Night Shift Nursing: The Good, The Bad, The Ugly

• There are many pros and cons to night shift nursing, and Nursing CE Central has an insider’s scoop on what it was like working in the Cardiac ICU throughout the night.
• Although night shift nursing may not be for everyone, there are great benefits for those who are willing to pull the all-nighter.
• Nurses working the night shift are more at risk for circadian rhythm and metabolic disorders diagnoses.

Have you ever worked the night shift as a nurse? I have, and I hated it – it‘s not for everyone. If you ask other nurses, they might say they are die-hard night shifters and would never enjoy working a day shift. Night shift is a completely different animal, and it has its pros and cons. Here is the good, the bad, and the ugly of night shift nursing.

Night Shift Nursing  

I started working night shifts straight out of nursing school. I worked in a Level I Trauma Center in the Cardiac ICU at a university–teaching hospital. It’s a 32-bed unit that takes open-hearts, heart and lung transplants, ECMO, and many other sick and critical patients.  

Contrary to popular belief, working the night shift in this unit did not mean you got to take it easy and put your patients to bed by 9:00p.m. In a Cardiac ICU, anything might happen with only a moment’s notice. 

Luckily for my co-workers and I, we had several university resources available on our night shifts, in the event things went south with one of our patients. We had a critical care team that we could call at a moment’s notice if something went wrong – other night-shifters are not so lucky.  

A significant downside to night shift nursing is the lack of resources you have. Most interdisciplinary team members that you would see during the day are not there at 3 a.m. – this can present extremely stressful situations. For example, when you have a patient that is trying to code on you, or you desperately need an order for Ativan because your patient has sun-downers, and you can’t get a hold of your attending. Womp. 

Health Impacts of Working Night Shift 

For me personally, night shift nursing was rough and not conducive to my physical or mental health. I felt like I was constantly battling exhaustion, sickness, and grumpiness. all of the time.  

During that point in my life, I was also in school, and I had to switch back to day shift in an effort to feel like a “normal person” again. On night shift, I wasn’t able to focus on school, let alone, have any quality time to spend with my husband.  

National research organization, The Sleep Foundation, estimates that one in five Americans who work non-traditional shifts (nights, early mornings, rotating) will experience shift-work disorder, a specific type of circadian rhythm sleep disorder.  

Many night shift nurses that probably do it the right way stay on a night shift schedule all of the time, even their days off. But for many of us, this simply is not possible. Nurses are people, too. We have kids, partners, and responsibilities that require our attention during the day, and we end up sacrificing our sleep and our health to accommodate our family and night shift schedule.  

Additionally, it was often challenging to maintain a healthy diet and workout schedule while working night shift. It required a lot of effort and meal planning, and often still fell short of my goals. Many night-shifters quickly discover that if you do not pack your own healthy lunch and snacks, the cafeteria only serves soggy grilled cheese, fried chicken tenders, and cold fries at 3 a.m. – the only time you finally are able to sit down to eat. 

Studies from the National Institutes of Health suggest a possible link between working night shift and receiving metabolic disorder diagnoses such as obesity and diabetes due to a disruption in metabolite rhythms. This contributes to further dietary decline. However, if you plan ahead, you can make it work — it just takes some diligence, organization, and willpower to continue eating healthy while working night shift. 

Impact on Work Performance 

A study from The National Council of State Boards of Nursing determines that fatigue significantly contributes to the prevalence of errors in patient care that occur from night shift nursing, regardless of how long the shift is.  

Like I said, on night shift, some units are easier than others. Some require baths, med passes, and answering call lights throughout the night. Some require dressing changes, blood infusions, or end-of-life care. Others require full codes, rapid response calls, emergent intubations, deep line insertions, and other complex procedures. 

When you are dealing with medication administration, whether it be oral medication pass, a heparin injection, or managing multiple vasoactive drips, there is no room for error.  

Physiological Psychologist at Rush University, Dr. Charmane Eastman, claims that working night shift can be detrimental to our natural circadian rhythm, which can further affect a nurse’s ability to react quickly in high-paced and high-performing environments. Many night shift nurses have Red Bull and coffee running through their veins to keep them alert and responsive to care for their patients. This isn’t necessarily a bad thing in the moment, but prolonged exposure can cause a “caffeine crash” and make it even harder to stay awake later in your shift.  

Overall Pros and Cons 

Pros:

• PAY! Night shift nursing can earn up to 8% more pay compared to those working day and evening shifts; this does not include time and a half or overtime, SURGE pay, or weekend shift diff. Bring on that money honey!  
• Fewer Everything. You often have fewer orders changing throughout the night, less team rounding, and less procedure schedules. You also have fewer interruptions such as physical therapy, occupational therapy, meal service, and patient family presence.  
• Calm Shifts. Sometimes, if you’re lucky enough, all your patients sleep! 

Cons:

• Less Management Engagement. Night shift nurses often have less management engagement. So, if there is a problem, it may be harder to catch your manager during the night shift. On the same token, you may have less chance of climbing the ladder within your job space. If you are not around your managers and other team leaders, it may be harder for you to achieve a higher-ranking position.  
• After-Shift Responsibilities. You may be required to stay longer than your regular 12-hour shift. Staying after your shift for an in–service or meeting when you just want to get home and get to sleep can be very hard when you are already exhausted from the night.  
• Disrupted Sleep Schedule. You may experience disrupted circadian rhythm and sleep schedules, especially if you are trying to flip back to day shift schedule on days off. 
• Fewer Resources. For some nurses, they may be faced with fewer resources such as MDs, PTs, OTs, RTs, etc.  
• Less Seniority on Nights. Many nurses do not want to work the night shift so a lot of the time, the newer, least experienced nurses at the bottom of the totem pole are put on the night shift – leaving you with less experienced nurses when things go wrong.  
• Childcare. Night shift nursing is not the most convenient for parents and many nurses have an extremely hard time finding childcare. Whether it is because your spouse/significant other is also working nights or you are a single parent and cannot find a sitter, someone has to watch your kids.  
• Disconnection from the World. When you work the night shift, you may feel like all you do is work and sleep. Your schedule is separate from many of the people close to you, sometimes leaving you feeling out of the loop from what’s going on in their lives.  

Whether you are a night–shifter for life or straight out of school and starting night shift for the first time, I hope you can read this and relate. I hope the down and dirty bits of the night shift nursing life doesn’t bring you down too much, and unlike myself, you can find ways to rise above and beat the fatigue! You’re a rock star!  

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