What really happens on the hospital night shift

Last month Muhammad from the RN Central blog sent me an interesting infographic about what really happens during a hospital night shift (see below). He also read my FAQ before contacting me which endeared him to my heart and put him ahead of 95% of the other requests I get.

But, reading the FAQ is not necessarily a way into my text editor. I thought the infographic was rather interesting and it made me think of two of my own experiences in the hospital which you can read about below the image.

What really happens on a hospital night shift

Night time staffers are fewer and less experienced

Oh, yes they are. When I was home from college for the weekend when I was two months shy of 18, I woke up in the middle of the night with a horrible pain on my right side. (Long-time readers of my blog and book will know where I’m headed with this.) My mother rushed me to the hospital where I was triaged…and then sent next door to the kiddie hospital because I was totally a child, not being 18 and all. There they triaged me again and an intern or resident examined me. (I don’t know the proper title, but she wasn’t a full doctor yet.)

My mother kept asking the not-doctor, “Could it be a gallbladder attack?” My mother and my father had both had their gallbladders removed and my pain seemed similar to what she’d experienced. I had lost 40 pounds that summer and rapid weight loss can trigger a gallbladder attack. But the not-doctor told us no, it wasn’t my gallbladder. It was probably just gas, take some Mylanta next time, blah, blah, blah. ONLY SHE WAS WRONG! It was my gallbladder, which I had to have removed several years later when I was on crappy insurance that stuck me with a $7000 bill. If she’d made the diagnosis when I was on my parents’ insurance, I would have a much nicer car. So, even when you give the night time staff a cheat sheet for your diagnosis, they can still fail big time.

Night and weekend shifts are filled with temporary or agency nursing staff, many of whom have less training and less familiarity with the hospital

And this is why I was born on Monday, October 27, 1980, boys and girls. There had been complications with my older brother’s birth, so I was to come into this world via a scheduled C-section. My older brother had been born on a Friday, so my mother had been stuck with the weekend nursing staff when she was recovering. She was not impressed. Her doctor originally suggested Friday, October 31 for my birth, but Mom was not going to let her daughter be born on a Friday or on Halloween. (Thanks, Mom!) When she was asked to pick a day, she chose the 27th because it was a Monday and she’d get the regular nursing staff.

Anyone else have bad experiences at the hospital at night? Of course, you’re in the hospital, so bad experiences probably aren’t hard to find.

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Jenn • August 11, 2011 at 8:22 am

Thankfully my middle of the night ER trip a few weeks back didn’t end badly. And they properly diagnosed a gallbladder attack! Unfortunately, I am already at the crappy insurance stage, and will have a 7-8k bill from last week’s surgery. Boo.

Scary statistics.

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Becca • August 11, 2011 at 9:16 am

Hey, exactly what is wrong with a Halloween birthday? I got cake, presents, AND bags of candy and my birthday parties were instant costume parties. Amusingly, my mom went into labor with me while in costume. I love my Oct. 31st bday.

Otherwise, I totally think your mom was quite wise to schedule for a Monday. I’m also now never going to be in a hospital at 6 pm.

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Debby • August 11, 2011 at 12:05 pm

Watch it – my sister was born on Halloween and she turned out okay. Oh wait….she’s a total witch! :-)

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PoppyK • August 11, 2011 at 2:20 pm

When I had my gallbladder out I had to stay in the hospital for three nights due to a pre-surgery procedure where they knocked me out to use some sort of search & capture device to see if I had any loose gall stones. Since it was so noisy in my wing of the hospital I asked my husband to bring me a pair of earplugs to wear for the next two nights. The night after I had my gallbladder out I was sleeping peacefully and the night intern came into my room to – I don’t know, stab me with a needle, see how much I’d peed, check my blood pressure, whatever – and I guess she must have softly called my name a few times and I didn’t respond because I was sleeping. She would up freaking out and shaking me awake because she thought I’d gone into a coma.

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kat • August 11, 2011 at 2:57 pm

I am in healthcare so of course I take this a bit personally, but an attack at 18 and then “several years later” does not mean that she should have taken it out because you had better insurance. If they had rushed in to take it out people would scream that they should have suggested behavioral changes before jumping into doing expensive surgery.

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Dup • August 11, 2011 at 3:37 pm

When my oldest son was 8, (he just turned 39), he had his tonsils out. They scheduled the surgery for afternoon, so he had to spend the night in the hospital. He wet the bed, and I pointed it out to the night nurse, but she never changed the sheets and he laid in that wet until they discharged him the next morning. I will never forget or forgive that.

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Sheila • August 11, 2011 at 5:31 pm

My in-laws have a talent for needing the ER on holidays and/or weekends. This results in them being seen by a “team” of professionals who never talk to each because there is no one person (their usual doc) to round them up and force some information sharing and consultation. Good for your mom for demanding a Monday birthday for you!

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Cathy • August 11, 2011 at 9:40 pm

This post made me laugh. My b-day is December 26th. My mom had a c-section and my Dad wanted me born before the end of the year so that he’d get an extra $150 tax credit so I was born on Monday morning 12/26. Thanks Dad! Really, it’s not that bad, it kind of makes me special and everyone feels sorry for me because I get gypped every year. :)

Oh, residents and interns are doctors. They have graduated from medical school so they are MD’s (or DO’s) and they are starting their specialty training. Interns are residents in their 1st year of specialty training. Fellows are residents in higher levels of training.

