When facilities are overwhelmed, nurses step in to find a way to manage quality patient care while maintaining personal safety. But Coronavirus has stretched nursing staff thinner than we ever thought possible. This is no more apparent than it is with the night nurse, working an impossible shift with even thinner staffing and completely unpredictable night.
As coronavirus continues to change what a night nurse’s life looks like, it will be interesting to see how a night nurse’s life transforms going forward into post-coronavirus times. Some of the changes that are currently taking place around the country give a glimpse of what that might look like.
Scope of Practice Changing Rapidly for Nurses
It normally takes decades for major changes to happen in an industry. Sometimes people resist change or don’t see the need for it. But when something like Covid-19 happens, you see decades of long-awaited changes happening overnight.
Night nurses are finding themselves doing things within their daily practice that they never before thought would be part of their jobs, from the practice nurse to advanced nursing degrees.
Sideline Nurses Stepping into the Front Line
Nurses who provide the vast majority of care for Coronavirus patients are also in more danger. Yet many nurses who never would have considered working in the ER or critical have stepped up to help in these settings.
They are filling voids left by nurses who have gotten sick or unable to continue their duties due to retirement, pre-existing conditions, or other causes.
Many new night nurses have found themselves working very different and more unpredictable hours. And that’s definitely an adjustment. But they are stepping into the role.
At the same time, many clinical night nurses are stepping into roles that are more traditionally those of a nurse practitioner as the nurse practitioner takes on greater responsibilities that once legally required physician oversight. So this is an adjustment for everyone, including some physicians who have long been resistant to certain expansions of the nurse’s role.
Most people who go into nursing want to help people, and nurses throughout the healthcare industry are showing why nurses deserve the designation of hero.
Regulations Changing to Try to Keep Up
As nursing scope changes out of necessity, many states are struggling to keep up with the much-needed regulatory changes. These barriers continue to keep many nurses in lesser roles when they could be doing more.
Many nurses support expanded roles because they realize that being able to do more under your license isn’t the same as having more you have to do. Often, the opposite is true. As night nurses today waste a lot of time waiting for an available nurse practitioner or physician when they could have completed the task faster on their own.
Many night nurses have advanced practice degrees, higher education, and years of observational experience that gives them the know-how but often not the authority to perform certain tasks in their states.
And these are not out of the question. For example, 22 states and D.C. authorize nurse practitioners to work autonomously diagnosing and ordering tests. But over half of states tie the hands of NPs when it comes to taking care of patients.
When seconds matter, allowing NPs to take on this responsibility without jumping through hoops can save lives.
This can be seen at every level of nursing as LPN, RNs, BSNs, and more are all finding they can do more, but often regulation holds them back.
Some state governments are signing executive orders to expand the roles of nurses and emergency technicians. But there’s still a lot of confusion as these orders are new and different in each state.
Licensing Boards in Open Debate
Licensing meetings are not something most nurses will actually get to see in person. But there is currently debate among licensing boards about formally and nationally expanding the roles of nurses with various credentials.
Still, resistance continues. Many advocates of change within licensing bodies believe that some of their colleagues have outdated views of how medicine should be administered. But with something like the coronavirus pandemic, many are changing their minds.
Renewed Interest in Pursuing Higher Education
According to USNews.com, US News and World Reports data, nursing school applications have gone up during the pandemic. Covid-19 appears to have spurred the interest of many individuals who are drawn to nursing by their desire to help others.
But it has also increased the number of applications for higher-level nursing degrees BSN and up, as many nurses who are working on the front lines believe that pursuing education may give them greater options for expanding their roles and incomes during and after the pandemic.
Night Nurses Appreciate the Convenience of Online Learning
Even if you’re not thinking about going back to school, many night nurses are also taking advantage of 100% online certification courses they can complete to get the continuing education credits they need for their licenses and add-on certification to advance their careers.
For example, you can complete online courses that comply with relevant ILCOR and OSHA standards and are Joint Commission approved:
- Advanced Cardiac Life Support Certification and Renewal
- Pediatric Advanced Life Support Certification and Renewal
- Bloodborne Pathogens Certification and Renewal
Teachers Just Don’t Understand
Having the kids at home during the day has been a struggle for many parents. But for night nurses, there is an extra layer to the challenge. Kids are at home during the day trying to attend classes while they sleep. And that’s never been a good mix.
This often leads to constant interruptions by teachers who don’t realize that they’re calling at your equivalent of 2 o’clock in the morning. Or you may have young ones who can’t stay engaged in front of a computer without some supervision. These are painful struggles for the night nurse who is already sleep-deprived.
We can expect an expansion of remote learning in certain situations after the initial threat of Covid-19 has passed, but it will be interesting to see how the technologies and processes improve the distance education of children while still allowing those who work the night shift to get much-needed sleep.
