10. When you start off on the graveyard shift, make sure you tell all the important people in your life that you work nights (your family, friends, the school your kids go to, your significant other’s place of employment, etc.). This will cut down profoundly on unexpected visitors, telephone calls and other daytime expectations from people and will help when people need to get a hold of you in a hurry — they’ll know how to contact you.

Alas, you will still have many people who “don’t get it” so keep reminding people that their 3PM is your 3AM. You need to have a backup plan in place for these people so they can reach you in an emergency!

9. Get creative and get some sleep. My current combination for daytime sleep consists of blackout curtains, white noise, earplugs and sometimes even a sleeping pill. You MUST be able to sleep during the day to make NOC work. Experiment and find something that works.

8. Find out what kind of shift schedule works for you. Currently I don’t like to work “three-in-a-row”, and find working smaller spurts is keeping me sane. But this changes for me periodically. Thankfully I self schedule so I’m able to do what works for me and my family. Fight for a schedule that works for you and you’ll find NOC can actually be pleasant.

7. Realize that in the beginning, your body may revolt. Yes, starting NOC usually means an adjustment period. You may get sick, you may feel exhausted—your body needs to get used to living like this so give it some time before you decide to start searching frantically for a day shift. Three months is the amount of time most people need to get used to NOC.

6. Watch the caffeine. Coffee and other caffeinated products can be a night-shift nurses best friend and crutch, but it can also truly screw up daytime sleeping. I don’t drink any caffeine after 0100. But I love my coffee and Red Bull on my way into work!

5. Be prepared with (healthy!) food and beverages. In most hospitals the cafeteria closes in the evening and there are few options besides vending machines and expensive, unhealthy take-out food to eat. I keep an insulated lunch box stocked full of healthy food (lots of protein) and H2O. Plus, I try to bring portable snacks that I can eat on the run when I don’t sit down all night!

4. Find ways to incorporate daytime activities into a night schedule. I find myself doing all kinds of things late at night on the night before I go into work. I stay up late and catch up on grocery shopping at an all-night place, work out at my gym which is open at 11pm, make plans w/ friends at places where we can catch a late evening movie or dessert, etc. It is amazing how much you can do on NOC hours these days!

3. Be safe. If you are too tired after a long shift to drive, know your options. Many hospitals provided quiet places for nurses to sleep between shifts—please don’t drive when you feel you may fall asleep at the wheel! Conversely, if you are unable to sleep between shifts and are exhausted, you need to know when NOT to work. Never endanger your patients by working on no sleep. Take care of that license — and more importantly, your life.

2. Don’t be afraid of using meds to help you sleep. If moderate use of OTC meds doesn’t work for you, please see your doctor and perhaps get a prescription for a sleeping aid. I believe sleep is serious enough that medication is warranted in some cases.

1. Know when you have to switch to days. Seriously, many nurses need a break from NOC at some point in their career — because it is very taxing at times physically, emotionally and socially. It really has a huge impact on life. So, know what you can and cannot do. Nights isn’t for everyone!

When I first started this new job I’ll admit I was pretty miserable! My husband urged me to give it 3-6 months and focus on the little things to get me through the rough shifts. Unfortunately there weren’t many enjoyable things to focus on: the good stuff was buried deep and my cup was pretty empty, as it were.

Yet now I am uncovering gems everywhere:  a very thankful and compliant patient population, coworkers who tell it like it is and have my back when things get rough, and a boss who is giving me carte blanche to instigate some change and grow in my own expertise by doing so. In other words, they like me and I really like them!

The funny thing is that I had to really give this job some time–and will have to continue to stay put in the game for a while longer to really get comfortable and happy. I’ll admit I was so stressed I was ready to jump ship a month into things, but am glad I’ve hung in there.

And so, I was given this gift from a  patient, with a really nice thank-you note, and with it came the realization that I am beginning to actually like my job. I’ve amassed enough “little things” to equate some big job satisfaction. And with a newly filled cup I am ready to go into the new year with high hopes for my career!

