Day Shift Vs. Night Shift: New Grad ICU Nurse

by | May 11, 2020 | Nursing, Video

Because I started my nursing career in the ICU, and have spent a couple of months on day shift and night shift, I’ve developed a little list of pros and cons to both sides of shift work. I’ve loved starting my career in the ICU, and organizing the ICU life in these videos. Subscribe if you’re interested in more nursing content, and comment below if you’ve had different experiences to add!

Hey, I’m Alley. I am a new nurse in the ICU, and I wanted to quickly go over the pros and cons of day shift vs. night shift.

A lot of times when you’re offered a job as a new nurse, the offer comes at you fast, and you can only really think about it for a couple of days before you decide to accept or reject the offer. If you’re a new graduate nurse, you’re most likely going to be offered a night shift job. And a lot of new nurses haven’t stayed up from 7 p.m. to 7 a.m. before, and worked a job during those hours. I’ve worked night shift at a pediatric med surge externship as a nursing student, and so I felt comfortable taking a night shift job as a new nurse. So, I work night shift right now in the ICU, but I have also spent two months working day shift in the ICU as well. So this is my new nurse perspective on day shift vs. night shift in the ICU, and a lot of this may apply to other nursing units as well.

So, let’s talk day shift. Day shift in most hospitals is 7 a.m. to 7 p.m. The pros for days: On day shift, you get all the professionals. You have all the doctors on the floor with you. You have speech therapy, physical therapy, occupational therapy, and you get those day shift professions there to help you. There is more hands on deck. Because those doctors are there during the day, you also get to see more bedside procedures. Especially in the ICU. When somebody gets a breathing tube put down their throat, that intubation procedure is usually done at the bedside. You might get to see arterial lines put in. You may get to see tracheotomies performed. Those kinds of procedures are usually done during the day. Because you’re seeing those procedures during the day, you also get to see the decisions that the ICU team makes with the patient’s care during the day.

There’s more family members there. So you get to talk with the family, talk with the doctor, and the entire ICU team, and see those decisions being made in the plan of care. So if they decide to take the breathing tube out of a patient’s mouth and extirpate them, that decision’s usually made during the day. If they decide to put a trach in, that decision is usually made during the day. So, if you’re on day shift, you get to be a part of that. Day shift also works well with your internal clock. Even if you consider yourself a night owl, research shows that day shift, and working during the day hours is better for you, both physically and mentally. And I’ll kind of get into that more when we talking about night shift.

So now the cons of day shift: Because all of those professions are there, there are speech therapies, there are occupational therapies, physical therapy, you as the nurse are pulled in a thousand different directions to accommodate everybody else’s schedule. You’re also pulled in a bunch of different directions by family members because usually they allow more family members to be there during the day. And of course, family is awake and talking to you, and asking about plan of care during the day. If you’re a new nurse, that can be really distracting. It is surprisingly difficult to hang an antibiotic on an IV pole when you’re talking to a family member when you’re brand new at this kind of stuff. As a new nurse, when you’re on days, it’s also harder to plan your shift. Maybe you’ll have it all beautifully planned out that are gonna be charting for 30 minutes at this time, and then the physician decides to intubate your patient, and you have to be there at the bedside helping out. So those kinds of bedside procedures, those plan of care that are cool to see, it’s also really hard to plan your day when those procedures are happening, and those plan of cares are being made.

Okay, let’s talk about night shift. Night shift is that 7 p.m. to 7 a.m. time slot. And I will say on night shift is a great environment for learning for new graduates. A common misconception with night shift is that it’s less busy. In the ICU, nights are not necessarily less busy, because you have fewer providers around. Fewer doctors. You don’t have speech therapy there anymore, to help you with swallow evaluations. You don’t have physical therapy there anymore to help get your patient up out of bed. So it’s not necessarily less busy, but you get more time to plan your shift out, and figure out what you want to do and learn how you best work as a nurse. On night shift, it’s kind of nice to look up and down the hallways, and they’re dimmed, and there aren’t people walking everywhere. You can barely move in the ICU on days, with how many people are on the floor.

One ICU-specific pro with the night shift is you get really good at drawing labs. You get really good at sending blood down to the lab, getting it out of the patient at whatever access they may have, whether it’s an IV or an arterial line, or a central line. And you also get really good at reading those labs because on night shift in the ICU, a lot of times you’re the shift that replaces electrolyte. So you will draw the lab at whatever time your hospital does it, usually around midnight, send it, and then the lab will tell you what electrolytes need to be replaced. And so if you have low potassium, you’re the nurse that is getting that information and hanging the bag of IV potassium and to replace it. So you get really good at knowing the physiology of your patient. You get to go look at a chart and really learn your patient. And get good at the skills of putting in IVs and drawing labs, and also the skill of that physiology. What’s potassium? What’s low potassium? How do I replace it? For all the electrolytes you get good at that kind of stuff. Because on nights you’re doing a lot of tasks and things related to your patient, you get to really see how those procedures work. How the treatments are working with your patient so you can report that to your patient’s doctors in the morning. So you get to really be the watchful eye over your patient, and really, truly be in charge of that patient in the ICU.

Another thing about night shift in the UCU that’s unique, is that you get a lot of really sick admissions. And I can kind of see this going for places like the emergency room, and labor and delivery as well. The people that come to a hospital at night, are usually emergent. They’re usually pretty sick. So you’ll get admissions. You’ll get people coming onto your unit that really need to be stabilized. In the ICU, they’re really sick. They had this stroke or heart attack, now. And you need to stabilize them, now. Because nobody just decides to come to the hospital at 3:00 in the morning. So now to kind of get into the cons of night shift in the ICU. Night shift, in general, it really takes a toll on your body. There are studies that show that people that work night shift on average don’t live as long. They age faster. They get sick faster. The immune system is repressed. And just get less sleep, overall.

So I could make a video later on how to survive night shift, and really make the best out of it, and beat those odds with night shift. ‘Cause I don’t think people do night shift correctly. It’s really hard to sleep during the day. So that’s definitely a con with night shift. You don’t really know until you try it, whether you’re a person that can adjust their circadian rhythm and sleep during the day and work at night. Another con is that in the ICU the ICU delirium and the sundowning of your patients comes out at night. And so sundowning is seen outside of the ICU as well. It’s seen in long-term care facilities. People with dementia. People with delirium. Those are two different states, but when the sun goes down at night, it is a documented thing that patients will get more confused and a lot of times more agitated. So if you’re a night shift nurse, you will get report from the day shift nurse while they’re leaving, and the day shift nurse will go, “Oh, yeah, sure, they’re fine.” And then they come back to get report from you the next day, and you’re like, “They were not fine.” They decided Obama was standing at the foot of the bed and tried to get out of bed and run down the hallway and say, “Hi.”

I mean, that’s just what happens at night sometimes. Is people will sundown, people will get delirious. Patients are not always sleeping, especially in the ICU. You will not have a bunch of sleeplng patients on night shift. You will have confused, sick, and delirious patients that you’ll be managing on night shift. You’re running on a crew of fewer people. There are fewer hands on deck, so when you sign up for night shift, you sign up to be one of the only providers around. You sign up to be the person who will run to whatever room needs help. Because there’s just fewer people around. So you do get that comradery with a night shift crew of nurses because it’s kind of just y’all at night. Those are my quick pros and cons on day shift vs. night shift in the ICU. If y’all have any other questions, feel free to comment. Any other comments on what it’s really like to work day vs. night shift, I’m new to it, but I’m definitely getting the gist of what it’s like. Thanks, y’all.