Why Do Some Nurses Prefer Night Shift?

I was reading a newly released medical thriller when I came across this passage:

“Nurses on night shift were often young (lack of seniority meant they had no choice but to work unpopular hours) and surly (i.e., pissed off about it.)”

Yes, that’s a quote. Perhaps I’m being oversensitive (okay, of course I am), but this is my profession and I don’t like me or my colleagues to be painted in such broad strokes so I thought I would give some reasons why some nurses actually prefer to work nights and are even very happy about it. These are not numbered according to importance.

1. Night Shift Differential. Nurses are generally paid a nice differential for working nights. This varies widely depending on the institution but can be a nice bump in pay. This may translate into working less and being able to spend more time with family or getting more bang for your buck for working the same hours.

2. We’re just night people. I know day shift people don’t understand that it is easier for some people to stay up all night. Our clocks are a little bit different than most other people. That’s a good thing, right? You don’t want your night nurses falling asleep and it’s a good thing some nurses like working nights because hospitals run 365/24/7. Personally, I think a crime has occurred if I have to be up before the sunrise. It feels wrong on a cellular level.

3. Child Care Reasons. Some families like to juggle one (or even both) parents working nights to limit or stave off daycare costs.

4. Less Administration on Site. This might be the night shift untold secret, but there are infinitely less administrators around during the night shift which means less overall scrutiny. I don’t mean to say night nurses are crazy with power and do inappropriate things, but there is a more relaxed feeling on nights because of this. Government entities don’t pop in at 0300 for a surprise inspection— though they might now that I’ve written this.

5. More Relaxed Pace. Many nurses prefer nights because of the more relaxed pace. Fewer tests and procedures to take your patient to. In the ER setting, less overall patients as the night goes on (though you also have less nurses to take care of those patients.) For inpatient and ICU nurses, doctors round during the day which is when the most orders are generated. Not having as many tasks leaves more time to truly connect with your patient. When we have only one or two ER patients at 4AM— we can spend a lot of time teaching and/or visiting with families.

6. They are smart, scrappy people. Not to say this isn’t true of day shift nurses, but night shift nurses usually have less resources available to them overnight. There are fewer people— fewer bodies to help in a code. Support services like lab, pharmacy, central supply, etc may not staff people 24/7 so if a patient needs something, night shift nurses have to think outside the box.

Overall, what raised my ire about these two small sentences from this author (a male physician) was the “surly” connotation. Even if a nurse doesn’t like to work nights, they do not take it out on their patients because of it. Are there cranky, surly nurses? Sure.

However, you can find them on both days and nights.

Love your night shift nurses. They are there for you when everyone else sleeps. And many are highly professional, excellent nurses with years of experience.

Civil War Medicine: Part 1/4

I’m pleased to host Erin Rainwater as she shares her expertise concerning Civil War Medicine.

Welcome, Erin!

Pre-war medical system.

This year marks the Sesquicentennial (150-year anniversary) of the beginning of the Civil War. If you’ve never studied it much, I recommend you use these four commemorative years as an incentive to expand your knowledge of it.

That war was a watershed time in our nation’s history like no other event before or since, in war or peacetime. It even changed the way citizens referred to their nation. From the time of the Revolution until then the country was thought of as a collection of independent states. Shelby Foote, the Civil War historian who made you feel like you were there, said that prior to the war people would say, “The United States are…” As a result of the war, it was grammatically spoken as “The United States is…” That’s what that war accomplished, Foote said. It made us an is.

There are many interesting facets regarding the standards of medical care and how it was delivered back when we were still an are. Some of what we read about seems barbaric to us now, yet American surgeons were up to international standards of medical science of the time. Furthermore, as often happens in time of war, this conflict quickly propelled physicians into the role of leaders in medical and surgical breakthroughs.

Prior to the war, cleanliness was regarded as insignificant except in respect to gross contamination by foreign matter. Surgeons operated in street clothes or donned a surgical apron. They might wipe bloody and pus-laden instruments on their aprons or a rag, but washing them wasn’t routine. Clean linens and washed hands were statistically proven to be of value but rejected as non-scientific.