2. May I have my (insert loaned item such as pen, stethescope, chart) back now?

3. How long will you be sitting at (my) computer and when can I have (my) chair back?

4. Do you believe in hand washing?

5. So, do you REALLY like your job? The nurses? Your patients?

6. If you could change professions, would you?

7. Did you used to have nice handwriting?

8. Honestly, what would you do without nurses?

9. Did you really just do that, say that, write that order, and/or act like that in front of a patient? (Actually, I DO ask this question a lot!)

And last but not least:

10. Are you as tired as you look???

Now I need a list of “Top Ten Reasons I Keep My Mouth Shut!”

I had to laugh at myself when I recently made a trip to the ED with a case of pyelonephritis. Not only did I want to assist the nurse taking care of me with finding a vein and taping up my IV, I actually yelled, “OW!” when the doctor palpated my flank area (oh, and I helped the tech change the sheets on my stretcher). What in the world? I felt like the world’s biggest drama queen/ control freak.

Oh, and then there is my refusal to call in sick. The rule seems to be that unless we nurses are dying, we don’t call in, and we then usually end up getting really sick because we haven’t called in so we can recuperate! I know so many nurses who show up to work feeling horrible who then pass it on to the rest of us—to the point where now I (guiltily) call in just to spare my colleagues, not to mention my patients.

And yes, I am guilty of letting my own health go at times—including my weight as of late—to the point where I can’t exactly say this nurse is a very good example. And every time I do get sick, I’m bad about self-diagnosing to the point of believing I have every incurable fatal disease known to man.

Not only am I a bad patient, I’ve become a huge germ-a-phobe and I now carry an arsenal of antibacterial products with me. Plus I make sure never to touch a “contaminated” door knob, pen, stethoscope, etc. Lot of good it does me as I seem to have caught every bug that’s gone around this year—most likely because I work too much and don’t get enough sleep.

When will we, as nurses, learn to take care of ourselves? For now, I’m back on antibiotics and trying to lose weight, and I’ve promised myself 7 hours of sleep between shifts no matter what. Here’s to trying to get and stay healthy so I don’t have to torture the ED with my neurosis anytime soon!

Yes, I did a happy dance:  I was free and elated. Being called-off  gifted the holiday to this nurse and my spirits experienced an unexpected boost. Yet for many nurses, this type of scenario rarely occurs, In fact, when I went not nursing school I had no idea how many holidays I would be giving up—not to mention soccer games, family get-togethers and romantic evening with my husband. Working, especially on nights, takes a toll on the quality time we have to spend with our loved ones—and no, that time isn’t really compensated for in a night differential.

But here’s the thing: I have chosen this profession, chosen my hours, and therefore need to find a way to make this job work for me, especially at the holidays. So my coping skills iunclude the following:

1. I participate in movable feasts. In other words, I’ve learned to move some holidays around to fit my schedule. There are limits to this, though. Some holidays and religious days can’t be moved so I,

2. Stay Flexible. I plan my schedule and work out trades. Most nurses are happy to trade holidays with me, I have found. I have gladly traded a Thanksgiving for a Christmas with nurses who maybe don’t celebrate Christmas, etc.

3. I also try to join in the fun. My unit also has lots of opportunities to celebrate for the holidays. The first year of my nursing career found me in such a funk that I became somewhat of a scrooge, didn’t go to the hospital ball, didn’t participate in the Secret Santa exchange, and didn’t even feast with my co-workers! This really affected my attitude, and now while I don’t do it all, I do add to the festivities and I have found my attitude has improved a great deal.

4. And most importantly, I communicate. I tell my family and friends what holidays I’ll be working, I work with my manager and coworkers to make things happen and overall I’ve found other people willing to bend a little so that I can be a part of the celebrations.

Holidays are still a work in progress for me, and I must admit to being frustrated at times about missing things. But ultimately, I am working it out. This year I miraculously was given a Thanksgiving—for which I am very thankful. Enjoyed it with my family and am anticipating a wonderful Christmas whether I work or not!

