Tired healthcare professional with stethoscope yawning
Career Development June 26, 2020

By  E’Louise Ondash, RN, contributor

Night-Shift Nursing: 15 Survival Tips for New Nurses

Are you dreading the move to night-shift nursing? Don’t be. 

Sure, working nights can be challenging for new grad nurses or others new to the shift, but there are some advantages, too. Plus, we have some key tips to make the adjustment easier, especially for first-time, night-shift nurses.

What’s good about working nights?

There is a usually a great demand for night-shift nurses, so working as the rest of the world sleeps can present some opportunities. 

“The new or recently graduated nurse may be able to start in the position or specialty desired by accepting less popular shifts,” said Sharon A. Morgan, MSN, RN, NP-C, senior policy advisor for nursing practice and work environment for the American Nurses Association.

“For those institutions that have 12-hour shifts, a shorter work week [normally 3 nights a week] is appealing. Also, pay differentials often accompany night-shift and weekend work.”

Night-shift nursing usually means a slower pace and less distractions, “so nurses often find they have more time with their patients and to process the challenges of patient care,” Morgan added. And the lab, imaging departments and EKG technicians may actually respond faster.

Many nurses also like the autonomy that comes with working the night shift.

Some cautions for night-shift nurses

The night shift does present challenges to a nurse’s mental and physical health, however.

Switching sleep schedules can interrupt your natural circadian clock, which research has shown can impact everything from insomnia to weight gain and heart disease. Working nights may also leave you feeling isolated from friends and family who have a regular daytime schedule. 

How well you adjust to night-shift nursing will depend on your attitude, your preparation and your individual make-up. Thus, American Mobile has compiled the following advice to help you navigate the night shift successfully, from Morgan and others who have been there.

15 Top Tips: How to Adjust to Night-shift Nursing

1. Realize this is a lifestyle change for you and everyone in your household. Your family members or roommates will have to understand that they may be seeing less of you on certain days, and may need to work around your sleep and waking schedule – which you should post for them, by the way. Get everyone on board to make some adjustments, such as scheduling breakfasts or dinners together so you still have quality time. 

2. Sleep – you need it! Get at least 7 to 9 hours of sleep within a 24-hour period and impress upon family and friends the importance of your uninterrupted sleep. Avoid caffeine at least four hours before bedtime. Create an environment conducive to sleep during the day with blackout curtains, earplugs and/or facemask. Shut off electronic devices (really!), and don’t depend on sleeping pills or alcohol for making you sleepy.

3. Be careful about your sleep/wake schedule on your days off. Some night-shift nurses try to keep the same wake hours and bedtime on their days off, so their body doesn’t have to keep readjusting. Others find some adjustments that work for them, and will do what they can to have a “normal” schedule when they aren’t working. 

What not to do? Stay up for 12 hours straight (or more) before your night shift. 

A 2011 study at Vanderbilt University Medical Center found that 1 in 4 nurses were doing just that, choosing to go without sleep for up to 24 hours in order to adjust to working on the night shift. The researchers pointed out that this is the least effective strategy for adapting one’s circadian clock to a night-time schedule.

4. Understand that every nurse adapts differently—it’s in your DNA. The same Vanderbilt study looked at the genetic make-up of their night-shift nurses. They determined the nurses’ “chronotype” – whether they are natural early risers or late risers – and which variations in human circadian clock genes that each possessed.

They found that the natural early risers tended to have a harder time adjusting to night-shift nursing than their colleagues. Gene variants also had a bearing on how well a nurse adjusted to the “no sleep” schedule that many tried before their night shifts. 

5. Give your body some time. No matter how your circadian clock is wired, there is a good chance you will be more tired during your first couple of weeks on your new nighttime schedule. Hang in there; it should get better. 

But if you are continually fatigued and don’t see improvement after a few weeks, talk to your hospital wellness team or your supervisor to discuss some solutions.

6. Expect the unexpected while on duty. While the night shift can be slower than days on many units, be sure you understand the procedures and who to call when the unexpected happens – such as disasters, short staffing or difficult patients. Know how and when to access your support system.

7. Take scheduled breaks—even naps, if allowed. You’ve heard it before: don’t skip breaks or meals during your shift, and take advantage of designated rest areas. You need to care for yourself, and your patients are counting on you to stay sharp. 

Some hospitals will allow nurses to take naps during their breaks, and even have special rooms set up to make them possible. Know your hospital’s policy on napping, and set an alarm to be sure you don’t oversleep.  (And don’t get caught napping while on duty!)

8. Beware of your own medications. Be aware of side effects from both over-the-counter and prescription drugs. They could impair your alertness and performance on the night shift.

9. Don’t drive when drowsy. Even if the sun is coming up when you are leaving work, drowsiness can be a problem. If you feel drowsy, call a family member, a friend or a ride-share service. And don’t stop for drinks with friends as a way to unwind.

10. Eat well, and stay hydrated. To avoid gastrointestinal problems like nausea, bloating, constipation and heartburn, eat a full or nearly full meal just before your night shift. This mimics eating breakfast for those on the day shift. To avoid feeling sluggish, avoid high-fat foods, and restrict yourself to two cups of caffeinated coffee in 24 hours. 

Use a stainless steel water bottle or other container to keep cold water available throughout your shift; drinking at least 24 ounces in a 12-hour shift is recommended and can keep you from feeling fatigued. Pack nutritious snacks that are high in protein and low in sugar for the necessary pick-me-up in those hours just before dawn.  

11. Move! Regular exercise is a must for so many reasons. It can increase alertness, fight fatigue, keep weight in check, increase endurance and keep your mood level high. It also helps combat gastrointestinal and sleep problems. Think of ways to increase activity while on the job, like taking the stairs instead of the elevator. Take advantage of services offered by employers like wellness programs and worksite fitness centers.

12. Stay productive when things slow down. Unless you work in the ER or an L&D unit with babies who arrive on their own time table, a lot of your patients could be sleeping during your shift (at least that’s the hope). Fewer people are coming and going than during the daytime hours, as well. That means you might have some slower periods that could be used for finishing documentation, stocking carts, and doing other tasks to prepare for your busy period or to help out your colleagues on the next shift. Staying busy will also help you stay alert.

13. Ensure stellar communications at shift transitions. Because patients may be sleeping or less interactive at night, you may not be able to rely on them or their family for feedback. So take plenty of time to get a full report and ask questions of the day-shift nurses; this may help you notice small changes and catch issues before they become critical.

14. Wear bright colors. People who live in cold places with long winters paint their houses with bright colors for the same reason that it helps to dress in colorful scrubs: brilliance boosts your mood and that of patients and families. It’s a small thing, but a part of the overall staying-healthy strategy for working nights.

15. Build rapport with your fellow night-shift nurses. Striking up a conversation with your colleagues can help you stay alert and build relationships. Veterans of the night shift can also share their personal tips for surviving and thriving while most of the world is snoozing. Even after shift, a meet-up for breakfast can help you unwind, debrief and continue to build those important nurse friendships.

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