Night shift work in care homes is very different to being on duty in the day. The main difference is, of course, the emphasis on sleep and comfort. Active therapies, talking and noise are discouraged and lighting is dimmed. It changes the atmosphere of the nursing home. The shift generally consists of a burst of activity, getting people into bed and settled, continence rounds, and eventually, helping up the early risers. Inbetween there are periods of time when very little happens, something rare during daytime nursing work.
Nights: The graveyard of ambition?
Some people like to work nights, others feel they have less choice. Night work is often about fitting in personal commitments. Night shift work may be the only time someone can put in enough hours to earn enough to live on. Nights can be more attractive to staff, especially female staff, so they can fit in their child care arrangements more easily around their work. When my daughter was little my partner and I often only saw each other for two or three hours in 24! Night work can also feel detached. The politics, banter, and even the opportunities for study and promotion can feel far away.
Problems differ from days. Staffing levels are often low and support services minimal. If a resident is ill, for example, nurses will be know that medical emergencies will not be dealt with as efficiently as they would be during the day.
There are universal problems of night work that can and do affect patient care. One of the most common is inadequate communication. The handover period from night to day staff, and vice versa, is hampered by the time allocated.If written information, care plans, medical notes or updates are patchy or overlooked this can adversly affect patient care.
In research called Supporting Older People in Care homes at Night evidence is provided relating to a series of problems for the organisation and management of night-time staff. Recruitment difﬁculties are common and result in minimum stafﬁng levels and high levels of agency and bank staff. The common use of agency or bank staff means the core night staff are burdened. Replacement staff usually have to have high levels of instruction and support throughout the night.
Working nights is not especially good for health. There has been lots of research into the long and short term effects of night work. Fatigue and problems of poor concentration are common even when nursing and support staff sleep well in the day. Night shift health workers are at greater risk of work-related injury than their day shift colleagues. Irregular working hours make it more difﬁcult to maintain regular eating and exercise regimes, which contribute to gastric and cardiac problems. Poor appetite and loss or gain in weight are well documented.
Depression and low mood in night staff is a significant problem. Increased levels of relationship difﬁculties and divorces have been reported and social life suffers.