MEDICAL NURSE - How working nights can work in your favor

How working nights can work in your favor

Issue Date: November 2011 Vol. 6 No. 11
Author: Colleen Claffey, MSN, RN-C, CEN, CPEN 

Shortly after I completed my master’s degree in nursing, I spoke with my nurse mentor about my career decisions. At the time, I was working as a night-shift emergency department educator. "Get off the night shift," she urged, "and into the real world."

Her response left me both troubled and intrigued. I had spent most of my nursing career working at night and hadn’t seen it as a limitation. Eventually, I did leave the night shift for the "real world." But I think night workers are misrepresented and undervalued. Many feel alienated and isolated from the rest of the staff.

Working the night shift can cause marked stress, with potential physiologic and psychological effects. Biological rhythm disruption, sleep disorders, health problems, diminished work performance, job dissatisfaction, and social isolation are common in nurses who work nights. Data show sleep deprivation raises the risk of patient errors, near misses, and personal injury. Sleep medicine researchers at Brigham and Women’s Hospital believe shift work causes increased problems in every body system. (SeeWorking nights: 

Challenges and consequences by clicking the PDF icon above.)

So why do many of us work nights? For some, personal or family reasons make it appealing. Others have no choice; the night shift is the only shift available. Of course, off-shift work is unavoidable for some nurses because patients need 24/7 care. And certainly, the night shift offers a financial incentive.

Five ways to optimize night-shift work

Here are five strategies for making the night shift work in your favor.

Make yourself more visible

Challenge yourself to stay visible and involved, even if it means staying later or coming in early. Routinely attend staff meetings or unit practice council meetings; voice your shift-work concerns and inform meeting attendees of your needs and unique obstacles as a night worker.

Years ago, I created and served as the champion for the first night-shift unit practice council for our organization. Our first project was to expand cafeteria hours for night staff. After much discussion with management and making multiple concessions, our effort led to improved quality and quantity of food selections in the vending machines, along with additional hot food and fresh fruit options. Although cafeteria hours weren’t expanded, we succeeded in casting night workers’ needs onto the administration’s radar. Presenting our plan to administrators sent a clear message that the night staff had specific needs that were going unmet.

Advocate for change

Lobby for changes in management strategies relevant to night workers. Rally fellow shift workers to support changes that would enhance work conditions. Build expanding relationships with leaders and encourage them to round on night shift to hear common concerns.

In one organization where I worked, top administrators and unit directors committed to a monthly “rap session” on the off-shift. This effort showed administration was invested in its employees and valued and appreciated them. The rap sessions proved productive, highlighting many night-specific concerns. For instance, administrators addressed workers’ security needs by improving security presence in parking lots at night.

Seek learning opportunities

Raise the professional bar. Take advantage of available learning opportunities, such as clinical or leadership classes. Communicate your learning goals to your manager and speak to him or her often about your career aims. Market your accomplishments and strive for professional elevation by earning professional certifications—an excellent way to showcase your competence and ambition.

Completing an advanced nursing degree program also can further your career. Most healthcare organizations offer some form of tuition reimbursement; take advantage of this. I completed my master’s degree while working nights, and found that free time during the day was ideal for doing my lengthy course work.

Find like-minded colleagues

Join a professional organization to further your career. Find colleagues who share the same challenges; besides giving you a sense of comfort and empowerment, this fosters discussion about best practices to address night-shift problems.

When I presented a poster at a national conference years ago about the use of a night educator, the interest was overwhelming. Several managers and night nurses were absolutely hungry for a chance to discuss the differences between night- and day-shift work. You can use this interest to identify and document the contrast between night and day work. Also, consider writing for publication or applying for grant money to explore your unique endeavors or interests.

Stick with it

Persevere. Be aware that altering preconceived notions of night nurses may be challenging. But remember that your perspective is important and may help shape future unit leadership practices or changes in clinical routines. Align with night-shift colleagues and share collaborative goals with leaders. Create and set a new professional standard for your team, and work to alter misconceptions about shift workers. Become the clinical benchmark for your organization.

As a young nurse on the night shift in the emergency department, I joined a group of night nurses who studied for and passed the Certified Emergency Nurse exam. Eight of us became certified at once—a first for the hospital, which was then trying to achieve Magnet^® status. This feat was pivotal for hospital leaders, who dubbed us "the night-shift dream team." It was a personal victory and a testament that shift workers can succeed.

Cast light on the real world of night work

Certainly, working nights or other off-shifts poses challenges and requires additional sacrifices, but the payoff is valuable. Whatever shift you work, leadership aptitude is evaluated the same way; personal integrity and motivation are crucial for advancement.

Career success shouldn’t depend on the shift you work. As a night worker, take steps to optimize your career growth. Go out of your way to share information and educate others about shift-work differences. Despite what my mentor thought, we all work in the "real world" no matter what our shift.

Selected references

Admi H, Tzischinsky O, Epstein R, et al. Shift work in nursing: is it really a risk factor for nurses’ health and patients’ safety? Nurs Econ. 2008;26(4):250-7.

American Academy of Sleep Medicine. Night shift nurses more likely to have poor sleep habits. June 11, 2007.http://www.aasmnet.org/articles.aspx?id=473. Accessed September 14, 2011.

Brooks I, Swailes S. Analysis of the relationship between nurse influences over flexible working and commitment to nursing. J Adv Nurs. 2002;38(2):117-26.

Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academies Press; 2004.

Schernhammer ES, Laden F, Speizer FE, et al. Night-shift work and risk of colorectal cancer in the nurses’ health study. J Natl Cancer Inst. 2003;95(11):825-8. doi:10.1093/jnci/95.11.825

Colleen Claffey is a nurse educator at Jackson North Medical Center in North Miami Beach, Florida.