It's You and the Gatekeeper and the Battle of Wit.
By Maureen Sharib
This is the first in a series of stories about people who work late or early hours.
The series is intended to showcase the lives of different people in different walks of life and delve into their motivations (or no motivations) for work.
I chose to highlight people who work early morning hours and/or late night hours because I believe there’s something interesting about people who are running the world while most of us are asleep.
"The early bird catcheth the worm." ~ John Ray, A Collection of English proverbs 1670, 1678
Chris RN/BSN Age 38 Hospital in the Deep South
Chris is in his third year of nursing. He spent his first year working in an acute care psychiatric facility and is presently in his second year working on a medical surgical step down (intermediate care) unit. He works the 7p.m. to 7a.m. shift, three days a week.
Before becoming a nurse Chris worked in healthcare from the age of 19. His first job was as a clerk for an electroencephalography (EEG) lab. He went on to become an intra-operative technician-performing outpatient monitoring, analyzing data collected over 24 hours on continuous monitoring, and monitoring surgical cases during cortical mapping.
He then married and relocated and there wasn’t a lab where he relocated that would allow him to do what he did. The opportunity presented itself to go to nursing school so he took it.
Chris finds nursing “an engrossing profession – one that offers continuous learning and one that is rewarding both personally and professionally.”
“Intermediate care” means that a patient who comes to the unit post-operatively or emergently at night is in (generally) a fragile state and requires frequent monitoring. They need frequent monitoring and medications and this takes a period of time for each patient. Every interaction with a patient must be charted so that a record is maintained. When you have three or four patients (a typical patient assignment number is four) it’s easy to see how an hour is spent.
Night shift responsibilities, overall, do not differ significantly from those on day shift. However, night shift has less available staffing scheduled to manage those responsibilities and, as such, the nurse is expected to take more direct responsibility.
In the case where something goes wrong (a second patient “goes bad” on top of another one already “gone bad” – industry lingo) Chris can call upon a Rapid Response Team consisting of an ICU nurse and a Respiratory Therapist who will come to the floor and take over the management of that second patient in its entirety. Chris will still be involved in the care of that second patient but these extra hands can make a world of difference in the outcome of the event.
In fact, if Chris were being recruited for another job one of the questions he would ask the recruiter was if the hospital had a Rapid Response Team. Chris would not work in a hospital that did not have one.
Working the day shift Chris feels requires much more interruption in a routine that he sees as vitally important. At 7a.m. doctors start “rounding” and setting out their orders. Once those orders “hit the chart” patients can be required to do anything and that generally means that the attendance of a nurse is required in the process.
Chris feels all this input/output detracts from a nurse’s ability to manage a patient assignment.
“Just the process of talking to a patient (or family) can be time consuming depending on the state of the patient or family. Some require less time than others and some require more. It can get chaotic really fast when you have more than one patient that requires special consideration.”
A day shift nurse has the help of a free-floating charge nurse and a unit secretary to help with the management of patients and unit responsibilities. Chris feels that at night he can be more involved with the total care his patient receives. Chris gladly trades the lack of extra help and the chaos of the day shift for the autonomy and increased responsibility of the night shift.
“There’s a guarded stance between the day shift and the night shift. They’re two opposing poles that have to be managed and managed differently. The personalities are different on each.”
Beyond the guard that exists, Chris added that reasonableness applies. If he can’t get something done in his twelve hours the next shift takes on the chore. The same applies to the day shift turning into the night. “It all evens out, pretty much; it’s a 24 hour a day job.” Chris said.
The timeframe also corresponds to his lifestyle. He does not have children and understands many people want to spend weekends with their children.
He gets paid more to work his schedule. He receives a flat rate plus $3.50 - $4 more for his nighttime service. He is part of a special program for people who will commit to working weekends (and nights) specifically.
In his geographic area (deep South) a typical day shift nurse in acute care makes $45-50,000 a year. The same nurse working nights makes $50,000-57,000. Chris feels if he has to spend his time working he may as well be remunerated at as high a pay rate as possible in a position that is also compatible with his lifestyle.
Chris said the stories you hear about nurses who make $80,000 a year with a BSN are mostly stories. If they are making this they’re working 1-2 extra days on 10-13 hour shifts.
He also said Nurse Jackie is a fallacy. “Nurses that divert medications for personal use are reprimanded and sanctioned by the licensing board. Nursing cannot be accurately portrayed on a sitcom due to the nature of the work.”
Chris added that most nurses (80-85%) feel they’re underpaid for the work they do. He said he doesn’t feel this way because of his committed schedule to nights and weekends. That stat is from a recent nursing magazine he told me when I asked. An interesting article seems to back this up.
