Nursing Blog with Expert Insights

Check out part 1 where I talk about the general good and bad of working night shift here . Talking about the patients at night is a whole new discussion. There are a handful of difficulties and patterns I've noted over the years, mostly just in the very sick/elderly patients. For example, if a patient passes away at night, it almost always seems to happen between 3 and 6am. I don't know if I'm the only person that thinks that or not, but most of the time in my experience, the

Hi again! I thought I'd write a post about the good and bad of night shift, since I see people ask on forums what it's like and all. I've been working nights exclusively since almost the start of my career six years ago, and there are distinct pros and cons to it. It's definitely not for everybody, and frankly it's not great for me considering my narcolepsy history, but I still love it and can't get myself to switch to days. There are several things I like about night shift.

They say love is blind. Grief is just an expression of love, and it can be just as blind. When people grieve, there are many ways it can...

Understanding Endocarditis and Its Challenges On a cardiac unit, I see all types of heart and vascular diseases. Many of them appear in the same "type" of patient. Peripheral vascular disease usually affects diabetics or smokers. Coronary artery disease often shows up in people who are a bit heavier than is healthy. And then there's endocarditis. This condition is often found in young people with a history of IV drug use. Endocarditis, an inflammation of heart tissue, is freq

This story is special to me because it was one of the times I had the opportunity to help family through a patient's passing. Most of the time, family isn't around at night. So if someone passes on my shift, pretty often the family isn't there. Sometimes at work we joke about how things tend to unravel or descend into chaos at shift change. Whether it's a rapid response, a code, multiple admissions, or suddenly every patient needs something, it seems like shift change is ofte

Wow, I've been out of work for 3 months now. I have suffered from narcolepsy for almost 10 years, but this year for some reason, my body decided to start having cataplexy episodes. It's been a long, long road, but this post is about describing my experience as a patient on my own unit. At the beginning of May, I arrived at work like normal for the first of 3 in-a-row night shifts. I got report on my patients and stood up to go meet them. After taking 3 steps away from the nur

This is actually a continuation of Larry's story from my previous post,"The night I was Shelley." I made it a separate post because if I included this part, I wouldn't be able to tag the first one as humorous. Unfortunately, his story ultimately has a sad ending that I struggled with for a little bit. I took care of Larry at least 5 times and grew quite fond of him. He was very kind and patient, very grandfatherly. I've lost all of my grandparents by now, so feeling the grand

Over the last 6 years, I had never had a "funny" rapid response until this one patient several weeks ago. Larry was a COPD (lung disease) patient presenting with acute respiratory failure, and he was definitely one of the kindest patients I've ever had. He was in the hospital for several weeks, so I ended up having him as my patient at least 5 times. He was fully alert and oriented and always remembered me, greeting me with a delighted smile when I'd reappear at his door. He

Okay, you got me. This one is more of a rant based on a couple short stories. For background, the hospital I work at used to accept doctor's notes for calling out sick. So, if I contracted COVID from one of my patients and was so severely ill that I ended up in the ER overnight, the ER doctor could write a note for work explaining why I was not at work. Seems logical, right? I mean, doesn't that just seem like the humane way to treat employees constantly exposed to illness?

As I mentioned in my "About" section of the Nurse's Refuge website, there was a particularly troubling code at work lately that took me almost a week to process. I remember feeling angry and sad about it, while also feeling ashamed about the fact it was troubling me days later. After all, I've been a nurse for over 5 years now. I've been in enough codes by now to be a little more used to it, right? And honestly, usually they don't hang around in my head for days. But this one

I have a lot of respect for doctors, both residents and attendings. I especially respect the ones who recognize the fact nurses can have valuable insights on their patients since we spend significant time face-to-face with the patients, implement their treatment plans, and do most of the hands-on stuff. We are very familiar with our patient's baseline, needs, preferences, history, etc. In my experience, most doctors recognize and utilize that, and even express appreciation di

Sometimes patients, both confused and oriented patients, think we do things just for the heck of it. Or for money, or for control, or for power, or even, according to some, it's straight up that we don't know what we're doing and we're idiots. Usually it's confused patients making these claims, but I see oriented patients making these claims too. However, this story was a confused patient. Believe it or not, we do tend to do medical interventions for a reason... In this case

Nursing isn't just about saving or improving lives. Sometimes it's also about helping patients die with dignity. So many times, I've seen patients decline to the point they are mentally gone and physically suffering, but their legal decision-makers can't accept death as an outcome. They refuse hospice and push for painful, risky interventions and surgeries. Don't get me wrong. I understand the pain of losing a loved one. I know it's hard to let someone you love go, and it of

Heart failure is a bitch to live with. You have to always be on top of your fluid intake, restrict how much you drink, carefully obey special diets, RELIGIOUSLY take your meds, monitor your vitals and electrolytes, keep your appointments, track your weight and output, and sometimes genetics STILL wins and you end up in the hospital anyways. Some people are really good at living with it. Others really just don't give a crap about keeping up with their treatment and end up repe

This is a sad one. It happened quite a while ago, maybe a couple years. I had a patient who had some kind of skin and tissue disease where large ulcers appeared all over and just grew in size and couldn't be stopped. Sort of like necrotizing fasciitis, but widespread in random spots. I don't remember what it was called. He was a bilateral amputee with an extremely poor prognosis. He'd been in the hospital for a long, long time trying different therapies and surgeries until al

I work on a unit that has a lot of so-called "frequent flyers". That is, patients that return multiple times because of relapses in their disease. Mostly, this is vascular and heart failure patients. I see quite a few patients who are current smokers that come in with peripheral vascular disease in unrelenting agony that end up getting their leg amputated, yet they refuse to stop smoking and end up returning later for the other leg. In the case of heart failure, patients slac

It was day shift, early in my career as a nurse, January 2020. I was still a code blue virgin, hadn't even witnessed one yet. I was on our sister unit across the hall talking to someone about my timecard. Suddenly, it happened. My work phone gave off that chilling code blue ring that alarms on the whole unit when someone presses the code blue button on the wall. I looked at my phone. "CODE BLUE, RM 357". Of course I was all the way across the hall... So I went off running. Mo

I have always referred to this event as "my big code", and I don't think I'll ever forget it. Several years ago, on night shift, I was charting at the nurse's station. It had been a quiet night. I have a habit of sometimes just staring at our telemetry monitors up front when I'm bored. I like to glance at each patient's heart rhythm and try to interpret it. I have caught abnormal things numerous times by doing this, and this night was no different. I glanced over at the monit

Have you ever seen Game of Thrones? There's this particular scene that I always used to think humorously and accurately represented the state of my hospital when COVID reached the US back in 2019/2020. It's this little clip of John Snow standing alone while epically drawing his sword at the Battle of the Bastards, bracing himself for the oncoming stampede of cavalry. In the gif, John Snow represents us, the medical staff at the hospital at the start of COVID, preparing our un