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.

What Does A Nurse Do? Part 1/3

I still find it interesting that many outside of healthcare don’t truly understand what a nurse does. Television, movies, and fiction all have varying takes on the subject– most of which don’t depict reality.

teen-girlWhat is your definition of a nurse? When you’re in contact with the medical system, what do you want a nurse to do for you? I would love to know.

My ultimate role as a nurse is to serve as an advocate for my patients. In pediatrics, that means my clients range from a newly born infant to a young adult who is most often accompanied by a parent. How can this be a source of conflict? Let’s take a look at an example of how my advocating for a child can become a source of conflict between me and the parent.

A parent presents with her teen daughter and wants her tested for drugs. The mother has concerns that her child may be experimenting and wants confirmation. Can we run a drug test that covers common drugs of abuse? Yes. Will we in this situation? Depends.

How are we going to obtain the urine specimen if the teen is not a willing participant? We would have to hold her down, pull her legs apart, and insert a catheter into her bladder. Legally, this would likely be considered assault if the teen is not having a medical emergency. A medical emergency would be something dramatic– like no pulse and no breathing. Or, the patient is unconscious and we’re trying to determine why. In this situation, the teen is not experiencing a medical emergency. The teen is awake, alert, and communicating appropriately. As a nurse, I am not going to do that to her regardless of the parent’s demands.

What are the options?

First, the physician will have a conversation with the parent and child to discern the parent’s concern. The child will be interviewed alone and asked pointed questions about their drug use. The parent may also be interviewed alone as well. The first issue is to figure out if there is a legitimate concern. If there is, will the teen willingly submit to the drug test? If so, we’ll run the drug screen. If not, in a non-emergency situation, the approach will likely be to get the family into some counseling.

However, if we do drug test the teen, we may or may not disclose the results to the parent. Whether or not this information would be released depends on the state and the age of the child.

How has a nurse advocated for you?

Author Question: Disclosing Protected Health Information Under HIPAA

Remember the nurse who committed suicide in the wake of the Australian radio DJ’s that posed as the Queen of England to get the medical staff to disclose private details of the Duchess?

I totally get, as a nurse, why she made that choice.

Every day, nurses face critical choices that can have dire consequences. Most often, I can say from being in this field for 25 years, that 99% of the time, medical people DO NOT have ill intentions toward their patients. They are not maliciously trying to harm people. Do mistakes happen . . . yes. But usually it is the result of a system wide problem.

This nurse that patched through the radio personality posing as the Queen of England probably was thinking, “Wow, the Queen! I better patch her through post haste. I wouldn’t want to do anything to upset the monarchy.”

She may have been star-struck– I don’t know. But we don’t ask for credentials over the phone. If you say your Britney Spears’s sister– why should I doubt you?

I can understand the horror this nurse must have felt when she learned of the prank. I know she likely feared for her job (and had every right to be fearful). I know she likely felt horrified that that one simple action of transferring a phone call led to mass attention being drawn her way.

Sadly, since I don’t know this nurse personally and am only guessing, this may have been the proverbial straw that broke the camel’s back.

HIPAA issues/violations can have dire consequences for the healthcare provider. We can lose our jobs.

In short, HIPAA is a set of laws designed to protect patient’s privacy. I’ve done a series on HIPAA that you can find here. Part 1, Part 2, and Part 3.

However, I recently got an author’s question that kind of took a new spin so I thought I’d cover it here.

Glenda asks:

In the novel I’m writing (my first), I have a young mother of a four-year-old who is in a coma because of an automobile accident hundreds of miles away from her home.  There are no other next of kin other than the child.  How can a minister who’s trying to help solve a mystery get more information about her condition? Who can the doctor disclose her condition to?  What information can be disclosed under HIPAA?  If you would address that in one of your future blogs, I would greatly appreciate it.  I’ve read through a lot of information but haven’t seen anything that addresses a situation such as this. Thank you so much!

Jordyn Says:

I think it will be hard for this minister to get information unless he became the appointed legal guardian over her (since she’s incapacitated and he’s caring for her son and they can’t find any other family.) This might be a better question to run by a lawyer– how could he become her legal guardian? The hospital is going to want someone they can go to. If he served that way— they would release information to him. Likely, he’d have to fill out a request through the medical records department.

In lieu of that– likely what he would be told would be the condition. Grave, Critical, Poor, Fair, Stable, Good— something along those lines without specific information.

In follow-up Glenda did ask her son-in-law who is a lawyer this question and here is her information after that consultation.

Glenda says:

My attorney son-in-law said that the minister would have to go before a judge to be a guardian ad litem (in South Carolina at least) in order to get medical information on the mother and to make decisions for the child while the mother was unable to do so.  Thanks for your advice!

My pleasure, Glenda. And best of luck with this novel.

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Glenda Manus recently retired after teaching 30 years in an elementary school. Her love of reading good books prompted her to try and write one of her own. Though book writing is a challenge (Amen, sister!) she feels God is with her on the journey.