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Recognise night nursing as a specialty

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3 February, 2014

During the hours when most of us are asleep, in hospitals and care homes across the country, night nurses are striving to ensure the care and recovery of patients.

Nursing at night carries significant responsibilities and challenges that often go unrecognised. Nurses are caring for the same number of patients as during the day but with far fewer staff and with much less infrastructure and back up.

They are responsible for their patients when the ward is not bustling with the multidisciplinary team. In the past when hospitals hung onto less acute patients, there were some wards where working as a night nurse meant looking after a ward of sleeping patients. Times have changed and night nursing is rarely such an easy option.

As well as the challenge of the work there is the challenge on the body. A wealth of research shows the physiological toll of working when your body thinks it should be sleeping.  And of course there are the social difficulties – trying to maintain a normal social and home life when your hours are so out of kilter with many others in your life.

It’s great to see that George Eliot Hospital Trust is investing £400,000 to increase the number of night nurses. It is heartening that there is currently a focus on staffing levels but I hope this will also include considering whether there are enough nurses at night. It is all too easy to pull the curtains and turn out the light on what is happening on the wards at night as most managers are not there themselves.

Part of this is to recognise the both different and difficult job that nurses do at night. And of course primarily because for the patients the experience of being in hospital is 24 hours.

Readers' comments (12)

  • I worked permanent nights and agree there are specific skills/knowledge needed. Rotation days/nights is commonly practiced by Trusts, this reduces the quality of care patients get at night I recently spent time as in/pt nursing staff clearly didn't understand needs of pts at night, among other things volume of the voices and clompy shoes reduced my sleep for sure!

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  • If managers are paid to have 24 hour responsibility then there should be the means to insist that one / some are in the hospital over night as well as at the weekend, especially when a hospital is working in bed crisis conditions.

    Those who work permanent nights deserve the same level of visible support as the day team do. Or perhaps night staff prefer being able to get on with their job of caring for patients without falling over clipboard waving, box ticking managers......

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  • tinkerbell

    However do we manage out of hours, weekends and nights without all the managers?

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  • yeah right...managers at night so they can't do a lot of the different aspects of the job they are meant to do.
    Then, in the day we hear the day staff say, "Where are the managers? we need this to happen...that to happen.." but alas they ain't there- they are in bed!
    There's probably a good reason managers don't work nights. Its not that they are above working the shite shift, its more to do with the fact that they need to get stuff done when other members of the human race are awake - that means DAYTIME!
    Maybe we don't need managers on a night shift, but rather senior staff who can make decisions etc.. (and yes, I'm a senior nurse who works nights, before you start bitchin)

    c'mon, not all managers are bad you know but some people want them to work day and night and suffer for it just because they are managers.

    The more we make a 'them and us' scenario, the worse it continues to be!

    Nights V day
    Nurses V managers
    'real' workers V pen pushers

    Change your focus and invest in good management (or maybe even get involved yourself to make a difference)

    Nights suck, but if we are empowered to do things, we can ensure that patients/clients/residents get good quality service at a time that they are most vunerable.

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  • SJRN_Ruth

    Although night shift is highly demanding and takes toll on emotional and physical well-being of a nurse, we as nurses seem to find little things to make it less stressful. It is that time of the day where we find small things to be amusing. And gets a lot of good laughs with co-scrubs. Well, as long as we serve with passion night shift will always be recognized as an specialty. Hope our employers are reading this.

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  • I'm pleased this piece has been written: I think for too long night staff were seen as lazy and somewhat second class to their day shift colleagues. Internal rotation was meant - apparently - to ensure the quality of nursing care over a 24 hour period, but it's had the opposite affect in many areas.

    Some people just can't function at night, whereas some excel. Nights often suit those with children or other commitments, days suit others.

    Permanent night teams are expert at nursing patients at night often doing vast amounts of work with far fewer staff than on days. I think its time that forced internal rotation be stopped to allow these night teams to flourish once more.

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  • I no longer do nights but did for 11 years. They were the mixed rosta of short periods of days and nights that really messed with my head. Staff were always bemoaning the 'old days' when you either worked a block of nights, then rested for a decent period of time, or how certain groups of nurses did permanent nights because it suited them. The skills required are different and we all know skill is truly embedded with repitition and consolidation. Switching from day to night and back again is just awful and, as already said, it just cannot be physically and mentally tolerated by some. I gave up when I woke up on the wrong side of the road, with another car coming straight at me. Something had to change for my sanity and safety.

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  • being a sister on night duty in a 10 bedded hospice I can honestly say - yes there is a physical impact working nights has on the body, but I work with an amazing team of nurses and truly feel we all work with the same aim. To enable our patients to have a comfortable and peaceful night. We do not have a multitude of support staff as is the case when working days. But this can be a serious advantage the majority of the time. Everyone knows exactly where each other is throughout the whole shift, everyone knows what has happened to each patient during the whole shift and everyone knows what needs to be done.

    Night staff work with patients whose needs can be very different from during the day, anxiety is often increased impacting on pain, stress and obviously sleep. I agree wholeheartedly that gone have the days where patients sleep all night. Patients still need the same level of care whether it be day or night. We also often have to deal with very distressed and stressed relatives at night (not saying this doesnt happen during the day, but visiting during daylight hours) if they are staying the night its because the patients condition has deteriorated or have been called in urgently. So the skills we as night staff have had to develop are essential to enable us to provide excellent care for our patients and their families.

    I am well aware that some nurses are not suited to night work and that there are advantages to working nights when caring for our own families. Ive seen first hand the impact that working a mix of days and nights can have on nurses especially in trying to recover and be able to function as a normal human being. We should not shy away from encouraging nurses talents and preferences and its so refreshing to read an article that celebrates and acknowledges night nursing as a speciality.

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  • michael stone

    This is generating some really interesting comments - that is my only comment.

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  • wait, wait for it,yes a night matron will solve all the problems. As they have solved all the problems during the day.

    That's what this article is leading to.

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  • Let's not forget those of us who work out in the community at night. Responding to distressed patients and families in their own homes definitely requires a specific set of skills ; very different from a hospital or other clinical setting. And I have done them all in my 37years of nursing. At night there is me...and my HCA. That's it..

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  • At last, night nursing is recognised as a speciality. I did night duty in HDU for over 10 years. There is no difference betwwen day duty and night duty in this settings. In fact it is harder on night duty in HDU as there are only one doctor on call and the nurses on the shift.I chose to do nights because I enjoyed it. Others who choose to do nights might have other reasons. I also come across nurses who slept on night duty because they are tired. If this is the reason then they should not commit themselves to do nights.

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