For example, my unit has recently laid off all the techs. On labor and delivery we are not too affected by this, but I know the mom/baby nurses are struggling. The techs did their vitals, ADL’s and were huge a huge help.

Now the nurses on that side of the unit are even more stressed and working conditions are pretty rough. I had a small taste of this the other night when I was ready to help with the delivery of a baby but was stuck at the nurses station asnwering one phone call and call light after another and buzzing people onto the unit because our unit secretary was floated off the unit. Basically I had to leave another nurse on her own w/ a huge workload which is not how I like to work. Thankfully no emergencies occured!

I know our med/surg unit also lost their techs and nurses are struggling to get everything done. Many nurses stay way past their shifts end just to catch up because the extra tasks have seriously cut into their routines and charting is a last priority. I’ve recently seen nurses still charting at 10AM (our shift is over at 7AM).

And things are absolutely awful when we don’t have a unit secretary—honestly, answering phones, call lights, putting in orders, etc are things I rarely have time for. Plus we nurses aren’t trained on half the things the unit sec. does, so when she is gone we are not only behind but we are confused as well. It really is the blind leading the blind when we nurses and teh doctors can’t get the paperwork and computer figured out!

There is a definite waterfall affect when we don’t have the support & human resources we need on the unit. Our patients receive inferior care because we are hustling to cover where there are holes. Plus things get missed and correcting mistakes is very time consuming.

Hopefully when the economy improves our hopsitals can start restoring some of these support positions on our units—I know people need the jobs that were taken from them, and as a nurse I highly value the people who make my job more efficient, more patient centered, and frankly, much more enjoyable on the whole.

No, you can’t get an epidural yet–you’re not even in labor!

No, I won’t increase the Pitocin on my patient who has an ugly fetal monitoring strip.

No, I won’t work an extra shift this week.

No, I don’t want to order out for dinner.

No, you can’t have ten visitors in your room at 2 AM.

No, eating Mexican food right before pushing your baby out may not be a good idea.

No, I don’t want more coffee at 0600 (though I really did)!

Interestingly enough, my typical response before becoming a nurse was to agree to EVERYTHING—I just didn’t want to upset anyone. When I first started on the floor as a GN I found myself intimidated by certain people and situations and saying, “yes” when clearly saying no was a safer and better answer.

So how have I learned to disagree in a way that is still professional while still getting the point across? I think saying, “nope” can be done in a pleasant way—with patients I always use humor and that seems to go over well (“I don’t think you want to see that Mexican food again anytime soon so let’s make a better choice for refreshment while pushing!”)

The assertive NO to a fellow nurse or doc can be done with firmness and civility. You just have to mean what you say and stick to it! I work with one nurse who instead of disagreeing will tell the docs frequently “I’m not doing such-and-such: if you want it done, do it yourself!” It’s no wonder the docs ask to work with other nurses—saying no is an art form. The admirable thing about this nurse is that everyone knows she means it when she takes a stance: I wouldn’t mess with her!

Sometimes an angry “NO! Absolutely not!” is needed for patient safety. Co-workers need to know I mean what I say and in an emergent moment, I’m not budging. This has been the hardest no-lesson because I have to have absolute confidence in my choices at the moment—pretty hard for new nurses!

At times I still get really nervous about telling doctors no but I am learning that patient advocation trumps any emotion I have. I’m getting better at refutation and honestly, my practice is improving because of it! In the end, it is all about context—oh, and learning when to say yes!

I really believe that our society helps us out with our discontent—we are told we can be anything we want, have anything we want—and that happiness comes from having it all. It’s difficult to fight against that mentality. Take my job for instance. Right now things are not easy in that arena. I’m still the new girl, working on my confidence, my autonomy, my rapport with other nurses, docs and patients. To me it feels like I am fighting a battle with myself just to go to work each day. I have so much to be thankful for, but how do I do that when I am not feeling that way?

Recently I was looking at the unemployment numbers in the U.S. (it’s easy to see that our country is under a ton of economic hardship) which then led me  to peek at the want ads. Right now escaping my current job feels like the simple way out, even though I know that is not true.

