DiversityNursing Blog

Infographic Design: Erica Bettencourt

The night shift can take a toll on you. We wanted to share some tips from other nurses on how to survive the night shift. 

By JEFF SHARLET

The photograph that Markisha McClenton posted on Instagram is a self-portrait, a close-up that is muted in dim light. She might be on her way to work. She might be coming home. Her workdays begin and end in the dark, and they are dark in between. She’s a lab technician in Jacksonville, Fla. Her specialty is blood. She has worked these dark hours since her son was 7. “Freedom,” she told me over the phone from her lab. That’s why she works these hours: The freedom to work at night and to raise her children during the days. To her, this is good fortune. She is smiling in this photo. But her eyes are midnight eyes, 3 a.m. eyes. Why take a photo at that hour? “People forget about us, the night shift,” she said. The #nightshift. That’s the hashtag she used. It’s how I found her.

I’ve been working at night myself for a long time now. Once it was out of choice, a preference for the quiet hours. More recently it was because I had no choice. Insomnia. One night, I was drinking my third cup of coffee — because when you can’t sleep, you might as well stop trying — and ignoring the deadline looming the next morning. Instead, I stared at the matrix on my phone, my own red eyes scanning a tiny sample of some 670,000 photographs under #nightshift. Most of them were people like me, awake when they didn’t want to be awake. And like me, they were looking at the screen in their hands, held up by the one in mine.

Night Life

This is the ghost world of #graveyardshift (#nightshift’s sister hashtag), whose workers file into Instagram every evening. These pictures may be clever or maudlin, silly or harrowing or sad. “Desperate” is a word that comes to mind, but so does “resigned.” And even “resistance.” Sometimes it’s in the form of a gag, a ridiculous pose; sometimes it’s in the form of a gaze so steady that it seems to warm the fluorescent panels framing so many of these pictures. The hashtag itself is a form of solidarity.

There are the warehouse workers who snap themselves letting a wisp of marijuana smoke slip from between their lips, little Instagram rebellions. There are the soldiers and sailors pulling a night shift for no good reason other than orders, photographing themselves and their comrades on the verge of sleep or already under. Cops in noirish black and white, their pictures framed to show a bit of badge. And nurses. A lot of nurses. Close-up, arm’s length, forced smiles, dead eyes. Scroll through #nightshift, and you’ll see some saints among them and some whose hands you hope will be more alive in an emergency than their ashen faces.

The #nightshift hashtag is especially well populated by the armed professions and the healing ones. Sometimes they are almost one and the same, as in the case of @armedmedic3153, a.k.a. Marcelo Aguirre, a paramedic in Newark and suburban New Jersey. He owns an AR-15, a ­9-millimeter­ and a shotgun, but the only thing he shoots on the night shift is his camera. He works nights so he can study days; he wants to be a doctor. Nights are good preparation for that: You get more serious cases. You learn on the job. A 12-hour course each night you’re on. Twenty-four hours if you take a double. After a while, the adrenaline that juices you when you’re new — when you’re still keeping a tally of the lives you’ve saved — disappears. You just do the job. “High speed and low drag,” Aguirre told me when I called. “Please ignore the siren,” he said. “We’re going to a call.” A stroke. Nothing to get excited about. Coffee sustains him. He stays clean. Some guys, he said, use Provigil, but that’s prescribed. “For shift-work disorder,” he said.

Markisha McClenton, the lab tech, told me that she no longer gets sleepy. “I program myself,” she said. She wouldn’t change her schedule now if she could. She likes working alone. There are nurses at the facility where she works, but they don’t often venture back to the lab. “They think it’s creepy,” she said. “At night.” Maybe it is: The long hours of the night shift are a reckoning with time.

“There’s people still struggling like I struggle,” a miner named Mike Tatum told me, explaining why he posts pictures and why he looks at them. “Working through the night, not sleeping next to your wife, missing your kids because they go to school before you get home.” Tatum likes to post pictures of the heavy machines used to dig coal from Wyoming strip mines. He drives a D-11 bulldozer. “I push dirt,” he said. Other machines dig the coal. Twelve hours of ‘dozing, four nights in a row. He came to this job — a good one, $30 an hour or more for as long as the coal lasts — after construction work dried up in California. “Nobody back home has really seen what we do out here,” he said. It’s a good job, he swears. He’s brought his 6-year-old boy out to see the machines. He’d be proud if his kids grew up to be miners. A good job. Rough on the back. But you’re just sitting. Driving the ‘dozer. Nobody bothers you. Hours without a word. “Pretty easy,” he said. Plenty of time to think. To make plans. Things he can do with his days, when he has days.