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Meg • August 12, 2011 at 5:14 am

As a nightshift nurse, I find this extremely offensive. I work on a critical care unit, with lots of residents I might add, and nights is when the best work gets done because there is less people around and less FAMILY to get in the way. And to be quite honest, most of our staff that work weekends are our most experienced staff, and they work weekends so they can take care of their families during the week. If I had to be in the hospital, I would choose nightshift on the weekend exactly to be there. Also, just because you have an attack of your gallbladder does not mean that you need it out. Maybe you should think about changing your lifestyle instead of blaming those around you.

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fd • August 12, 2011 at 5:32 am

of course this kind of thing is totally country specific and depends how shifts/training and so on are managed and arranged. where i live it is highly inadvisable to need emergency health care (or pretty much any health care in a hospital) in the first week of January or the first week of July, as this is both when senior staffers have holidays, and all the teams of newly qualified doctors or those starting in their specialisation training have to rotate. so its a bunch of strangers trying to deal with issues that are not necessarily their expertise or experience yet without optimum supervision. its stressful and scary and exhausting for the patients and professionals alike.

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Lauren • August 12, 2011 at 9:30 am

FYI- night shift doesn’t start until 7pm. Those 6pm deaths happen when most day shift staff is there (most work 7a-7p).

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JenFul • August 12, 2011 at 12:53 pm

@kat @Meg – Regardless of whether it would have been best to have my gallbladder removed when I was 18, it *would* have been best if the doctor had correctly diagnosed the problem so we could have made an informed decision. Instead I had several milder attacks over the years and one horrendous, 9-hour attack that was THE MOST PAINFUL experience of my life, all of which could have been avoided if a treatment plan of some sort had been recommended to me.

It’s also possible my gallbladder could have burst at some point, which would have led to serious complications or death if not properly diagnosed.

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Debbi Does Dinner Healthy • August 12, 2011 at 3:11 pm

Hilarious that as I clicked on this post to read, I also put in the show ER in my comuter to watch. I thought I’d read your post quick while the beginning credits came on. How appropriate!!

I totally agree. If you have to go to the hospital, don’t do it at night. I’ve only been in while having babies but there is a noticeable difference.

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amanda • August 15, 2011 at 3:23 am

@Dup – why did you let him stay in wet sheets? why not just change them yourself? seriously!!

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anRNtoo • August 15, 2011 at 3:36 am

@Meg – hmmm,…. maybe we work at the same place?? ;) i agree with all that you said.

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Steph • August 15, 2011 at 7:24 pm

I’m a long time fan and also a night shift ER nurse. This article is really critical and kind of hurtful. It’d be nice to remember that one experience does not make for a crappy doctor or nurse; they are people, just like you, and medicine is not a set in stone science–it is people who are willing to try to figure out what is wrong based on evidence that has worked in the past to diagnose a problem. There will always be wild cards. There is a really good chance that the nurses and doctors that worked with you that night had not eaten (or peed) for eight hours but were still working really hard to make sure that you received good care. For every mistake that is made, however big or little, there are thousands of perfect decisions or diagnoses that have been made to change a day or save a life. Please remember to extend a little grace on the people who are willing to do what no one else will do for people they don’t even know.

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JenFul • August 19, 2011 at 2:15 pm

I meant to respond to this sooner, but I wanted to pop in and apologize that this post offended some of my readers who are night-shift nurses. I didn’t think about the fact that some of you might be medial professionals who work at night. I know not everyone on the night shift is incompetent or bad at their jobs. I still stand by my dissatisfaction with my one nighttime visit to the hospital, but I also know that one doctor doesn’t represent everyone.

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Mary • August 25, 2011 at 11:03 am

This one RESONATED with me.

I was recently in the hospital overnight with a back injury. Long story short, I lay in the ER waiting for a bed while the nurse (who happened to know my husband through his work with the fire department) chatted with him…

I was given muscle relaxants to combat the (painful!) muscle spasms in my back, and then she mentioned giving me something “for the pain”.

Ok, so I was half out of it, but I stated very clearly that I don’t do well with narcotics.
The nurse replied brightly “Well you’ve got to have something… it’s ridiculous to be in this much pain.”
She proceeded to give me an IV narcotic called delotid (sp?) which a nursing friend told me later is “like morphine on steroids”.

By the time the doctor came in, I’d gone into shock and they had to fight to get my bloodpressure and oxygen levels back up.

Needless to say, I think that nurse will listen the next time a patient tells her that they should not have a particular medication. As for me, I’m just glad to have made it home to my kids… And you can bet I won’t be returning to the ER for anything any time soon. :-p

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Jack • August 25, 2012 at 4:06 am

Try wetting the bed at hospital then being given a sponge bath in front of 4 old people 1 child 5 middle aged guys and my mom with no privacy then have them all stare at you when you get out of bed and the next night there wasn’t enough staff so the eldest guy (kind but embarrassing) change you. Then the kid next door plays the warm water prank with the cup of tea she was supplied and the the others but 1 were in for the joke and wouldn’t tell me so I believed I wet my self again.

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Chocolate & Vicodin: My Quest for Relief from the Headache that Wouldn't Go Away Half-Assed: A Weight-Loss Memoir

Jennette Fulda tells stories to the Internet about her life as a smartass, writer, chronic headache sufferer, (former?) weight-loss inspiration, and overall nice person (who is silently judging you). She was formerly known as PastaQueen. You can contact her if you promise to be nice.

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