But here is what I found out when searching for a way out: First, there are few jobs in my specialty out there. The more I read about and see what has happened to the nursing industry because of the financial climate, I realize that my landing a job when I did and where I did is nothing short of miraculous. I must believe I am where I am at for a reason!

And secondly, the unemployment rate in this country is 10.2%, according to various news publications around the ‘net, jobs are still being cut in every industry, and the fact is that there are more qualified people than there are good jobs. Those of us with jobs can’t afford to let hardship put us into a tailspin because really, escape is not an option! (Plus, there are no guarantees the next job will be any better.)

I’m realizing that much like real love, being thankful is more of an action than an emotion.  And I can be thankful for my job despite my current negative emotions and feelings.  How?? By continuing to work with excellence and integrity, treating others with respect and dignity and valuing my job like the prize and blessing it truly is. Much like love, it is the actions that breed the emotions. The better I work as a nurse striving for excellence in all I do (excellence—not perfection), the better the outcomes for my patients and the more my job satisfaction grows. Just acting thankful leads to true thankfulness and gratitude.

Daniel Defoe once said: “All our discontents about what we want appear (sic) to spring from the (lack) of thankfulness for what we have.” Daniel, I’m with you–and I’m setting out to change that for myself! It’s time for this new nurse to act more thankful.

The reality is that sometimes I have rough nights where it feels like nothing I do goes right. Like on a recent night on the unit where I missed two IV starts on a difficult patient, had a huge confrontation with a doctor and then to top things off, accidentally put a piece of paperwork containing orders in a wrong patients chart which screwed up not only my own charting but that of a colleague’s (thankfully it was just clerical errors)! I spent the evening close to tears and was again wondering why I chose such a stressful, chaotic job.

Then I went into my patient’s room to say good-bye on my way out the door, only to find her whole family awake and ready for the day (her family members had spent the night after the arrival of her baby). They each repeatedly thanked me for my care and they went on to tell their doctor (yes, the one who I had had the confrontation with) about how great of a nurse I had been with my patient.

This trickled into the doctor thanking me, then later the management thanking me… and I began to realize that actually hearing that I was appreciated and knowing that in most people’s perception I am doing a good job is a huge reward in itself. Thank you gave a new slant to that night as well as induced some more positive feelings in me about my job.

So why are these two words really so important to nurses? I think because we are a helping profession, we need to know that we have actually helped someone. How do we know that if we don’t have some feedback? No, some of our patients are not able to thank us—but we need to hear from our coworkers, management, our families, etc that yes, we are making a difference. Nursing is NOT all about a paycheck—we have to know on some level that what we are doing has changed the life of those we serve, and thank you says it all.

Suddenly I hit a weird intersection where all the lanes reduced and I was forced to quickly hit the brakes…

I was stopped for a couple of minutes when I looked up from the gray pavement and bumper-to-bumper cars only to find myself surrounded by towering trees that had seemingly overnight turned gold, yellow, red, orange and a million other different hues. The sun was rising and peeking at me through the leaves while setting the forest blazing with light. It was absolutely gorgeous and the honking, crazy traffic around me faded into the background for a moment. At that moment I had an epiphany.

Sometimes in nursing I am so intent on the road—navigating others, doing my work, passing the time away until I can go home—that I forget to look around me and really “see the trees” as it were.

I forget to look into the faces of my patients and really see them and their newborns; I often don’t really pay attention to the miracle of new life I get to hold in my arms. Just the other day I held twin newborns in the crook of one of my arms and was struck with how amazing my job is and how privileged I am to be a labor and delivery nurse.

The reality is that if I get too focused on the road and never really look up and see what I am doing, I will miss out on the joys of my profession. It’s a struggle to be present, to be intentional—a struggle I don’t want to lose. Making time to really understand what I am doing as a nurse and how I affect people is a huge part of my job satisfaction! Seeing the big picture and reaping its rewards is like everything else in life: it takes some work!