Thoughts from the Night Shift

A few years ago, I was working at a large medical center and decided to go out on the floors in an effort to connect with the night shift. As part of the leadership team I know it’s important to get out and talk with the direct-care staff, and it’s especially important to visit with the often overlooked night shift. 

My alarm went off at an hour when most college students are just going to bed. It was a time of night I haven’t seen in decades and I couldn’t imagine how anyone could be awake, let alone work. I dragged myself into the shower hoping the steady stream of hot water would bring me back into consciousness. It worked. I got dressed, put my face on, and headed out into the dark.

When I got to the hospital, I discovered one of the few perks of working nights: plenty of parking. Plus, it’s really quiet. That’s something we never experience during the day.

While I was able to get through most of the hospital, I spent the majority of my time in two different med/surg units and the differences between them were startling. In the first one, the nurses seemed genuinely happy to see someone from administration. When I walked up to them, they smiled and were very eager to talk about what they liked about working there. They had some suggestions about what could be improved but overall they were very positive. As I was leaving, I thanked them for taking time out of their very busy shift to talk to me. “No problem,” they answered. “We like seeing you guys up here. Thanks for not forgetting the night nurses.”

I walked toward the elevator smiling. “Wow,” I thought. “This is great. This is going to be a really good night.”

The other unit was completely different. I approached the small group of nurses at the desk and introduced myself. “Hi, my name’s Kate. I’m the director of patient experience and I’m out tonight visiting the units to…” 

“Ambush us?” said the tall one.

“Oh my goodness, no,” I said. “Is that what you think?” She shrugged and said, “Well, we never see you guys here. Something must be up.”

I spent the next several minutes trying to reassure her and the others that this was something the leadership team was committed to doing: getting out on the floors and talking to the people who are caring for patients, both days and nights. They seemed unconvinced. 

After some gentle prodding, they opened up a bit about what it’s like to work nights. The thing they liked best, they said, was the teamwork. They don’t have the same resources as the day shift so they pull together and help each other out. And while they complain that they never see anyone from administration, they like that they never see anyone from administration.

They said they feel more free to just be nurses without having management looking over their shoulder every minute. 

That struck a nerve. Free to be nurses without management looking over their shoulder? Wow. What had we done to make them feel this way?

I asked them to tell me more about that and, essentially, it all boiled down to one thing: their manager acted more like a taskmaster than a supporter. The relationship was less about re-engaging great nurses to continue doing great work and more about pointing out all the things they were doing wrong. We do ask a lot of our direct-care staff, that’s true, and for good reason: we want patients to be safe and feel well cared for. But there’s a way to ensure that all of those required steps – like asking a patient’s name and birthdate before giving a medication or foaming in and out of patient rooms – are done without it coming across as punitive.  

Until we give our leaders the right training on how to get the job done while still serving as an ally, a resource, a champion for the staff, we will hear things like I heard: just let us be nurses.

Author: Kate Kalthoff

It's simple: leave people, places, and things better than I found them. For more than 20 years, Katherine Kalthoff has been working to improve the way healthcare organizations connect with the people they serve. She began her career at Gift of Hope, the organ procurement organization for Illinois, approaching families and securing their consent to donate a loved one’s organs for transplant. Through compassionate, empathetic listening, Kate led the Family Services team to one of the highest consent rates in the country. From there, Kate went to Advocate Health Care, Illinois’s largest healthcare system, as a Physician Relations and Business Development Manager, improving physician satisfaction and strengthening the relationships of both the employed and independent physicians with the system as a whole. Just prior to joining Northwest Community Healthcare as the Patient Experience Officer, Kate was the first Manager of Patient Experience at DuPage Medical Group where she built a platform of organization-wide service excellence through her inspiring brand of education, training, and one-on-one coaching. A much sought-after speaker and trainer, Kate has a very simple approach to her work: leave people, places and things better than you found them.

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