Medical school in the 1860s was normally two years long. Microscopy was taught, as was the cell theory of tissue structure. Tissue samples were stained and analyzed, urinalyses and stool studies were performed.

The primary anesthetics available were ether and chloroform, each having its pros and cons. Chloroform was non-flammable, which made it preferable during the war when gunpowder was lying about and bullets flying about. It was also faster acting. On the down side, it was easier to overdose a patient with chloroform, and anesthesia-related fatalities were higher. Surgeons and attendants, however, were more easily overcome by the vapors of ether while performing surgery.

At the outbreak of hostilities, there were few military physicians, fewer military hospitals, and lack of a hospital corps. Nursing and other duties were performed by soldiers temporarily assigned to hospital detail, and who were not necessarily qualified nor of upstanding character. After the fighting began, civilian doctors flooded into the military system. Others chose not to join up but worked as contract physicians. Doctors not only were required to be skilled but were expected to organize, equip, supply and administrate their hospitals. The enlisting, training and disciplining of subordinates was also in their job description.

Female nurses were rarely tolerated. They were believed to lack the physical strength to help wounded men, and especially in the South they were considered too delicate and refined to assist a rough soldier in bathing and tending to personal hygiene. It was generally conceded, however, that women were more attuned to the emotional needs of the sick and more skilled at “sanitary domestic economy.”

As word of Florence Nightingale’s notable work in the Crimean War spread, women’s abilities in the field of nursing became more widely acknowledged. Some American physicians who had gone to the Crimea to assist the British came home reporting that the female nurses were undeniably competent and able to care for soldiers with war-related wounds and illnesses. It was finally becoming more seemly for females to care for male patients. Their pay, however, was half of what civilian male nurses received to care for military patients. In my novel, True Colors, Cassie Golden receives the standard pay for civilian female nurses working in a government hospital—twelve dollars a month plus meals. That is for twelve-hour shifts, usually five days per week but often more. And she was glad to have it.

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Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Contest reposted from January 10th, 2011.***

 

Author Beware: This Is Us

Dear This Is Us— please portray nursing accurately. 

Few can argue with the success of the new NBC drama This Is Us. I’m an avid watcher of the show myself. If you like your heartstrings being tugged at every conceivable corner and you’re not watching then you’re missing out on a great opportunity for a good cry. Well, really, several good cries per episode.

nbc-this-is-us-midseason-aboutimage-1920x1080-koThat being said, I was mildly disappointed in a medical scene portrayed in Season 1, Episode 11. If you haven’t seen it, I don’t think I’ll be spoiling much unless you don’t the the fate of Toby post his Christmas collapse. If that statement is true then you should stop reading here.

In episode 11, Toby is getting prepped for heart surgery. He is anxious, but not overly so. It’s a cute and funny scene. There is a flurry of activity as the nursing staff gets ready to take him to pre-op. The conversation goes something like this:

“Name.”

“Toby Damon.”

“Place of birth.”

“Hope Springs.”

At this point, a nurse comes in with a very large needle and makes it noticeable to the patient.

“What is that?” Toby asks. “Holy Cow. Look at the size of that thing! I’m a big guy but geez.”

The nurse then inserts the needle into the IV port and delivers the medication. Another staff member says, “Look this way, we’re getting ready to take you to prep.”

Toby— after the medication takes effect. “What’s in that?”

Nurse replies, “You’re fine. Don’t worry about it.”

Toby asks again. “What was in that needle?”

Nurse responds. “Just medicine.”

Ugh. I mean, really? Let’s take a look at the medical problems with this scene from mild to annoying.

Problem #1: Place of birth is never asked. Although, I do like that they use what is called two patient identifiers— it’s never place of birth. Usually, it’s your birthday. Also, if he’s going to surgery, there should be some communication with the patient about his understanding of the procedure he’s going to have. “Sir, my name’s Jordyn. I’m one of the OR nurses here to take you to the pre-op area. What procedure are you going to have done today?”

Problem #2: It’s called Pre-op. Not prep.

