Nurse's Notes From The Nightshift

Holistic Nursing Care and Existential Epiphanies at 0300

Written by Bryan Christopher Warne RN, BSN

As nurses we wear many hats. Especially at night, when many of our co-workers and counterparts have gone home. On nightshift, most of the surgeons, the therapists- both physical and occupational, many of the chaplains, and most of the midlevels and physicians have left. Nursing supervisors, social workers and the majority of administrative and support staff go home overnight, leaving floor nurses to take on a variety of roles at night.

In the midnight hour, there are still many colleagues in the hospital, because healthcare never really sleeps…but as a nurse on the floor, you become the backbone of your facility after hours. You are one of the very closest contacts when it comes to patient care and represent a multifaceted conduit to their health. At this point, you become holistically responsible for your patients- assessing each and every need, and providing for many of them yourself.

You are there, in the absence of all these other specialties, as a representative for each of them. First and foremost, you are known as a nurse, but there may be other roles within the spectrum of patient care that you find yourself able to readily identify with. Pay attention to these other aspects of yourself, for when you are without your support staff, you will be filling these roles for your patients.

Finding and developing your multiple strengths in this vast field of healthcare can, and will, bring better outcomes for your patients. Oddly enough, these improved outcomes may affect more than just your patients!

Applying the principles of holism not only affects your patients, but can have unexpected effects on your own health as well.

While night shift nurses are pushed to assume multiple responsibilities, including that of unit secretary, distribution tech, housekeeper and of course, social worker—there is also a hidden benefit to patients that you may have already started to learn about on overnights. Night shift can be sparse and scary at first, but there are times when actually get to provide your patients with something they may not normally get from nurses during the day.


As a result of working nights, I have found an area of patient care that I'd urge you to explore more, if you find yourself exploring it only minimally at present. What I have come to find as an integral portion of care in nearly every single patient I come across is this…taking the time to get to know them.

Allow for yourself to take the time to sit, if even for a moment-- whether figuratively or literally—just sit with your patients.

Be still and present and talk with them. Take the time to talk, not only about the medications you are going to give them, or about the procedure they have in the morning, but about how their day was. Take the time to talk, and then take the time to listen.

If they'd rather not talk about their day, then find out what makes them tick. What excites them about life? What brings them joy? These are great open ended questions that can provide a wide array of responses. You are there for their health…their whole health. Remember that holistic health piece you learned about in nursing school? This is where it begins.

By allowing your patients to describe themselves, talk about their families, their occupations, and their own multifaceted roles in life, you will learn more about how to help them achieve their own self determined health goals. By really listening to their concerns, you can design your nursing interventions and interactions in a way that reflects the enhanced self image they are ready for, and improves the efficacy of care.

And the thing is, when you sit down, take the time and get to know your patients - if you haven't yet stumbled onto who you really are - you probably will.

Even if you feel you have known yourself for a long while, you may re-find yourself, explore new versions of yourself, and find new horizons for your self, through learning about others.

Through genuine, open conversation-- often in the dark hours of the nightshift-- you'll likely find that while we are all different in many regards: be it culture, age, race, gender, beliefs, or aspirations; deep down, there is a thread that connects us all. There is a thread of commonality that binds us.

When you are on your way to getting to know your patients, you are also on your way to getting to know YOU.

Take your time, when there is time—or choose to make the time, each day, to allow your patients the opportunity to open up. Allowing them to open up can not only improve their health outcomes, but can lead you to understand more about that which drives us all, that which connects us all, and binds us all together.

Take the time, to share in this human experience, together.

And remember, nurses can and do change lives, in big and in small ways...every day. And every night.