Adapting to Overnight Shifts: 5 Common Mistakes and How to Avoid Them

Adapting to Overnight Shifts: 5 Common Mistakes and How to Avoid Them

Mar 30, 2018 | Blog, Minority and Community Health

Working overnight shifts is a big change for many nurses, but it’s also extremely common. With the 24-hour demands of the bustling, modern health care system, there’s a good chance you’ll have to work the night shift at some point in your career, especially when you’re starting out. But don’t fret! There are many ways to ensure that the transition from day to night goes as smoothly as possible.

All nurses need to be on their A-game with technical medical skills and emotional resilience no matter what time of day they’re working. Night shift nurses have to shoulder even more burdens because they often work mostly or entirely alone for their shift. While there’s no one “right” way to adapt to the night shift, there are several common mistakes that you’ll want to avoid to build good habits.

Common Mistakes to Avoid When Switching to the Night Shift

Going against your circadian rhythm is no small task. However, resorting to quick fixes will only make your shifts more difficult in the long run. Avoid these five common mistakes and you’ll adapt to the swing of a night shift quickly.

1. Not getting enough rest before starting a shift.

As a nurse, it’s important to always be sharp on the job. The staff at Gurwin Jewish Nursing and Rehabilitation Center emphasize that not getting enough rest is the number one mistake that new night shift workers make, and it’s one of the most dangerous. Since shifts are often upwards of eight hours long, there’s no safe way to “power through” on too little sleep. This goes for both on-shift work and driving when sleep-deprived.

How to Avoid It:

Install blackout curtains where you sleep and get a fan or white noise generator.
Turn off your phone, get a “Do Not Disturb” sign, and inform loved ones of your schedule.
Staying up for a few hours to relax and take care of yourself may be easier for some nurses than going straight to bed at the end of a shift. You’ll figure out what works for you with time, so don’t be afraid to experiment.
Take proper care of your legs and feet while on your shift, so you won’t be troubled by pain or soreness when you’re trying to sleep.
Light soothing candles and practice stretches to relax yourself before bed.

2. Leaning on sugary foods, alcohol, or caffeine instead of proper nutrition.

It can be tempting to snack on chocolate or chug coffee to keep yourself going through your night shift. Keep in mind that, if consumed in excess, coffee can lead to jitters at first, followed by a crash. You’ll be far better off if you instead focus on getting more sleep.

How to Avoid It:

Plan and pack your meals ahead of time to avoid relying on vending machines.
Schedule your heavy meals so they won’t interfere with sleep.

3. Letting your personal life fall into disorder.

Sometimes it’s hard to keep your personal life in order while working the night shift. Errands, social gatherings, and childcare all battle for your attention when you’re not at work. This reduces your ability to get good sleep and, in turn, to focus at work.

How to Avoid It:

Yoga and meditation help you relax and leave work behind so you can be present when you’re engaging with family or friends.
Establish a schedule for sleep, chores, and activities. This will reduce the stress of missing out on things.
Plan gatherings ahead of time with friends and family to ensure you can make it to fun gatherings.

4. Not asking for help or feeling like you have to “do it all.”

Yes, there are fewer resources available overnight at the hospital. This can lead to superhero-esque thinking, where you refuse or even genuinely forget to ask for help. Being honest about needing a hand is better than dropping the ball because you’re juggling while tired.

How to Avoid It:

Get to know the others who work nights so you can trade favors.
Get to know the resources available to you during your shift.
Ensure that your roommates or family are sharing the load with you at home.
Choose sleep over chores when possible at home. Others can help you with chores, but they can’t sleep for you!

5. Missing out on workplace bonding, training, or resources due to night shifts.

It’s easy to feel forgotten when working the night shift. Try not to miss out on opportunities for bonding, continuing education, or extra support because of your schedule. It can be hard to make time or schedule changes for these opportunities, but they’re integral to your career development down the line.

How to Avoid It:

Check announcement boards and learn about opportunities available at your workplace.
Make it known to your boss and coworkers that you’re interested in additional training, support, resources or team bonding even if you work the night shift.
Ask if there are online resources available for any opportunities that you simply cannot attend.

Your job as a nurse is important. Don’t let working the night shift get in the way of providing the best care possible to your patients and yourself. Getting enough sleep is integral to your job performance and personal health, but that’s not always enough. You also need to make sure you’re practicing good self-care and focusing on your health along the way. With these great tips, you’ll adapt to the night shift in no time!

