usually are. Usually antibiotics or PRN meds).

• Chart and answer call bells as needed. Help with ADLs.

12:30 AM to 3:30 AM

• Lunch and a coffee run.

• Charting, answer call lights, and ADLs

• Charting and safety checks. Help with VS, as needed. PRN meds as needed.

• Even if I’m having a rough night, I aim to be completely caught up with my charting by this point.

3:30 AM to 6:30 AM

• Chart, prepare AM meds due from 0400-0700.

• I’m sure to ensure my care plans and shift notes are updated during this time.

• Review VS and I/Os and help with getting them, as needed.

• Draw AM labs on my patients with lines.

• Give AM med pass and tie up loose ends for charting.

• I’m sure to ask about PRN meds during this time. So my incoming coworkers won’t have to start off their shift

• Review new lab results and check for new orders.

6:30 AM to 7:30 AM

• Finish up any leftover charting, like safety rounds.

• Complete safety huddle and give bedside report and handoff.

• Finish any charting, if for some reason I was behind.

That’s pretty much it. It’s hard to write out every single step of what I do, but this is a pretty good framework for what a typical shift looks like for me.