Problem #3: This is getting more egregious. We don’t insert needles into IVs anymore. They are all needleless system. I get that it looks more dramatic to come in wielding a big needle, but it isn’t medically accurate. I haven’t seen an IV system you had to access with a needle in over fifteen years. In fact, in most tubing systems you can’t even insert a needle anymore.

Problem #4: If you are using a needle and the patient is anxious— don’t show them the needle. Obviously, this is one way to increase the patient’s anxiety which is not the direction we want them to go.

Problem #5: The patient asks the nurse twice what he’s being injected with and she doesn’t disclose it. Honestly, this goes against the very fiber of the nursing code. Nursing is about telling your patient the truth and educating them about what’s happening to them medically. Now, in an anxious patient, the explanation doesn’t need to be long. She could have simply stated, “Sir, it’s very common to be anxious before surgery. This medication is called Versed and will help you relax a little bit.”

Just so the staff writers of This Is Us are aware, I am available for medical consultation. Don’t make me hate a show I love by portraying medical people like they don’t care about a patient’s very direct questions. Little is seen in this scene of the medical staff using other methods to calm and relax this patient other than shoving a medicine in his IV and not even educating him about what it is.

That’s not how we take care of patients.

Sarah Sundin: WWII Nursing Part 3/3

This is Sarah’s final installment concerning her research into WWII nursing. I want to thank Sarah for all the great information she provided. I know I learned a lot. What was one interesting thing you learned?

Click the links for Part I and Part II.

wwii-nursing-2US Army Nursing in World War II—Part 3

“Lieutenant Holmes is going into anaphylaxis.”

 Harriet’s elfin face blanched. “Oh no. Thank goodness Dr. Sinclair is on the ward.”

“Not yet.” Ruth grabbed a tray and put two sterilized syringes on top.

“So—so why are you already getting the meds?”

“I want to be ready when he comes. I can’t waste any time.” One vial of adrenaline.

“But he hasn’t ordered them yet.”

 Ruth leveled a look at the girl. “I know the treatment for anaphylaxis.”

“That—that’s presumptuous of you. You’ll make the doctor angry.”

Ruth pulled a vial of morphine. “I don’t care about the doctor’s feelings. I care about my patient’s life.”

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty, serves as a US Army Nurse in England. The amount of research seemed daunting, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

On November 24th, I covered requirements to serve in the Army Nurse Corps. On November 26th, I discussed the training the nurses underwent and rank in the Army Nurse Corps. And today I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Uniforms

On the job, nurses wore a white ward dress with the white nurse’s cap. They were also issued a set of “dress blues,” a dark blue service jacket and a medium blue skirt, a white or blue shirt, black tie, black shoes, and a dark blue garrison cap or service cap. This uniform is pictured on the cover of A Memory Between Us. A dark blue cape lined with red and an overcoat were also used for outdoors wear. Starting in July 1943, the blue uniform was replaced with an olive drab service jacket and skirt and cap, khaki shirt and tie, and brown shoes—but implementation was slow and sporadic.

In combat areas, white ward dresses and skirted suits were absurdly impractical, but the Army was slow to provide appropriate clothing for women. In 1942 during the early campaign in North Africa, the women resorted to wearing men’s fatigues and boots—in men’s sizes. In time the nurses were issued WAC (Women’s Army Corps) field uniforms and the popular Parson’s field jacket, as well as easily laundered seersucker ward outfits, both dresses and pantsuits.

Nursing Practice

On the ward, the nurse was assisted by a male medic, an enlisted man. Some men had serious problems taking orders from women, and some didn’t. In stateside hospitals, Red Cross nurses’ aides also served. Physicians entered the Medical Corps with the rank of captain and only male physicians were admitted to the Corps. As was typical in the 1940s, the physicians expected unquestioning, speedy obedience from nurses.

For the writer, it’s important to remember this was long before our disposable, single-use, universal precautions era. Syringes were made of glass and were sterilized in bichloride of mercury before reuse. Gloves were washed and reused—and holes were even patched. Improvisation was the rule, especially in combat areas, and nurses used their creativity and imagination to turn trash into useful items.

Resources

http://history.amedd.army.mil/ANCWebsite/anchome.html (The official website for Army Nurse Corps history.)

