In Nursing, Some Things Never Change: Shift Report, 1985

Several days ago, we published “A Day in the Emergency Room for a Nurse Who Loves Her Job.” It gave an engaging, sometimes moving account of one nurse’s experience of a normal/stressful day in the ER. As it happens, colleague Theresa Stephany recently sent me the bare bones report we’re sharing today—an actual shift report from 1985. She received the copy many years ago from a friend who worked the night shift at a local hospital, and who had typed and sent it to her manager at the end of the shift. Stephany wrote to me that she “kept it all these years because it’s so horrible that it’s poignant.”

I’m sure that poor nurse was exhausted. Anyone have a shift story to tell, nightmare or otherwise?

SHIFT REPORT, 1985

TO: DIRECTOR OF NURSES
FROM: HEAD NURSE 2ND MAIN
SUBJECT: ACTIVITY RECORD, 11-7 SHIFT, 9/8/85                

Memorandum:

  1. 12 patients in restraints, 2 in leathers, acquired during the night.
  2. 3 Foley catheters pulled out
  3. 1 chest tube inserted with 1300 cc’s pus out
  4. 2 temperatures over 103°
  5. 3 Temperatures over 102°
  6. 7 Temperatures over 101°
  7. 3 patients having DT’s
  8. 3 Patients having chest pain
  9. 3 patients having respiratory distress
  10. Approximately 50 “now” or “stat” orders during the shift
  11. Several chest x-rays done (staff to deliver to x-ray and return)
  12. 2 beds had to be moved to make room for a sitter patient
  13. […]

Sleepless Nurses

“If I couldn’t even figure out what goes into my lunch box, how could I possibly have multitasked . . . on a busy unit?”

Awake for 40 hours.

Photo by Jeff Greenberg. The ImageWorks.

I recently had the disorienting experience of being awake for 40 hours. This had to do with a family member’s interminable emergency department visit, a 3 a.m. car breakdown, and a post-ED MRI and medical visit.

I’ve never been up for 40 hours in my life. I didn’t pull “all-nighters” in school before exams, and never worked longer than a double eighthour shift. Partying the night away wasn’t in my DNA. So this experience was strange and new, and something I pondered over for days afterward.

An ‘otherworldly’ state.

By the time I’d been up for 24 hours straight, I was operating at a level about two beats behind everyone around me. Physically, I felt a little off-balance, as though I might fall if I didn’t step carefully. My brain seemed mired in muck, and I found myself trying to recall what I knew about depleting bodily stores of ATP. Preparing to return to work around hour 26, I stared into my lunch box. I couldn’t remember what food I was […]

2018-05-21T08:29:35-04:00May 21st, 2018|Nursing|4 Comments

AJN in May: Night-Shift Naps, Intrathecal Cancer Pain Relief, Teaching Nurses to Write, More

On this month’s cover is A Maid Asleep (1656–57) by the Dutch master Johannes Vermeer. We chose this painting to call attention to the issue of sleepiness in nurses who work the night shift, which is explored in this month’s Original Research article.

On-the-job sleepiness among nurses can increase the risk of patient care errors, job-related injuries, and long-term health problems.

For night-shift nurses, one potential solution is being allowed to take brief naps during a shift, which the American Nurses Association recommends as an evidence-based countermeasure to fatigue. But nurses may face barriers to doing so, including a lack of formal breaks on the unit and concerns about impeding the quality of nursing care. To learn about a project that explored those barriers and attempted to implement night-shift naps, read “Napping on the Night Shift: A Two-Hospital Implementation Project.”

Some other articles of note in the May issue:

CE Feature: Intrathecal Pumps for Managing Cancer Pain.” Among patients with cancer, moderate to severe pain is prevalent and can be refractory even with the use of systemic opioids, which may cause adverse effects that are difficult to manage at the doses required to control pain. When delivered intrathecally, however, opioids and adjuvant analgesics may provide greater pain relief at dramatically lower doses and with fewer adverse effects. This article provides an overview of intrathecal pump therapy, including its benefits and potential risks and complications; the medications that can be delivered intrathecally; and the nursing care […]

Evening Shift, Christmas Eve: A Nursing Memory

By Shawn Kennedy, MA, RN, AJN editor-in-chief

One of my fondest memories of working Christmas Eve was after an evening shift at Bellevue Hospital in New York City. This was at the “old Bellevue Hospital,” when it still occupied a series of red brick buildings along the East River.

I had finished my evening shift in the ER, which was one of the busiest in the nation. It had been a crazy–busy night and I was too wired to just go home and sleep, so I decided to stop in the chapel for midnight mass. I was surprised to see my friend Helen there, since she was Jewish. I knew Helen always volunteered to work over the Christmas holiday so those who celebrated could be with their families, but I didn’t know that after work she’d go to the chapel to listen to the Christmas music, which apparently she loved.

We sat together, enjoying the quiet, calm pace of the service and the music. Helen knew all the words and sang along; she had a beautiful voice. Staff, visitors, and some patients (wearing the classic blue-and-white-striped Bellevue bathrobes—like draw sheets, these were hard to come by) shuffled in and out during the hour, clinicians sometimes leaving hurriedly after being summoned by a beeper.

Illustration for "A Change of Heart," AJN, December, 2014, by Lisa Dietrich for AJN. Illustration for “A Change of Heart,” AJN, December, 2014, by Lisa Dietrich

On the way out […]

A Lasting Gift for a Nurse’s Holiday Shifts and Lost Family Time

Illustration by Lisa Dietrich for AJN. Illustration by Lisa Dietrich for AJN.

As we know, gifts come in many forms, and often are as valuable to the giver as to the receiver. The best ones come at times when we least expect them. Readers will find that the start of AJN‘s December Reflections essay, “A Change of Heart,” describes a frustration that may be familiar to many nurses. In this case, it’s Christmas Day, and a nurse is kept by the urgent demands of her job from spending time with family. She writes:

I’ve been a nurse for more than half of my life . . . I love my career and consider myself blessed to have found my calling. But we all experience times when our long hours and the rigorous demands of this job make us feel that we sacrifice too much of our personal and family time to care for strangers.

The author had planned to be home for Christmas dinner. But, she tells us, “we had four back-to-back emergency CABGs starting at 8 am and stretching long past my scheduled 3 pm end of shift.” The essay develops from there as the hours pass. And then we meet a patient with everything at stake. The author is not the only one in danger of missing Christmas with family, and not just this year but for all the years to come.

We are reminded again and again that nursing has […]

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