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I’ve always envied those who can flip flop back and forth between day shift and night shift. How do they do it?

I think I’ve nailed down some of their secrets, and in so doing have been able to work both day shifts and night shifts in succession. Happily! Nights are often a more peaceful time in the hospital and it’s definitely a nice change in my routine.

So, need some tips on how to survive the “dark side”?

Surviving the night shift.

Here are steps to jumpstart your circadian rhythm and allow for easier transitions from the normalcy of day shift to the non-so-routine night shift.

(1) If you are strictly a night shift nurse and you are having problems adjusting to the schedule, try a couple weeks of grouping all of the shifts together, three in a row. That way you can completely convert to night owl status for half of the week and then have four days to recover back to normalcy (that being if you indeed do work three 12-hr shifts).

For those who rotate and really cannot stand working three nights a week, ask your scheduling manager if you can split up your weeks into day and nights (be sure to work your days towards the beginning of the week and allow ample time for recovery after night shifts). For example, you would work Monday day shift and Wednesday and Thursday night shifts.

Wake up early on the day of your first night shift and take a nap in the afternoon. This strategy allows you to have a bulk of the morning to get stuff done and having some decent sleep prior to going into the long shift. I have heard people that just sleep in late (until like noon or 1 in the afternoon) crash around 3 or 4am because they have been up for so long.

My technique for the last day is to return home post last night shift, sleep for about four hours, then force yourself to wake up! You’ll be so tired by that night that you will be able to sleep during the night and be back on a somewhat normal day routine by the next morning.

(2) Right before a night shift, eat a substantial dinner prior to going into work (even if it is “breakfast-like”). That will hold you over for hours and give you a boost of energy to get the shift started. Try your best to avoid the comfort foods of night shift and bring a light meal full of protein and complex carbs that will fulfill your midnight munchies.

(3) Exercise! This not only applies to those working normal business hours. It becomes extremely important for those on night shifts because working out allows you to have more energy and creates for more sound sleep. I have friends that exercise after they get off their shift in the morning (I’ve always been too tired for that). If that is your preference, be sure to take time to wind down and drink a warm, non-caffeinated drink prior to going to sleep. I tend to exercise after I wake up – the beauty of that being that as opposed to working out early in the morning like a “normal” shift worker may do, you will be inundated with daylight hours for a nice run, pleasant early evening temperatures, and you will most likely beat the post 6pm rush at the gym. Hitting a wall at 4am? Run the stairs, it will most certainly wake you up

(4) Isolate yourself! Be sure to tell your loved ones, your neighbors, and your kids that just like they don’t like being woken up at 2am, you don’t like to be disturbed during your “night”. Turn your phone off, buy dark curtains that will keep the daylight out of your room, wear an eye mask, lock the dog out of your room, tie up the children (kidding), and for goodness sake don’t drink coffee within four hours of going to sleep. If you “need” coffee to get through the shift, drink it early in the shift and combine water with a stair run later in the shift as an energy boost.

You mind is a powerful tool. Keep in mind all of the positives of night shift. It can be extremely conducive to family life if you are a working parent. The shift differential is an added bonus in the bank account. You typically have more autonomy as a nurse on the night shift and have ample time to develop skills and master your assessments. With the pace of the shift usually being slower, you have more time to develop close relationships with your coworkers because you are relying on each other for second opinions, assistance with tasks, and camaraderie in staying awake when everyone else is snug in their beds.

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When you don’t get enough of it, you suffer. Big time.

No, we’re not talking about money, we’re talking about sleep. And if you’re among the third of working nurses who work the night shift, you probably don’t have the luxury of setting a typical sleep schedule. Sleep expert (and fellow nurse) Terry Cralle helps you identify whether you have what is called “shift work disorder,” suggests ways for night shift nurses (and their managers) to ensure a safe working environment, and offers up the following tips to help you get some shuteye.