Sarnecky, Mary T. “A History of the U.S. Army Nurse Corps.” Philadelphia: University of Pennsylvania Press, 1999. (A comprehensive history with a thick section on WWII).

Tomblin, Barbara Brooks. “G.I. Nightingales: the Army Nurse Corps in World War II.” Lexington: University Press of Kentucky, 1996. (A wonderful history, including all theaters, full of personal stories).

Brayley, Martin. “World War II Allied Nursing Services.” Oxford: Osprey Publishing, 2002. (Detailed information on military nurses’ uniforms).

http://library.uncg.edu/dp/wv/ (The Women Veterans Historical Project—a vast collection of oral histories, letters, photographs, diaries and other treasures).

http://history.amedd.army.mil/books.html (Prepare to get lost…this website contains dozens of on-line historical medical texts, from detailed—800 page!—books describing medical services in each theater, to period textbooks used for neuropsychiatry to infectious disease to orthopedic surgery).

***This blog originally posted 11/29/2010***
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sarahsundin2Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Sarah Sundin: WWII Nursing Part 2/3

We’re continuing our three part series with historical author Sarah Sundin about her research into WWII nursing. You can find Part I here.

US Army Nursing in World War II—Part 2

wwii-nursingRuth hugged her knees to her chest, her dark blue cape tented around her against the gray chill.

            Where would the money come from? Promotions were meager in the Army Nurse Corps. All the nurses were second lieutenants except the chief nurse, a first lieutenant. At twenty-three, Ruth was too young and inexperienced to become a chief nurse.

            She’d always solved her own problems, but now she longed for advice, and she kept thinking about Major Novak.

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty serves as a US Army Nurse in England. The amount of research seemed daunting, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

On November 24th, I covered requirements to serve in the Army Nurse Corps. Today I’ll discuss the training the nurses underwent and rank in the Army Nurse Corps. And on November 29th, I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Recruitment and Training

The American Red Cross served as the traditional reserve for the Army Nurse Corps. On October 9, 1940, the ANC called the reserves to active duty, to volunteer for a one-year commitment. At first there was no formal military training for nurses. On July 19, 1943, the first basic training center for nurses opened. Training centers were located at Fort Devens, MA; Halloran General Hospital, Staten Island, NY; Camp McCoy, WI; and Brooke General Hospital in San Antonio, TX. The nurses trained for four weeks, learning military courtesy and practices, sanitation, ward management, camouflage, the use of gas masks, and map reading. They also drilled and underwent physical training.

To train the increased number of nurses needed during the war, Congress authorized the Cadet Nurse Corps on July 1, 1943. The government paid for women to attend civilian nursing programs in exchange for service in the Army Nurse Corps upon graduation. The women in this accelerated program (two and a half years instead of three) had their own special cadet uniforms.

Rank

Nurses entered the ANC as second lieutenants, and the vast majority of them stayed at that rank. The chief nurse of a hospital was usually a first lieutenant, but sometimes a second lieutenant or a captain. The highest rank in the ANC was held by the superintendent of the ANC, a colonel.

Even so, nurses held “relative rank.” They held the title, wore the insignia, were admitted to officers’ clubs, and had the privilege of the salute, but they had limited authority in the line of duty and initially received less pay than men of similar rank. On December 22, 1942, Congress authorized military nurses to receive pay equivalent to a man of the same rank without dependents, and on June 22, 1944, Congress authorized temporary commissions with full pay and privileges.

One of the main reasons nurses were granted officer status was to “protect” them from the great crowd of enlisted men, and—it was often thought—for male officers to keep the women for themselves. The Army had rules against fraternization between officers and enlisted personnel.

***This blog originally posted 11/26/2010.***

*********************************************************************************************sarahsundin2Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Sarah Sundin: WWII Nursing Part 1/3

Redwood’s Medical Edge is pleased to host historical author Sarah Sundin who has done extensive research regarding nursing during WWII.

US Army Nursing in World War II—Part 1

a-memory-between “I love this smell, don’t you?” May said.

            “Bichloride of mercury?” Ruth laughed and shook water from a pair of gloves. “Only a nurse would like this smell.”