Deborah Swanson is a medical office professional with two decades of experience helping small practices and large hospitals alike improve efficiencies. She recently started consulting with allheart.com providing insight into the daily activities of medical professionals and how best to serve them.

RN and a Healthy Lifestyle

 Living a healthy lifestyle

Publication Date: March 2014 Vol. 9 No. 3

Author: Beth Battaglino, RN, BSN

As nurses, we know how to check blood pressure, administer medications, and counsel patients about healthy living. But let’s face it—some of us don’t practice what we preach. At the end of a long shift taking care of others, we sometimes fail to take the best care of ourselves.

It doesn’t have to be that way. Take it from me—a busy practicing nurse, chief executive officer of a women’s website, a wife, and the mom of a 1-year-old boy: You can fit healthy habits into your life. You just have to want to. And once you do, you’ll see how much better you feel, physically and emotionally. As a bonus, exercise and healthy eating habits improve your cardiovascular health—a major concern as we age. (Heart disease is the #1 killer of women.) If improving your own health and well-being isn’t reason enough, keep in mind that getting healthier can help you take even better care of patients.

The power of exercise: Working out your body and your stress

I learned at a young age I’m not one of those women who can eat whatever they want and stay thin. I also discovered I can’t simply cut calories to lose weight; I need to exercise, too. For weight and overall fitness, I can’t stress enough the importance of physical activity. As a country, we exercise more today than we did 10 years ago—yet obesity rates are higher than ever. Why? Researchers suggest diet and other lifestyle changes are also components to maintaining a healthy weight.
Most people need to exercise (and eat well) to keep weight off and stay fit. The American Heart Association recommends at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week, or a combination. This comes to at least 30 minutes, 5 days a week—a good goal.
What form of exercise is right? Like me, you might want to mix up your workouts to keep your mind and body challenged. I run one day, do kickboxing the next, and go to boot camp the next. (Kickboxing and boot camp are great ways to relieve work stress, by the way.) I also do strength training a few times a week.

To stay motivated, I exercise with friends. It’s much harder to make excuses for skipping an exercise session when you know others are counting on you. Once you show up, friends will push you to give it your all. I run with a group of 40+ moms every Saturday morning. Last year, I trained with the group and completed a half-marathon and three triathlons. Running is a great therapy session, too. One of us might say, “Hey, I’ve been having this problem at work”—and get great feedback from friends while running.
During the week, I fit my workouts in early—at 5:30 in the morning, while my husband stays home with the baby. He gets his turn to work out at night. It’s all about juggling and balancing your schedule to fit exercise into your life.

Nurse Nutrition 101

I plan my meals ahead of time. Healthy eating is crucial to controlling weight and promoting cardiovascular health. Research has deemed the Mediterranean diet a winner for a healthy heart. With this diet, you consume a lot of vegetables, fruits, beans, whole grains, and olive oil, plus a weekly intake of fish as the primary protein—but very little red meat or other sources of saturated fat.
To follow both the Mediterranean diet and U.S. nutritional guidelines, try to eat fish high in omega-3 fatty acids, such as tuna, salmon, or mackerel, at least two or three times a week. As an added bonus to its heart-healthy benefits, fish may improve brain function and fight depression. (And in nursing, we all know the power of a clear head and a positive mood.)
Here are more nutrition tips:

• Always eat breakfast. To be on your feet all day taking care of patients, you need the proper fuel. I never miss breakfast. My regular breakfast is instant, high-fiber maple oatmeal with walnuts. If I go out for breakfast, I order an egg-white omelet with cheese and ham.
• Keep healthy snacks with you at all times. Unless you plan ahead, a busy shift can leave you reaching for the worst convenience foods. Mix a pouch of tuna with low-fat Greek yogurt topped with avocados (hold the mayo). Sprinkle this over your lunch salad or make a sandwich packed with super foods. Also, I never leave home without an apple, yogurt, an energy bar, and a package of almonds.
• Don’t set yourself up for a binge. Fight the urge for a peanut-butter cup. If my sweet tooth beckons, I give in—but just a little. If I really feel as if I need something sweet, a few Twizzlers or Swedish fish usually do the trick. (Editor’s note: If you work shifts, read “Nutrition for night-shift nurses” for more ideas on how to eat healthy.)

No need for extremes

You don’t have to go on an extreme fad diet or exercise 3 hours a day to become a model of health for your patients. Healthy living isn’t hard. Go online and bookmark webpages that offer tools on how to eat right and maintain a healthy lifestyle. If you incorporate small, enjoyable steps into your life, before long you’ll see a real difference in how well you work and play.
Click here for a list of selected references.