Here are 19 things you can do at home to ensure you’re getting the sleep you need:

1. Make sleep a health priority, like diet and exercise.
2. Wear sunglasses if you’re commuting home in bright sunlight. Light is the most powerful zeitgeber, or influencer of the body’s circadian clock, and will negatively impact your ability to fall asleep. In contrast, once you wake up, go outside into the sun to cue your biological clock that it’s time to be awake and alert.
3. Only go to bed when you’re sleepy. Don’t go to bed just because it’s “time.”
4. Your body likes routines. Like light, your bedtime routine is a powerful zeitgeber. Establish a standard, relaxing, soothing bedtime ritual. Put on your pajamas, wash your face and brush your teeth to signal your brain you’re preparing for sleep. Play soothing music; take a warm bath for 30 minutes, one hour before bedtime; read a relaxing book or magazine. Allow enough time to unwind and relax, but try to go to bed as soon as possible after your shift, ideally within two hours. Don’t fall asleep in your recliner or sofa with a television blasting in the background.
5. Try to maintain a consistent and regular sleep schedule on work days AND days off/weekends. Keeping a routine helps your body know when to be alert and when to sleep.
6. Stop working at any task and attempt to resolve anything potentially stimulating, worrisome or upsetting one hour before bedtime. Writing down your emotional worries and thoughts in a journal may help release these concerns from your mind. Learn a relaxation technique, such as progressive muscle relaxation, and practice it in bed.
7. Use your bedroom only for sleeping and sex. Keep it stress and clutter-free. No paperwork, bills, unfolded laundry, TV, electronics or pets.
8. A darkened room signals your brain that it’s time to sleep. So keep your bedroom as dark as possible. Blackout shades, heavy curtains and eye masks can help. Standard window shades let too much light in. Cover an illuminated alarm clock, especially if you’re a “clock watcher,” or remove it, if necessary. If you need to get up, use a small nightlight instead of turning on bright lights.
9. Eliminate noise with earplugs, a fan or a white noise machine. Turn off or unplug the phone. Install carpeting or sound-absorbing curtains, drapes or shades.
   Keep your room well ventilated and the temperature on the cool side, ideally between 60 and 65 degrees (range: below 75 and above 54 degrees).
10. Invest in a good mattress. A poor or an old mattress can disrupt your sleep. The average mattress lifespan is about seven years.

More tips:

1. Make your sleep time sacred. Enlist the help of your family and friends and request that they respect your sleep. Put a “Do Not Disturb” sign on the front door, so friends and delivery people won’t knock or ring the doorbell. Have family and friends wear headphones when watching TV or listening to music. Ban vacuuming, dish washing, lawn mowing, loud games and any other noisy activity.
2. Tell your kids not to go into your room unless it’s an emergency, and be sure to specify exactly what is and is not an emergency. Schedule appointments outside of your sleep period.
3. Get at least 7.5 to 8.5 hours of sleep per day. Try to make up for lost sleep on days off.
4. Nicotine and caffeine are stimulants. Alcohol, while initially a sedative, causes arousals and awakenings, sweats and nightmares after it’s metabolized. Ideally, avoid caffeine-containing beverages and food such as coffee, tea, sodas and chocolate at least six to eight hours before bedtime. If you’re having problems falling asleep in the morning, avoid caffeine after midnight. Avoid cigarettes before bedtime and during awakenings, and alcohol at least five hours before bedtime.
5. Don’t go to bed too hungry or too full. Avoid eating two hours prior to bedtime. If needed, have a glass of milk or light snack before bed. Milk contains the amino acid L-tryptophan, which research has shown helps people fall asleep. Avoid consuming protein at bedtime, which may be harder to digest. Don’t drink excessive fluids prior to bedtime to avoid having to get up to urinate.
6. Don’t lie awake in bed for more than 20 minutes to avoid developing a negative association between your bedroom and sound sleep. After 20 minutes, leave the room and do something relaxing, such as reading, listening to music or watching television. Don’t return to bed until you feel sleepy.
7. Schedule 20 minutes of regular aerobic exercise and work it into your normal routine, but not within three hours of going to bed. Exercising raises the body temperature and can be alerting too close to bedtime. Walk or bike to work instead of driving; climb the stairs instead of taking the elevator. Consider exercising before work or during breaks to help you stay alert on the job. Keep a resistance band or hand weights at work for strength training. Find an exercise buddy to make exercising more fun and keep you motivated. Exercise will improve your sleep, energy level, mood, stress and cardiovascular fitness.
8. Address your partner’s sleep issues, if present. One partner’s sleep problem causes the other to lose, on average, nearly one hour of sleep a night.
9. Begin altering your sleep schedule three days in advance of a shift change. On the third day prior to the shift change and each subsequent day, postpone your bedtime and wake time by one to two hours compared to the previous day. By the time you begin the new shift, your circadian sleep-wake rhythm will be reoriented. For example, if you’re on a 5 p.m. to 1 a.m. shift and moving to an 11 p.m. to 7 a.m. schedule, do the following:

