Night shift vs. day shift and patient advocacy.

I've only worked nights, so I would appreciate perspective from day shift nurses, too, re: patient advocacy and how easy or difficult it might be depending on the shift you work.

I had a situation last night that upset me because I felt a bit helpless. I did manage to pass on my recommendations to the day shift nurse, and I only hope she's able to address it. However, based on her comments to me, I'm not sure if she can/will.

I work in a community hospital without residents, so we have to wake up docs for emergent issues, and we don't usually directly address plan of care issues with the docs.

Does anyone else on nights sometimes feel that their hands are tied and limited to meager recommendations that you just hope are carried out?

Do day shift nurses feel more able to effectively address issues and are generally more involved with the overall plan of care? Or, are you also so involved in just getting the orders filled, charting, addressing immediate needs, etc. that you can also feel impotent in really advocating for what you know your patients really need?
When I worked nights on an inpatient unit, we would start to see at least some of the day MDs beginning at about 5am. So there was an opportunity to communicate directly with them, about issues that were not emergent but nonetheless important.You can also communicate these kinds of things to the case manager, and s/he might address it with the MD at the appropriate time.So no, I can't say I've ever felt "helpless" regarding a patient's plan of care, except in cases where I felt strongly that unnecessarily aggressive intervention was being continued futilely -- and that was despite the best efforts of the MD in communicating with a patient's family.

I work nights & know what you mean. Only a few of our docs come in early before shift change but if they don't (we don't have residents either) I write them a note along with pass on my findings/recommendations to the dayshift nurse. Now, they don't always read the note or care but at least I know I'm passing it along. There's not much else I can do but leave notes or tell the dayshift nurse my findings/recs. If it's something of real importance that I feel the MD should address (& hasn't because dayshift couldn't do it or the docs didn't respond to my notes)...I'll call at the beginning of my shift when it isn't too late to call. I usually work 3 shifts in a row so I already know what's going on with my patients. If you come in the next night & find something still unresolved, try calling at the beginning of the shift. It's not too late to call the docs or ask your charge if there's another way to communicate with the docs besides calling them in the middle of the night or just passing along your findings to dayshift.

Quote from Soon2BNurse3If you come in the next night & find something still unresolved, try calling at the beginning of the shift.

I work in a teaching hospitals with in house coverage for most services and I still feel this way. Since we have residents I see most patient's doctors on the floor sometime before I leave usually and try to get things addressed that way. Alot of nurses on nights where i work do not take that initiative and pass stuff on to days and keep passing it on and on and on................

I work days. I always try to follow up on the night shift recommendation but sometimes other things are more important and I just run out of time. However, I find it extremely annoying when night shift takes absolutely no responsibility for getting things done because they "don't want to wake the dr", especially when its a hospitalist pt and we have 24 hr coverage.

Quote from LynnLRNI work days. I always try to follow up on the night shift recommendation but sometimes other things are more important and I just run out of time. However, I find it extremely annoying when night shift takes absolutely no responsibility for getting things done because they "don't want to wake the dr", especially when its a hospitalist pt and we have 24 hr coverage.

I can't stand it when I get report in the morning and a pt came in at 1000 pm and you didn't clarify the meds or pt's bp has been declining and you don't call the dr when the pt has a new onset of hypotention, negative lab work, proper assessment ex: pt cardiac labs don't look good so most likely the pt will have a stress test or something and not to critical think and say...."Hey after the MD's assessment they might order this, let me give pt a stress breakfast or npo so pt is not waiting all day or the next day for procedure or test.I could go on and on but you what I am saying. I find many night shift nurse and rude (not all)

I worked day shift for ~ 3 years before moving to nights, and this is one thing that I truly DISLIKE. I finally have time to actually READ the notes and understand a bigger picture and half the time I can't do a darn thing about it!I work in a teaching hospital so we have residents on call 24/7, but it isn't usually someone from the patient's primary team so they won't address anything but the urgent stuff - no bp, no urine output, etc. Oftentimes it's hard to get them to even replace electrolytes! If it's a resident that I feel like I have a good relationship with I'll ask them to pass stuff on in sign-out. I take advantage of the med students a little bit too. They always come around really early - 4:30 or 5:00 am - to do a chart review, write down vitals, and so forth. They are usually really good about passing stuff along to the rest of the team, because of course they don't want to be the student who missed something. When I was a day shifter I used to hate hearing "oh and the team needs to address this...and this..." in report but now I understand ...

Quote from simonemyheartI can't stand it when I get report in the morning and a pt came in at 1000 pm and you didn't clarify the meds or pt's bp has been declining and you don't call the dr when the pt has a new onset of hypotention, negative lab work, proper assessment ex: pt cardiac labs don't look good so most likely the pt will have a stress test or something and not to critical think and say...."Hey after the MD's assessment they might order this, let me give pt a stress breakfast or npo so pt is not waiting all day or the next day for procedure or test.I could go on and on but you what I am saying. I find many night shift nurse and rude (not all)