So far, this is enough to see him through the nights safely. “Quite a few fatalities the past year,” he observed. He heard about a man at another mine who drove a machine into the pit. “Maybe a suicide.” It didn’t seem like an accident; he had to drive through a couple of berms. “Splat,” Tatum said. “And a couple more like that.” He says other guys have died on the road, Highway 59. It’s a long drive out to the mines, and drug testing never stopped anyone from drinking, especially after the shift is over.

Pan out to take in some fraction of the 670,000 faces. Pay attention to the eyes, drooping or unnaturally wide. Is it fatigue? Or something more? Something less? Stay sane, and the night shift may seem like just another set of hours. Lose yourself to the loneliness, and the daylight leaks out of you. But something else can come in. A kind of calm. The kindness of dark hours.

When I was first drawn into this nighttime Insta­gram grid, I was looking for a distraction, for ­images to displace the thoughts that had agitated me to exhaustion. What I found instead was something that seemed descended from Walt Whitman’s “Democratic Vistas,” his great prose poem of an essay that was really a proposal for a new kind of literature, a way of speaking, a way of seeing. We shouldn’t mistake Instagram’s squares for the public one. But neither should we miss the quiet dig­nity afforded by gathering under this hashtag: the solidarity of recognition, of being seen.

“Nightwalkers,” Pierre Bell calls the men and women who find their peace after-hours. He’s new to the night himself, working as a nurse’s aide on the behavior unit at an assisted-living home in Akron, Ohio. “What’s behavior?” I asked. “Combative,” he said. “Lockdown. Spit, kick, hit, bite.” Sounds terrible, I said. It’s not, he told me, especially at night, when the anger subsides, and when the alarm I can hear beeping in the background is an event rather than a constant song. The other aide will get that one. Bell, a 28-year-old father of a 9-month-old, was sitting with the nightwalkers. The strange ones, the restless ones, the story­tellers. “Some were in wars,” he told me. “Some were teachers.” Sometimes they talk for hours. If they’re up, he’s up. It feels to him like a matter of courtesy. The behavior unit is his patients’ home. He’s only visiting. Trying out the night they live in.

And on his break, he can slip away. Take a snapshot, make a record of himself in this new country of the other hours, post it on Instagram as ­@piebell522.­ He took the one that caught my eye when he was in the bathroom. “I saw the dark behind me,” he said. “I thought it could be a picture.” A lovely one, as was the shot that followed hours later: Bell’s baby boy, the reason he works the night shift. Not for the money but for the days he can spend with his son, a handsome little guy with his father’s gentle eyes, but warmer in the golden sunlight of the morning.

Source: www.nytimes.com

Fastaff

Making the transition to working nights may feel a bit intimidating, but many night nurses, myself included, have grown to love the position! It tends to be quieter and less chaotic because the patients are generally asleep, and there's a special camaraderie that develops between a team of night nurses. Put these tips into practice to survive, and even thrive, in your night shifts.

Stack several night shifts in a row: Rather than spacing out your night shifts during the week and having to switch between being up during the day and up during the night, try to put all your night shifts for the week in a row. That way, you can really get yourself onto a schedule of being awake during the nights you work and sleeping during the days in between.

Nap before work: As you transition from being awake during the day to being awake as you work at night, take a nap in the afternoon to help you go into your first night shift as rested as possible. Alternately, if your schedule allows, stay up later than usual the night before your first night shift and sleep in as late as you can the next morning.

Fuel up with healthy foods: While sugars may seem like they provide energy, they also come with a crash. Before heading into work, eat a filling meal with a healthy balance of carbohydrates, protein, and fiber. Then bring healthy snacks for the night that include protein and fiber to keep you going strong. Some options include yogurt, mixed nuts, hard boiled eggs, cheese cubes, or carrots with hummus dip

Plan caffeine carefully: It can be tempting to drink a cup of coffee anytime you feel sleepy, but you may develop an unhealthy dependence or be unable to fall asleep when you get home after your shift. Therefore, try to limit yourself to just one or two cups of coffee per shift, and drink your last one at least six hours before you plan to go to sleep.

Create a restful sleeping environment at home: The key to surviving night shifts in the long term is getting lots of restful sleep after each shift. Set up room darkening curtains and a white noise machine to help you block out signs of the day. When you get home, don't force yourself to go to bed right away. Instead, develop a routine that includes some time to bathe, read, and relax as your body winds down after work. Try to avoid bright screens, which block your body from releasing melatonin, the hormone that makes you feel sleepy.

With some attention to detail, you will probably find yourself really enjoying working at night. Many of the night nurses I know started out stuck on the shifts, but grew to prefer them. Plus, the pay differential doesn't hurt at all!

Source: http://www.fastaff.com