• Three days prior to your shift change, rather than sleeping from 3 a.m. to 11 a.m., postpone your bedtime to 5 a.m. and sleep to 1 p.m.
• Two days prior to the shift change, sleep from 7 a.m. to 3 p.m.
• One day prior to shift change, sleep from 8 a.m. to 4 p.m.
• On the day of the shift change, sleep from 9 a.m. to 6 p.m.

To learn more about shift work disorder and what you can do to make your work environment safer and more productive, read all three parts of our Shift Work Disorder series!

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Random, right? But she had this amazing-looking water with oranges, ginger, cucumbers, and berries in it. Just looking at it made me thirsty! It got me thinking: I wake up, drink coffee, take coffee with me to work, drink that, get more, and don’t drink anything else for the rest of the shift. How bad is that!?! And what’s worse is that I never even thought about it.

So I went home and dug through the cupboards looking for just the right water cup–one of those plastic, reusable ones with the straws (straws help me drink more of just about anything…not so good when it comes to cocktails, but GREAT when it comes to water!). I even filled it with lemons and ice to keep it flavored and cool.

What a difference! I don’t feel as tired anymore, and I don’t snack as much (when your water tastes good–try flavoring it with Mio drops too!–you don’t feel the need to snack on whatever’s lying around). It’s a lot easier to make it through my shift when I’m well hydrated. Sure, it means more bathroom breaks, but that’s a small price to pay. Even my skin feels better now.

So lesson learned: wanna feel great, hydrate! It’s amazing what you learn when you least expect it. Now excuse me while I go fill up my water bottle!

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So I’ve been on the NOC shift for two weeks, though it seems much longer than that.

I’d really like to know how long this “adjustment period” is going to take. My body’s had enough already!

Here’s a little bit of how I’m feeling now, two weeks in:

• My days seem a lot longer – on the bright side, time doesn’t fly by so quickly.
• I generally have NO IDEA what so ever what the date is, and most often, what day of the week it is.
• On that note, I also have a lot of trouble figuring out if I’m trying to say “tomorrow,” “tonight,” “yesterday,”  or “last night” because the day changes 4 hours into my shift but my mind is still back in yesterday… or, I mean, last night?
• My body hasn’t figured out when it’s supposed to sleep versus when it’s supposed to wake up.  This is more of an issue on my days off when I try to switch back to “normal” time. My brain says sleep but my body says stay up, and then I can’t ever wake up before 10:00 am to get anything done – even if I DID get to bed on time!
• I see a lot less of the sun – especially since daylight savings time. I enjoy my drive home for the bright crispy autumn days that we’ve been having (we’re actually getting seasonally appropriate weather here!), but I am a bit bittersweet about not getting to enjoy them more because I am asleep through most of it.
• I AM adjusting to more independence. At this phase in the training, my night shift preceptors are letting me do a majority of the work on my own, but are always there for me when I have questions. I’m finally starting to feel like a REAL nurse.  With emphasis on “starting to.”