Beth Battaglino is the chief executive officer of Healthywomen.org, a nonprofit organization providing objective, in-depth, medically approved information on a broad range of women’s health issues. In addition to her BSN, she holds degrees in political science, business, and public administration from Marymount University (Virginia) and the University of Oklahoma. Ms. Battaglino currently serves as an educational consultant to the National Fisheries Institute, a nonprofit organization that offers a health-focused website with fish tips and recipes.

Compassion fatigue: Are you at risk?

Compassion fatigue: Are you at risk?

Publication Date: January 2016 Vol. 11 No. 1

Author: Kate Sheppard, PhD, RN, FNP, PMHNP-BC, FAANP

For many of us, nursing isn’t just what we do; it’s who we are. Most of us became nurses because we care about people and want to make a difference in their lives.
Over time, nurses develop a nursing intuition and a working knowledge of disease and trauma. Our intuition, knowledge, and caring don’t automatically shut off when we leave work. For example, have you ever seen a worrisome mole on a complete stranger? Have you felt concern about a friend’s weight or a neighbor’s smoking habits? Have you ever been in a public place when you heard someone coughing—and wondered at what point you might intervene? These experiences are common among nurses. Yet, inability to shut off our knowledge and caring may leave us feeling emotionally saturated and raise our risk for compassion fatigue.

Ideally, as nurses, we should feel satisfied with our work and derive satisfaction from providing excellent care. Compassion fatigue has been defined as loss of satisfaction that comes from doing one’s job well, or job-related distress that outweighs job satisfaction. Sometimes, merely being exposed to another’s traumatic experience leaves us feeling emotionally distraught. Called secondary traumatic stress, this is a part of compassion fatigue. As our sense of job satisfaction decreases, we may feel more burnout. A reaction to our work environment, burnout can stem from such conditions as short-staffing, long work hours, workplace incivility, and feeling dismissed or invalidated. (See Research on compassion fatigue.)

Who gets compassion fatigue?

Compassion fatigue can happen to any nurse—and it can be unpredictable. We know that nurses who work in oncology or see more patient deaths may be at greater risk. Also, when we form close, caring relationships with patients (especially if we lose our personal boundaries), we may be putting ourselves at higher risk.
Sometimes a particular patient or a patient’s family member may remind us of someone important in our lives. If that patient or family member has died, we may be triggered emotionally. Many nurses I interviewed in my research described being triggered unexpectedly and profoundly by a smell (caring for a child with second- and third-degree burns over 50% of his body), a sound (a mother screaming with grief when told her 3-year-old child had coded and died), or a sight (a dog on the hospital bed with his head across his master’s chest). Nurses who skip breaks, take extra shifts, or come in on their days off out of a sense of duty may be more at risk for compassion fatigue. One of the greatest risks for compassion fatigue comes when nurses forgo their own self-care.

What does compassion fatigue feel like?

In many cases, the first symptoms are emotional. Nurses talk about feeling bored with their work or feeling detached and distant from patients and colleagues. They may realize they’re irritable and short-tempered. They may feel they’ve failed to relieve a patient’s pain or to help a patient get well, losing their sense of pride in being a nurse.
Frequently, nurses with compassion fatigue talk about sleepless nights as they worry about what they forgot to do at work or replay disturbing events in their minds. They may be forgetful at work, in school, or at home. As compassion fatigue progresses, physical symptoms typically arise. Most nurses describe feeling physically and mentally exhausted, and many report headaches or backaches. Frequently, I hear nurses say they feel queasy just driving to work, and those feelings intensify as they walk in the door.
What happens to nurses who don’t deal with compassion fatigue symptoms? First, their work performance changes; for example, they may be at risk for medication errors. Without realizing why, they may start to call in sick more frequently. They may be short-tempered, sarcastic, or rude to colleagues and even to patients or families. They may appear tired and may become more easily startled.
Unfortunately, they may attempt to reduce their emotional saturation through alcohol or drug use. Ultimately, when emotional saturation becomes too intense, some nurses may view leaving the profession as the only means of escape.

Can you have compassion fatigue but still feel compassion?

Absolutely. In my studies, some nurses volunteered that they felt symptoms of compassion fatigue, yet stated, “But I also still feel compassion.” Clearly, a nurse can have symptoms of compassion fatigue while still feeling compassion. If anything, the more compassion a nurse feels, the greater the risk that she or he will experience emotional saturation or compassion fatigue.