            May rolled syringes in a pan of the blue green disinfectant. “In the orphanage I had no control over my life, but with soapy water and a stiff brush, I could scrub away the smells and pretend I lived in a castle.”

            Ruth draped the brown latex gloves over a clothesline to dry before being sterilized. “Cleanliness may not be next to godliness, but it beats back the demons of poverty.”

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty serves as a US Army Nurse in England. The amount of research seemed daunting at first, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

Combat produces injuries. Injuries require treatment. If you write a novel set during World War II, you may have to write a medical scene—and you’ll want to get the details right about your nurse characters.

During World War II, 57,000 women served in the US Army Nurse Corps (ANC), 11,000 in the Navy Nurse Corps (NNC), and 6500 in the Army Air Forces. More than two hundred nurses died serving their country.

Today I’ll cover requirements to serve in the Army Nurse Corps. On November 26th, I’ll discuss the training the nurses underwent and rank in the Army Nurse Corps. And on November 29th, I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Requirements

To serve in the Army Nurse Corps, women had to be 21-40 years old (raised to 45 later in the war), unmarried (married nurses were accepted starting in late 1942), a high school graduate, a graduate of a 3-year nursing training program, licensed in at least one state, a US citizen or a citizen of an Allied country, 5’0”-6’0,” have a physician’s certificate of health and a letter testifying to moral and professional excellence.

Pregnancy was the main cause of discharge from the Army Nurse Corps, or as the women called it, PWOP (Pregnant WithOut Permission). To discourage pregnancy, the Army had a cumbersome process to gain approval for marriage. Other methods to prevent pregnancy included careful placement of nurses’ quarters, discouraging drinking, and encouraging the women to socialize in groups. The second main reason for discharge was “neuropsychiatric,” what we call combat fatigue nowadays.

Remember that gender and race discrimination was still rampant in the 1940s. Male nurses were not allowed in the ANC during World War II, and only a limited number of African-American nurses. Despite a large number of black registered nurses in the United States, fewer than five hundred were allowed to serve, and then only to care for black patients or for prisoners of war.

***This post originally published 11/24/2010.***

*********************************************************************************************sarahsundin2Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Author Question: Cardiac Catheritization

Sandy Asks:

Hi, Jordyn. Wondering if you could help me with a couple details for my WIP. I have an 82 year old character, he had a heart attack in the presence of a couple trained in CPR. They save him, he’s had an angioplasty, and doctors are shocked because all the prayer got him through this.
 
1. How long does he need to lie still?
2. When would the nurses move him to a chair?
3. How would he feel?
4. How long would he remain hospitalized if he’s got folks to care for him at home?
 
Any help you can give would be appreciated.

Jordyn Says:

I actually pulled in a couple of my medical colleagues for your question since adult cardiac care isn’t my main focus and I wanted to get you the best answer possible.

Here are the answers I got through a nursing friend, Crystal, from a Cardiac Unit Educator at the hospital in North Carolina where she works. Thanks, Andrea W., RN, CCRN!

1.  Well, bedrest varies per the doctor and the closure method after pulling the sheath. I guess I have seen anywhere from 2-6 hours for bedrest after pulling the sheath. Nowadays, they use closure devices most of the time and this lessens the amount of bedrest. A good average would be 4 hours.

2.  They can get him up to a chair as soon as the bedrest ordered timeframe is up and if the patient has not had any further bleeding from the site or if they have not developed a hematoma at the site.

3.  He should feel pretty good, some patients complain of soreness in their chest from the procedure.

4.  He should stay in the hospital 2-3 days max if no complications.


Sandy, best of luck to you and this book. Keep me posted on how your road to publication is going!

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Sandy Nadeau loves to go on adventures, photograph them and equally loves to write about them. She and her husband do a lot of four-wheeling in the back country of Colorado and share those experiences with others by taking them up in the mountains. With a background in writing a column about her community for a local newspaper, she also has had several magazine articles published. She loves to write novels about adventure, mystery, romance, but most importantly sharing God’s love. She is currently a member of the American Christian Fiction Writers and Vice President of the ACFW South Denver Chapter. Married for 37 years, she and her husband are loving life as grandparents to their two grandchildren.