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The other night my husband told me that he has a new dream for our lives: that I would get a day job.

I had to laugh a little, because as we nurses know, switching from days to NOC or vice versa is a difficult task. Having all the pros on the night shift in mind (it works well with my kid’s schedule, the money is better, I love my night team and the night environ), I also had to sit back and count the cost of nights at my husband’s urging.

A coworker told me recently, “So what if NOC takes 7 years off my life–working with the day crew would probably take off ten!” I laughed and laughed, but the fact remains: NOC is really hard on the body. Scientific research aside, I can personally attest to the fact that nights has completely jacked up my sleep cycles (I take Unisom with a vengence).

Another issue I can attribute to working the night shift are my weird midnight eating habits, which I am convinced has messed up my metabolism. And dieting is almost impossible for me: if the schedule doesn’t throw me off, the stress does! I wonder if statistically speaking, night nurses are fatter than day nurses? Hm?

And then there are my emotions: only nurses that work 3 and 4 night stretches know how crazy they can feel after such a run. I usually have a crying jag when I try to turn myself around, and am somewhat irrational, plus I laze around in my PJ’s and have trouble feeling really awake on my days off! And just when I get turned around and feel human again, I have to go right back to a night regime.

The solution is to switch to a day job. Yeah, not so easy! Day jobs are the last to open up–and working days brings with it it’s own nightmares (think waking at 5AM, morning traffic, management on the floor, and visiting hours with consequent family members everywhere).

So yeah, my body is feeling it and is telling me to do something. In the next year I see myself making the change and going to days. That should be fun to blog about!

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This is year 4 of the night shift for me, and I think I have finally gotten comfortable with balancing the autonomy of the night shift and working with doctors. For a while, I’ll admit, I had the whole “doctors chose this job so I don’t care if I have to wake them up” attitude–which didn’t really endear me to my doc-co-workers (not that I want to be buddy-buddy with them, but it does make sense to try and have a good working relationship). We all know that good working relationships between doctors and nurses increase patient satisfaction and safety.

So, here are my doctor-rules for NOC nurses in hopes they help someone who maybe is new to this whole night-shift-world:

1. Most nurses never wake a doc for a tylenol, a Tums, or a fever under 100.4 (to name a few). To do so equals an almost guaranteed chewing-out. Expect it!

2. Think hard before calling a doc at 3AM–can you use your autonomy or critical thinking to work out a problem, or do you REALLY need them?Can you bounce stuff off your charge nurse or do you REALLY need a docs input?

3. If a patient wants to see or speak with their doc at say, 2AM, it IS totally appropriate to call the doc/wake them, IMHO. Yes, try to problem solve w/ the patient, but the reality is that you shouldn’t come between the doc and pt relationship. That type of behavior not only goes beyond the nursing scope of practice, but it will bite you in the butt big-time in terms of doc-nurse working conditions.

Plus…

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Starting in November I’m switching over to the NOC shift, something I’ve never done before but need to get used to, since I’ll be a night owl once I start working on my own.

I just read these tips on trying to survive, but I must admit, I am freaking out a bit…ok, maybe more than that.

Like I said, it’s something I’ve never done before. Believe it or not, I’ve never even pulled an all-nighter to study – I’ve never been able to. The only time I can ever remember staying up all night was when I was about 13 when we had a movie night slumber party with lots of laughing, candy, and Mountain Dew to keep me sugared up. And I remember crashing out after watching the sunrise. Not very effective.

I’m actually not so worried about surviving the shift,  because I think that if I can prep myself for it and sleep ahead of time, I’ll be okay. But I am worried about prepping myself for it.  What do I do? Do I sleep the day before? Do I sleep all day in between shifts? Is it better to get work done before I go to sleep or after I wake up and before I go to work? What about on my days off? Can I go about sleeping at night like a regular person?