Reducing compassion fatigue

What can you do to reduce or even prevent compassion fatigue? Start by being aware of how you feel physically and emotionally. If you realize, for example, that interactions with a specific colleague often feel uncomfortable or unpleasant, reflect on that a bit. Explore what’s beneath that feeling.
Perhaps you feel overlooked, ignored, invalidated, unfairly treated, or criticized—but instead of accepting those feelings and trying to make a change, you compound your feelings with guilt and shame. When you experience negative emotions, pay attention to how you feel physically. By bringing physical and emotional feelings to the surface, you can more efficiently address the underlying cause.

Establish healthy boundaries.

Establishing healthy boundaries is an important way to reduce the risk of compassion fatigue. Many of us face minor boundary issues frequently without really considering the consequences. Examples might include answering a question you feel uncomfortable with, sharing personal information you’d prefer to keep private, doing a favor for someone not because you want to but because you feel you have to, having someone hug or touch you in a way that makes you uncomfortable, and tolerating a rude or pushy person. By slowing your response and doing some self-reflection, you can address these issues with firm but courteous responses.

Make self-care and self-compassion priorities.

Perhaps the most important way to prevent or reduce compassion fatigue is to take care of yourself. As nurses, we work hard and really need our breaks. We need to eat, and to take time for ourselves without being interrupted by alarms, patients, or colleagues. We also need our time off, for our mental and physical well-being.
Before you were a nursing student and nurse, you probably had hobbies or activities you enjoyed. But later, between working long hours and trying to balance your personal and professional lives, those hobbies and activities were probably the first things you let go of. So try to bring them back into your life. Take the dog for a walk every day, listen to music, read a book for pleasure, go for a hike, call a friend—do something for yourself every day.
Self-compassion is important, but it may be hard to attain. Start noticing how you talk to yourself when frustrated, upset, or angry. Do you berate or criticize yourself? Try replacing that talk with kindness, just as you might talk to a loved one.

Practice self-reflection and mindfulness.

Parts of your job may make you feel frustrated because you feel powerless. As burnout and compassion fatigue build, your emotions may grow so strong that they become an overwhelming blur of anger, resentment, frustration, or helplessness.
Thoughtful and quiet self-reflection away from work may help you slowly separate events, interactions, and experiences. By examining each event or interaction, you can become more aware of your triggers (specific people, situations, or events) and address each one individually. Even if you can’t change your work environment, you can find power within by listening to your emotions with kindness and approaching colleagues and others from a wise and centered perspective.
Mindfulness is an important part of self-compassion. Although mindfulness has its roots in Buddhist meditation, it’s also a secular cognitive practice in the form of mindfulness-based stress reduction.
To practice mindfulness, take note of the present and pay attention with kindness and curiosity. You may notice physical or mental feelings of pain, fatigue, or pleasure. If you feel pain, ask yourself what your body or mind is trying to tell you—and address those concerns. By engaging in mindfulness, you can learn to identify which areas of your body react to your emotions. Mindfulness can reduce stress and anxiety and improve your physical and mental well-being. Through self-reflection and mindfulness, you allow yourself to consider events and triggers, learn from them, forgive yourself, and move forward.

Taking action

We can all reduce our risk of compassion fatigue and emotional saturation by reflecting on our triggers, practicing mindfulness, replacing self-criticism with kind self-talk, and engaging in daily self-care activities. Finally, if you’re suffering from sleeplessness, poor self-care, loss of interest, or other symptoms of distress, reach out for help from an employee assistance program or a mental health provider.

Kate Sheppard is a clinical associate professor and the psychiatric–mental health nurse practitioner specialty coordinator at the University of Arizona College of Nursing in Tucson.

Selected references
Hinderer KA, VonRueden KT, Friedmann E, et al. Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. J Trauma Nurs. 2014;21(4):160-9.
Maiden J, Georges JM, Connelly CD. Moral distress, compassion fatigue, and perceptions about medication errors in certified critical care nurses. Dimens Crit Care Nurs. 2011;30(6):339-45.
Neville K, Cole DA. The relationships among health promotion behaviors, compassion fatigue, burnout, and compassion satisfaction in nurses practicing in a community medical center. J Nurs Adm. 2013;43(6):348-54.
Sheppard K. Compassion fatigue among registered nurses: connecting theory and research. Appl Nurs Res. 2015;28(1):57-9.