To The Night Nursing Staff

To The Night Nursing Staff,

I definitely would struggle with your job. I can barely walk around with sufficient light without falling over things because I’m so clumsy, let alone managing it with dim lighting. Nursing at night is clearly an art-form in itself. I’m pretty sure lots of you will know or appreciate what I’m explaining here already, but I was on a ward with some new nurses and Healthcare Assistants last week (I know because they told me so), and their Nurse in Charge had to remind them of a few things which make a big difference to patients’ care at night.

It can be really hard to sleep in hospital at night. It’s a strange and lonely place. You’re surrounded by lots of people but you feel really insignificant and small. For me, it’s because the routine of meals, snacks, drinks and obs slows down and I suddenly have hours of ‘quiet’ ahead of me and my brain wakes up and thinks a lot. Lots of the elderly get distressed at nighttime and call out, but if they’re not on your bay you have no idea if they’re about to take their last breath or they’re just sundowning and it’s normal for them. So my brain kicks into overdrive and thinks a lot about why I’m in hospital, if any of it’s my fault, panic about what the doctor might say in the morning, frustration because I’ve had a setback and fear because I’m worried about what I’m going to be like when I’m elderly, if I survive that long. On every admission I’ve had, I’ve been on a ward/bay with someone who has either died while I’ve been there, who is in the process of dying and receiving palliative care or someone who tells me they want to die because they’ve had enough. As practical as I am about being in hospitals, nighttime is when I lie and think about my future and my complex medical problems, which is a depressing prospect before I’ve hit my 30th birthday. I try really hard not to, because I know it doesn’t help, but a lot of the time my internal chemistry is out of whack because of my adrenal insufficiency, which is why I’m there in the first place, and it’s really hard.

So it’s already hard to sleep. I usually have an IV in, sometimes 2 if I’m lucky, and they’re usually in my arms because they’re hard to get into my hands. And they hurt if I pull on them, or they don’t work properly if I lie on them or bend my arms, which adds to difficulty sleeping. They usually need changing at some point in the nighttime, and obs will also happen at some point, which means you have to wake me up so you can do your job. The drugs I’m given and the nature of my condition at that point make me need the toilet regularly so I have to get up a lot (and take my IVs with me). All which make sleeping pretty stressful.

Then there’s the noises and activities of the ward. Call buttons ringing, beeping from monitored beds or pumps to signal something is wrong, sounds of people being ill or in pain, the cardiac arrest alarm going off all can’t be avoided. I’ve worked out what the different sounds are now, but it can be quite scary if we’re not familiar with them. You obviously know what they all mean, but we don’t necessarily, particularly if you can hear them coming from other bays- it adds to the already morbid commentary in our heads. The cardiac arrest one is particularly frightening, especially if it’s a ward where all the lights come on as well when it sounds. The best night nurse I had was one who purposefully came to check on me after a cardiac arrest because she recognised that I was the youngest patient, that I’d probably find it quite scary and I’d also probably be with it enough mentally to work out what was happening. She reassured me the patient was ok, which made a lot of difference even if it was only a small thing. Another nurse came to see me once and said that it would likely be a noisy night because there were lots of distressed elderly patients, so if I wanted to chat I could push my buzzer and she’d pop down. That meant a lot as well.

On emergency wards, I completely appreciate why nighttimes are still noisy and full of bustle. People come and go all the time, patients get admitted or moved to other wards, and it’s necessary for tasks to happen at specific times. But on other wards where things slow down at night, there are a few things which help us as patients to get a better night sleep, some which the Nurse in Charge highlighted last week:

  • Quiet footsteps. Footsteps are necessary, but stomping around the ward can be avoided. When I was a teacher, I purposefully didn’t wear heels on days I knew I had to invigilate exams, opting for soft soled shoes, so that I didn’t disturb the students’ thoughts with my clopping.
  • Not banging cupboards and doors. Speed is important but it doesn’t take much longer to close a cupboard rather than kicking it closed (excluding emergencies obviously).
  • Silencing unnecessary alarms. I’m not remotely qualified to say which alarms are necessary and which aren’t, but I do know that last week the Nurse in Charge had to keep reminding nurses to turn off unnecessary ones.
  • Wake us up before doing obs. One nurse was great and just said our names softly at the end of the bed before touching us, which allowed us 5 seconds of wake up time. Another nurse didn’t and just picked up my arm, which if you’re asleep can make you feel like you’re under attack even when you’re not! Then it takes a while to go back to sleep again because you’ve got adrenaline crashing about.
  • Avoiding turning all the lights on. To start off with, one nurse was turning all the ward lights on every time a patient needed anything, which obviously woke us all up. Every ward I’ve been on has had a patient light which could be used.
  • Not ignoring the elderly. The thing I hate the most about hospital at night is that there’s always an elderly patient who is shouting. They can’t help it, they’re scared and have no idea where they are. The problem is, there’s nothing ‘wrong’ with them necessarily, they’re just making a noise, so some nursing staff ignore them because they have other things to do. But it makes it difficult for other patients to sleep, so while there might not be anything that can be done for that patient, taking time to calm them down and reassure them actually helps the rest of us.
  • Talking quietly. I don’t actually mind nurses talking to patients, those conversations are necessary, I find it really frustrating when I can clearly hear nurses at the station talking about their weekends and social lives. Those conversations could be quieter!
  • Telling us what’s happening. I know ward routine now, but things are still slightly different in the mornings depending on what ward and hospital. I know roughly when breakfast is, what time we’ll get woken up, when meds rounds are and when ward round is, but it can be sometimes done really abruptly, which can make you feel really unsettled after a bad night’s sleep. Last week we were woken up at 6.30am by a healthcare turning on all the lights and bellowing at us ‘WHO ISN’T ABLE TO GET TO THE TOILET THEMSELVES?’ and then when we didn’t answer quickly enough ‘SO I ASSUME YOU CAN ALL GO TO THE TOILET THEN?’, which was wrong because I was the only mobile one on the bay. She then came back later and literally stuck her hand in a patient’s face and said ‘I’m not doing that’ (talk to the hand style) when she said she needed help washing. If she’d have come in and explained it was time to wake up and wash then it wouldn’t have taken her much longer, but we would have felt less like a herd of cattle being pushed from one activity to the next. The other thing to bear in mind, is that you know there’s been a change of shift and who’s responsible for what on the day staff, but we don’t unless you introduce yourselves to us.

Lots of night nursing staff have been great. I really like the ones who give off a calm aura even when all hell is breaking lose elsewhere, because they really get that it helps settle us down so we can sleep. It’s great to know that you can have a quick chat about your worries or concerns, even if you don’t take them up on it. And it reduces the stress of being in hospital if you know your nurses will do all they can to try to help you get a good night’s sleep.

A good night nurse is worth their weight in gold. I always feel reassured and a lot calmer if I know I have a good night nurse with me and my bay-mates overnight. Thank you to those who get that night nursing is an art, it really makes such a difference!

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