It seems so very different from what I’ve always been used to that I don’t really know what to think.  I’ve heard lots of great things about NOC, but then everything I read talks about your body hating you, gaining weight, and getting sick all the time.  NO FUN!  And with a wedding in my future sometime in the next year, I’ve got nerves about starting married life and not being home at night

What’s a new-grad to do? What works for you and how long did it take you to adjust to the night schedule?

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I wonder if those who conducted the research have ever worked a rotating shift in their life??! It seems that there is now a more ‘ideal’ formula for rotating your day and NOC shifts. Instead of working 2 weeks of days and then 2 weeks of nights this article ‘claims’ there is now a trend to work day-day-night-night then five days off in a row. I like the adjective they used in the article I read though. They called this trend of rotating shifts more ‘humane’.

I must admit, I’m glad to see research is being conducted on ways to minimize the detrimental effects of shift work. I don’t think they will ever eliminate the health risks involved with ‘flipping’ your circadian rhythm.

When I read the word ‘humane’ I immediately blurted out ‘Darn right!’. Working a NOC shift has got to be a warped zombie-apocalypse training scheme in my book. I don’t know about you, but working ANY type of NOC shift turned my brain into much and pretty much guaranteed all my autonomic bodily functions would short-circuit. I couldn’t see straight, I could stand without swaying and stringing more than two words together to form a comprehensible sentence just wasn’t possible. I remember feeling like I had the ‘flu’ every month when I had to do the shift ‘flip’. My hats off to those that can ‘flip’ with minimal damage.

It probably didn’t help that I have chronic insomnia and I am such a light sleeper. So much of light sleeper than a kitten walking on a newly installed carpet woke me from my sleep (true story). When I would work nights every trick in the book to help you sleep would not work for me, since the wind blowing outside would wake me up.

*sigh*

This would explain why I don’t work nights anymore.

…

I’m still chuckling at the word ‘humane’.

Article of interest:

Modern Shift Work Patterns May Be Less Harmful to Health

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!

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This absence or lack-there-of always leads to what I call ‘shift spill-over’. I end up leaving tasks for the next shift inadvertently. I do my best to not ‘dump’ on anyone, so I make it a point to wrap up as much as I can before I officially clock out and leave.

The other day was one of those ‘off’ days for me. I just couldn’t stay in front of the 8-ball with my patients. Everything from ventilator weaning and extubation to med changes and of course the traditional admit and discharge right around the change of shift sure didn’t help.

On my way home, I began to wonder if I’m the only one that has that end of shift guilt? I mean it’s not something that was ‘taught’ during nursing school. And it surely wasn’t mentioned in ANY of my hospital orientations. Yet, every shift I work I’m circling through my head all the tasks that I didn’t get done and have to pass on to the next nurse.

I know, I know… nursing is a 24 hour-a-day job. (One of the many nursing pearls I teach and have been taught)

I guess I always remember what it feels like to get ‘dumped’ on. I’ve taken shift report from some pretty horrible nurses. Nurses who failed to chart meds from the beginning of their shift (8 or 12 hrs). I’ve cleaned up messes in patients rooms that were made at the beginning of their shift or even a previous shift. I’ve gotten my rear-end chewed out by a distraught family member because they weren’t called and updated properly on something I wasn’t even present for! And yes, I’ve had many physicians question my integrity because a med error was made or a med was missed on a previous shift.

*sigh*

I know I’m not dumping on anyone (at least I don’t think I am), but I can’t shake the feeling of it. Call me crazy, but that end of shift guilt keeps me on my toes throughout my shift. The last thing I want to do is let down a fellow co-worker.

I can’t say I’ve been approached or accused of ‘dumping’ – but that doesn’t mean the oncoming shift nurse didn’t feel that way.

One thing is for sure, I’d like to think I’m a fairly decent bedside nurse. It’s the nurses who don’t have even a shred of this guilt that scare me.