ABSTRACT; Working the night shift can be perceived by some veterinary nurses as a chore to be endured. In this article, I aim to highlight some of the benefits of this work and take a light-hearted look at the personal attributes needed for night nursing. To be a good night nurse, I believe you need three skills: the ability to stay calm, to cope with sleep deprivation and, most importantly from my experience, good ears!
For optimum levels of continuous patient care, night nursing is essential and many – if not all – veterinary nurses will (and indeed should) complete a period of night work at some point in their career. Within human adult-centred medicine, the Nursing and Midwifery Council insist that student nurses complete some form of night work during their training. It is a mandatory part of the course.
Stay calm and carry on
Night nursing and emergency work rest hand-in-hand. You don’t see many routine vaccinations at 3am and the thrill of night nursing is that you never know what you are going to open the door to or hear at the other end of the phone.
This is where the ability to stay calm is of paramount importance, as you may have to deal simultaneously with the phone call from an owner who is sure that his cat is dying, the bleeping transfusion pump, the terrier who is determined to pull his drip out, the vet who needs help with a savage parrot and someone at the front door with an unconscious animal in their arms, tears streaming down their face. The ability to prioritise – and not throw everything up in the air and run – is essential!
Occasionally, this skill is advantageous from more than a professional perspective. One evening, while staying with some vet friends in Tasmania who were living above a small animal practice, we realised that there was a ‘scene’ erupting below. The senior partner of the practice wanted to start a Caesarean, but his on-call night nurse could not be located. We offered our help.
Three vets and one nurse in this situation meant there were three people willing and able to perform the surgery, and one who could operate the anaesthetic machine and remember that we also needed a surgical kit, a tilted table, pain relief, fluids and a comfy warm kennel prepared. Eleven healthy puppies later, there was also only one person who was able to clear up the mess without dripping blood all along the floor between the surgery and the laundry, via reception!
As we waited for the owner, conversation turned to my quandary since I had arrived in Tasmania. Where was 1 going to live while 1 explored the island? The practice partner immediately offered me the use of another flat above the practice, rent-free, for the six-week duration of my stay, in return for my help that evening. I had never been so grateful for a 1 am Caesarean in my life!
Sleep is significant
The reality of night nursing can be tough – working the night shift demands that you must be alert and active when in reality your body wants you to sleep. It also requires the ability to sleep during the day when your body wants to be awake. Not being able to catch up on sleep during the day can have serious effects.
Research suggests that sleep deprivation can reduce the ability to perform psychomotor tasks. This level of reduction is equivalent to that of a person who has a blood alcohol level concentration of 0.10%, which is above the legal limit maximum in the UK for driving.11 have just completed some night shifts at an NHS Trust Hospital, as part of my human adult nurse training, and fighting the urge to sleep while looking after a bay of eight patients, all tucked up, warm and cosy in bed, was tough.
Before my night shift at the hospital, I was given plenty of friendly advice, both for my health and well-being, and for the well-being of my patients. I was reminded to wear quiet shoes so that I would not disturb sleeping patients, bring a pen torch so I could avoid putting lights on if I needed to perform observations and asked to turn the ward phone down so the shrill ring did not wake anyone.
This advice also caused me to reflect on my veterinary night shifts. It is well known that sleep aids recuperation and healing, but 1 wonder if we give priority to sleep for our animal patients? Surely the data supporting sleep and rest for recovery after illness could be extrapolated and applied to animals?
How often do we try to arrange medications to avoid waking the patients? How often do we try to ensure that lights are turned off during the night to help our patients sleep, rather than just to save electricity? How much importance is placed on the need for sleep and its link to a good recovery when teaching student veterinary nurses?
Can you hear that?
The final attribute necessary for a successful night shift is excellent listening skills. Often I have been asked by owners to ‘listen’ as the phone is held up to the patient so that 1 can listen to its symptoms.
My first encounter with this aural consultation technique was with a rat with breathing difficulties. The main problem with this – apart from the obvious – was that I could barely hear the rat’s respirations over the owner’s breathing which was so wheezy and rasping. I very nearly told him to get to a hospital, dropping his rat off with us on the way!
Another telephone listening exercise that sticks in my mind was on a bull terrier with a gurgling stomach. The earnest request to ‘Listen’ was issued, in fact whispered, and I obliged, listening hard and then asking, ‘Why are we whispering?’ The owner’s reply conjured up such a cartoon in my mind, I have never forgotten it. ‘I don’t want to wake him,’ she said.
I attempted to clarify the matter; and, as suspected, the dog was fast asleep, snoring gently while his possibly over-zealous owner held the telephone receiver to his stomach so I could hear the grumbling sound which was causing the client such distress.
When the phone rings on a night shift, you really never know what you are going to receive and your ward rounds with hospitalised patients are often interrupted by the sick and not-so-sick patients.
‘My cat hasn’t eaten for six months’ turned into a cat that had been missing for six months. It hadn’t crossed the owners mind that ‘Pumpkin’ had probably managed to find an alternative source of food while on her six-month sabbatical. Anecdotally, I often find that owners’ descriptions can’t always be trusted, either. Therefore, ‘My dog’s leg has fallen off’ turned out to be a small scratch on the stifle; whereas, ‘The dog has cut his leg a bit’ was a Jack Russell post-RTA, who barely had a leg remaining!
Pinnacle of professionalism
I consider night nursing to be one of the most rewarding clinical roles for veterinary nurses. It teaches you to think about your patient holistically, as you are often responsible for all aspects of the care plan. With a vet on call, it teaches you to gather data and evidence on your patient’s condition before you wake an exhausted colleague.
I have always been extremely fortunate and worked with supportive and knowledgeable veterinary surgeons. In this role – more than any – I believe that a professional, collaborative vet/nurse relationship is of primary importance.
The other significant benefit of night work – as well as the knowledge and experience gained from it – is that delicious indulgent feeling of crawling under the duvet with an old black-and-white movie, knowing that you have earned the right to nap during the day!
Author
Helen Ballantyne BSc RVN
Helen qualified as a VN in 2005 whilst working at Mill House Veterinary Hospital, Kings Lynn. She has worked with giant pandas in China; with wildlife, in practice and at the University of Melbourne in Australia; and with an animal charity in India.
Back home Helen is a locum veterinary nurse and has just started the Postgraduate Diploma in Adult Nursing at Sheffield Hallam University. She is currently a BVNA Council Member and the BVNA Congress Scientific Programme Co-ordinator.
To cite this article use either
DOI: 10.1111/j.2045-0648.2012.00186.x or Veterinary Nursing Journal Vol 27 pp 237-238
References
1. WILLIAMSON. A M. and FEYER. A. M. [2000] Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication Occupational and Environmental Medicine. 57[10] 649-655.
Further reading
PEATE. I.[2007] Strategies for coping with shift work. Nursing Standard. 22|4| 42-45.
• VOL 27 • June 2012 • Veterinary Nursing Journal