Some people have the idea that people who work nights - sleep. I brought this up to Chris. He laughed. He said they run their tails off all night long.
“Working nights is like bookends. There’s activity at the start and activity in the end and in the middle there’s stuff management wants taken care of that the day shift doesn’t have the time to do or aren’t required to do. Audits generally happen at night. Nobody sleeps at night. It’s a terminable offense – you’ll be asked to leave on the spot - it doesn’t require justification.”
He also said something else that was interesting.
“In other professions when someone has a “good day” they’ve made someone else a ton of money. When I have a good day, somebody is healthier, better or maybe even just alive because I’ve been involved in their care.”
Chris has patients or family members approach him from time to time – people he doesn’t even remember caring for – and thank him for the care he gave them in the time they spent in the hospital. He finds that almost astonishing and is always grateful when it happens.
Besides the autonomy he gains with his patients Chris likes working nights and early mornings because it’s compatible with his lifestyle. His contract calls for him to work Fridays, Saturdays and Sundays from 7p.m. to 7:30a.m – three days a week with four days off. He will rotate into weekdays if the hospital needs it but he likes his schedule even though he is working when most people aren’t.
Chris will take a fourth day for the overtime when he can get it but says these days with Medicare’s reluctance to pay for services the hospital(s) are “cracking down on overtime.”
His contract calls for him to take no more than one weekend off a quarter.
He mentioned that older patients (those over 60, both female and male) prefer female nurses. Those younger don’t mind that he, as one of the less than 9% of all nurses who are male, is their male provider. Chris said that he feels most male nurses work in acute care where they can micromanage their patients’ care.
Some people ask him if he is going to become a doctor. He tells them there are separate motivations for becoming either a nurse or a doctor.
The burnout rate for nurses is 2- 4 years on units like his where patient acuity is high. Chris said that the nice thing countering this is that someone with an ASN (Associate, Nursing) or a BSN (Bachelors, Nursing) can generally do anything from working in a doctor’s office (at a slower pace) to working in Intensive Care or the Emergency Room units, which have a lot of activity.
“Nurses in long term care live in a different world (than floor nurses).”
He went on to say that some practice areas wouldn’t normally “float” to other areas. For instance, rehab and OB wouldn’t “float” to ICU or ER because not only are personalities different but the tools used and the specific care given is different. On the flip side:
“ICU and ER get a smattering of everything so they can pretty much go anywhere.”
“Intermediate or Cardiac care nurses can pretty much float to any unit except ICU or ER.”
He’s thinking about going for his Masters as that will open up a new range of opportunities for him that include both management and education.
When he was a kid he did not think he would become a nurse. “I discovered it’s in my nature to be a caregiver,” he said.
He went on to say that nursing draws caregiver personalities. “Time management and prioritization skills are critically important to successful nursing,” he added.
If a recruiter approached him to change jobs the most important thing for him today would be salary followed closely by relocation requirements.
“A recruiter not needing me to relocate will attract me to your company,” he said. “But, if you want me to move, offer me a relo package. A sign-up bonus would be good, too!”
Regarding salary - because the base rate pay is on the low side the differential is what really makes his pay so what the whole works out to – what he takes home – is what he’s interested in hearing about.
A better benefits package wouldn’t hurt either. Retirement and matching is what catches his attention and one would expect a nurse’s healthcare package to be better than they actually are.
“The healthcare packages are what they are. “
He said he’d continue with his own malpractice insurance – about $200 a year for a million dollars liability. “The hospital insures me but I maintain my own additional insurance.”
Scheduling is important to Chris. “I won’t work for someone who says I would have to shift to day from night and back again.”
I asked him how recruiters would find him. His first thought would be for them to go to the state licensing board. He said most boards are going to online posting, which is true.
”Anyone can look up a nurse’s (or doctor’s) license online and learn if there is any action against that nurse (or doctor).”
He went there as we talked. He told me that it gave his name, his degree level and then he said the degree level could be misleading because it’s not always up-to-date (his wasn’t.) It then told him what city he’s in.
“It doesn’t say what hospital/facility you’re associated with - does it?” I asked.
He said, “No, it doesn’t,” and sounded a bit puzzled by that.
“All of my customers want nurses who work in specific practice areas in specific hospitals,” I told him.
“That could be a problem,” he said.
“Not really,” I replied.
I didn’t elaborate and he didn’t ask.
But you know what I mean.*
*Phone sourcers like me will find you wherever you are.
If you have trouble staffing your offices or facilities with health care staff - call me.
I'll find them where they work so you might contact them with your opportunity!
513 899 9628
maureen at techtrak.com