Continually Adopting New Measures and Adapting
The health and well-being of patients continue to be a top priority in hospitals. But without healthy nurses that just isn’t possible. So nurses are facing day-to-day changes that make it hard to find a sense of routine at work as facilities strive to expand their capacities with protecting their staff.
This has leveled out somewhat since March/April 2020, when many night nurses say they were in improv mode with no clear guidance from their administration
A nurse in New York discussed the challenges of learning to use new technologies in a high-pressure situation. The introduction of virtual visits technology was welcome by most nurses. It reduced their exposure while allowing them to more regularly follow-up with patients.
Telehealth Is Suddenly Accepted…At Last
There has been a lot of opposition to telehealth even though the technology has been largely possible since the invention of the telephone. Obviously, it’s much better with video.
For a long time, many in the industry believed that diagnosing and managing care without in-person visits could be not only ineffective but also a legal lightning rod.
But during coronavirus, those in the industry are seeing a broadened use of telehealth from the EMT to the Interns to the Night Nurse.
Some Nurses See a Shift Toward a More Administrative Role
A Nurse Practitioner at Johns Hopkins says that the bulk visits and follow-ups in the Baltimore area are now done through telemedicine. It was tough at first to switch to a more “administrative role” as some of the nurses see it. But facilities are seeing increased productivity in addition to reducing the risk of contracting COVID-19 from or spreading to patients who just need annual visits for depression, dermatitis, and other non-Covid diagnosis.
Some Nurses Struggle to Keep Up with New Technology
You don’t have to look far to hear stories from nurses, especially those who are closer to retirement who didn’t use a lot of tablets, smartphones, and video conferencing for work or personal life before the pandemic. Many of them had gotten by most of their careers without technologies that most people now take for granted.
And they say Covid-19 was the catalyst that finally got them to learn and appreciate modern communications technology that they didn’t think they needed before.
Conflict Between Admin and What’s Happening on the Floor
Especially early on in the pandemic, night nurses were sharing that there was a bit of a disconnect between what the administration was telling them to do and what was actually happening in the ER and ICU.
As is common, it took a while for the administration to understand what was happening on the ground floor. But as the pandemic has advanced, greater coordination between the administration and front line staff is occurring. This is leading to enhanced safety protocols.
Incidence of Insomnia
According to a recent study reported in Global Health by Cleveland Clinic, nearly 35% of nurses (day and night) are struggling with sleep significant disturbances directly related to the pressures of caring for COVID patients.
When life gets stressful, losing sleep is common. But what happens when you spend a whole year struggling to protect yourself? What about picking up extra shifts because of increased rates of illness and general worry for your own health and life–not to mention your family, yes? Yes, you might lose more than a few Zzzz. And this has sadly become an epidemic of its own among night nurses during the pandemic.
Pure emotional and physical exhaustion but no time to sleep! That’s worrisome given the importance of sleep for critical thinking, mood stability, immune function, and more.
A night nurse at Novant Health says she works 12 hours shifts 3-4 days a week. And she’s taken to setting five alarms that go off in a row. That’s what it takes to wake her up these days. She then spends her day proning patients, staying alert for spiking fevers, and calling families-of of which have taken an even greater toll on her health and sleep.
While there is no easy solution for Covid-19 or shift work sleep deprivation, Cleveland Clinic has a few recommendations to manage the chaos:
Get 7-9 Hours When You Can
This will be a luxury many days. But on your off days, try to prioritize sleep. You may want to spend time with family or curl up on the sofa and binge-watch something on Netflix. But to whatever extent possible, try to shoot for getting regular sleep when you can during this time.
Be a Strategic Napper
Even 15-20 minutes can improve alertness and give you a little boost. When possible, take a little nap before commuting home to increase your awareness to have a safer commute. If you have 15-30 minutes before you need to get ready for the night shift, try taking a little nap. But set a gentle yet persistent alarm to wake you up and give you enough time to kick any grogginess before heading out the door.
Find a Place to Catch a Quick Nap at Work
Depending on the facility, you may have safe places to catch a little shut-eye. Try to take advantage of this when you can. If napping during the night shift makes you feel more tired, then have a shot of caffeine ready to take when you wake up. This can eliminate the feeling and help you get back to work faster. But you still get the benefit of getting a little sleep.
Recognition of the Night Nurse’s Role and Value
The nation’s nurses are keeping the healthcare infrastructure together. And COVID-19 has brought to like what night nurses are really made of. It has empowered all nurses to expand their roles and push the limits when they need to push in order to provide better care for their patients.
While many already understood the importance of nurses as “unsung heroes,” many more a beginning to realize just how vital nurses are to maintaining health and life. The pandemic has brought to light strength and potential to shine during a national emergency.
What’s it like to be a nurse during the coronavirus to you? Share with us.