Looking to start your nursing career but unsure if night shift is right for you? Continue reading for an hourly nursing guide to night shift to help you decide!
1800 aka 6pm
It’s an hour before your shift begins. You’re probably parking in the parking structure and walking into work at this time. Getting in a bit early helps you be a better nurse by looking over your patients charts and getting your brain ready for the shift.
Visit Organizational Brain Template for New Nurses and Start of Shift Plan for New Nurses for organizational help.
1900 aka 7pm
You clock in and your shift officially starts. You get handoff report from the outgoing nurses on your patients and you update their whiteboards. Check over your patients IV, rate, and fluid during change of shift report to make sure it’s in line with what’s ordered. If anything needs to be urgently addressed, like pain, you start doing what you can now.
For more information on how to treat a patient in pain, visit Nursing Fundamentals: A Guide to Pain and Patient Education: How to Effectively Manage Acute and Chronic Pain.
2000 aka 8pm
You take your first round of vital signs and begin your head-to-toe assessments. If your patient is in pain and it hasn’t been addressed, then now’s the time to do so. Maybe the patient isn’t due for any medications at this time, see if you can offer them a heat or ice pack or if repositioning might help. If they are in too much pain, you can postpone your full assessment until they are properly medicated. If there aren’t any pain medications ordered, and you’re expecting to need some on your shift, then page the doctor now before it gets too late.
Make sure to check all lines and drains coming from your patient, if they’re patent, and what type of fluid it is going in or coming out. Also take note of how often you’re emptying the drain and how much fluid you’re emptying. What color is it? Is there a smell? Is it the expected color and amount? You’re going to need to chart all this later so take notes along the way and encourage your CNA’s (Certified Nursing Assistant) to do the same as well.
Also visit How to do a Quick yet Effective Head-to-Toe Assessment and Tips for New Nurses on Calling the Doctor for more.
2100 aka 9pm
Complete your assessments and start your medication pass. Come up with a plan for each patient and communicate the plan with them. Work systematically with each patient and cluster care as much as you can. For example, if you have medications due for your patient at 2000 and again at 2100, then go in and give all their medications at 2030. Usually, medications are good to give anywhere 60 minutes before and 60 minutes after its due time, but check your hospital policy first. If you have a diabetic patient, you may need to do the before bed blood sugar/accu-chek. Check patient orders and your hospital policy.
Be sure to visit Nursing Fundamentals: An Intro to Pharmacology, A Guide to Diabetes, A Guide to Treating and Managing Type 1 Diabetes, Type 2 Diabetes and the 10 Rights of Medication Administration for more information.
Pro Tip: When giving medications, make sure the nurse ahead of you gave the medication at the scheduled time. If for whatever reason they gave it off schedule, then you are going to have to adjust your medication due time to match the doctors’ orders. You don’t want to be giving medications too close together, you want to give them as directed by the physician.
2200 aka 10pm
Now that you’ve completed your head-to-toe assessments and done your first mediation pass, you can move onto the less pressing matters. Did a patient ask you for a warm blanket? Do they need new ear plugs to go to sleep? Make sure all your patients are set to go to sleep if they’re able to. The hospital isn’t the most comforting place to sleep in but making sure they’re as comfortable as possible will help for an easier night for both the patient and you.
2300 aka 11pm
Go back into the chart and make sure all the patient orders are being met. Do they have nightly bladder scans that you didn’t see before? Are there any new orders put in from the doctor? Did the doctor respond to your request for pain medications? Is your patient NPO at midnight?
Pro Tip: If your patient is NPO, aka nothing by mouth, at midnight, remind your patient BEFORE it’s midnight! Put a sign on their door so no one accidentally brings them something to eat or drink. And remind the patient before they go to sleep, or around 11 if they’re still up, that now is their last chance to have something to eat or drink before their procedure tomorrow. They’ll be able to have that last cup of water and a little snack, and they’ll thank you for it!
2400 / 0000 aka 12am
Continue to round on each of your patients every hour throughout the night. If your patient has vital signs every 4 hours, now is your time to take them again.
0100 aka 1am
Now is usually going to be your first chance to take a seat and begin charting. So use this time wisely.
Visit Charting Tips for New Nurses for more info.
0200 aka 2am
This is usually the time I like to take my 30-minute lunch break. Round on each of your patients before your break and again the second you come back on. Before leaving for your break, give the breaker a quick rundown on why your patients are here and if they’re going to need anything, like more pain medications, while you’re on your break.
0300 aka 3am
You’re tired. It’s night. You just ate, and it’s all hitting you. Drink some cold water and keep moving to help you stay awake.
Also be sure to visit Adjusting to Night Shift for more tips.
0400 aka 4am
Those q4 (every 4) hour vitals need to be taken again. See if your CNA (Certified Nursing Assistant) is able to take them and if not, take them yourself. Chart accordingly.
Visit Nursing Fundamentals: A Guide to Delegation and the Nursing Process for more information on task delegation.
0500 aka 5am
Finish up your charting. Make sure there are not any new orders from those early rounding doctors. If you have any labs to draw from your patients, now is the time to do so. If your patients are prepping for surgery in the morning, them make sure their surgery checklist is complete and ready to go for day shift.
0600 aka 6am
By now your patients are going to start waking up and needing things again. Be proactive and offer what you think they might need. Remind them when breakfast is and ask if you can get anything for them in the meantime. Make sure your charting is complete and get ready to give day shift report by planning your ISBAR; Identify, Situation, Background, Assessment, and Recommendation. If you have diabetic patients, you may need to do morning blood sugar checks, check orders and your hospital policy. You’ve almost made it!
0700 aka 7am
Day shift is coming on and it’s time for report! Go into each patients’ room to give day shift report and introduce your patients to their day shift nurse. If you’re working again the next night you can let the patient know that you’ll likely be assigned to them again if they’re still there.
All Night
All throughout night shift you need to be rounding on your patients at least every hour. Answer the call lights in a timely manner. Communicate with your patients and your CNA’s on the plan of care. Make sure if your patient is a total care, that they are being turned appropriately and the turns are being charted accurately. And don’t forget to be educating your patients with every new treatment or medication!
Visit How to Spot a Stroke and Save a Life for more patient education!
And You’re Done!
Some nights you’re going to be crazy busy and won’t be able to do your charting throughout the shift, so make sure you use your time wisely. But for the most part, this is how a chill night on night shift goes with the addition of things like dressing changes, insulin administration, round-the-clock pain medications, and new admissions at any time. Make sure you’re looking over all those doctor’s orders, implementing them, and communicating with your patient and your staff and you’ll be in good shape.
Be sure to visit I’m a Night Shift Nurse, What Should I Do with My Days Off? and What to Expect in the First Year as a New Grad Nurse for more info. And if you find yourself getting nervous before your shift, visit How to Overcome Pre-Shift Anxiety for Nurses.
Unsure of what nursing specialty you’re wanting to go into? Check out the Specialty Nursing Series:
- What Makes a Good Med Surg Nurse?
- What Makes a Good ICU Nurse?
- What Makes a Good Peds Nurse?
- What Makes a Good ED Nurse?
- What Makes a Good OR Nurse?
- What Makes a Good NICU Nurse?
- What Makes a Good Labor and Delivery Nurse?
- What Makes a Good Psych Nurse?
- What Makes a Good PICU Nurse?
- What Makes a Good Onc Nurse?
- What Makes a Good School Nurse?
- What Makes a Good Home Health Nurse?
- Plus be sure to head over to their matching Specialty Nurse Interview!