Earlier this month, when one of our night-shift pharmacists took a long-overdue vacation, I found myself staffing from 9 PM to 7 AM on Monday and Tuesday night.
This isn’t the first time I’ve covered nights, so I went in with the knowledge that yes, it’s tough to pick up one or two shifts and then try to acclimate back to days. I think I slept for a grand total of nine hours out of 48 – brutal, but pretty good for me, actually.
When the mid-morning sun hit my window after that second night on duty (and I knew that any chance of extra sleep was lost for good), I resigned my zombie-like self to holding down the couch. Since my body refused to allow me to sleep, I took the opportunity to stream random YouTube videos all afternoon. Before I knew it, I was engrossed in a highly-entertaining theatre arts piece – one that had singers, dancers, and aerial performers telling a story of the fictional(?) off-screen antics of Hollywood actor Shia LaBeouf. I think I streamed that particular video about nine times.
But I digress.
My point is, despite the inevitable lack of sleep, I survived. In fact, I have always found working nights to be a rewarding experience – and you will, too.
If you’re a pharmacist or a technician who traditionally works days or evenings, here is what I have to say to you about night shift in the pharmacy:
Work the shift. Pharmacist or technician, rookie or seasoned employee, staff or clinical – regardless of your position or level of experience, you don’t get a good appreciation for what happens on off shifts unless you’ve been there. Likewise, if you’re a manager, you can’t effectively manage if you don’t know what’s happening on all shifts. So when the opportunity presents itself, take it. Volunteer, even! You won’t even know it’s the middle of the night while you’re there – the bright fluorescent lights and a steady stream of coffee will make you feel right at home. And the knowledge you stand to gain by working the shift far outweighs any temporary disturbances in sleep.
Provide excellent handoff communication. As a night shift pharmacist, there’s nothing worse than discovering that you need to call a physician to clarify an order at 2 AM when it could have been done at 9 PM. Likewise, it is very tough for a night shift tech to batch time-consuming compounds when there is no other tech to cover for the time spent in the IV room. Make sure you have a mechanism in place to provide the best possible handoff communication for smooth transitions between all shifts.
Inform and educate. As a manager, I’ll admit: this one is easier said than done. It’s easy to slip into a mode of “management by email” for your night shift staff, but I’ve learned the hard way that email alone is a sorely inadequate substitute for in-person sharing of information. This is an area for which I have made a personal goal to improve.
It’s hard for night shift staff to stay up-to-date when all of the department meetings take place on days. Make sure your night shift employees have ample opportunity to participate in live competencies, staff meetings, and huddles. Take thorough minutes and distribute them to all staff in a timely fashion. Consider arranging schedules so that there is enough shift overlap for either morning or evening huddles (or both!) for information sharing. If you can’t train in person, utilize train-the-trainer models and designate trusted day- or evening-shift staff members to pass information to nights. Schedule standing appointments with night shift staff to touch base in person, and stick to them.
Don’t underestimate night shift responsibilities. Sure, volumes of orders and patient care activity may be reduced on nights, but traumas and critical patients demand attention often, even in the smallest of hospitals. While many practice models situate clinical chart reviews and time-consuming medication distribution tasks (i.e., cart fill) on nights, also realize that – in many instances – your pharmacists and technicians on nights have a far greater patient load than your other shifts. In most cases, there are only one or two pharmacists and techs covering every patient in the hospital, and that’s a big responsibility.
I am also always impressed by how heavily relied-upon our night shift pharmacists are by other health care professionals; while all of our pharmacists are highly integrated into the patient care model, it almost feels more so on nights. Many times, the night-shift pharmacist gets involved in a far greater scope than they would on days, when more resources are available to all disciplines. For example, when I was working nights, the nurse operations manager brought a patient’s family member to the pharmacy to mitigate a complaint; that would likely not have happened on days. And in my institution, we even have night-shift hospitalists who elect to hold informal, seated patient rounds in the pharmacy with our pharmacist as he works in order verification and distribution. Pretty cool stuff.
Appreciate your night shift staff members. This one is self-explanatory, but it demands your attention, regardless of the position that you hold. It takes very special people to be dedicated to working nights. Be thankful for them, and for all that they do for your patients and for your organization.