Working Nights

[RachelBu]

I've just interviewed for a critical care PA job that is willing to train and take on a new grad.  However the position is for the night shift, 6pm-6:30am.  During the interview they said in a perfect work the shifts would be 3on and 4off 3on.  It doesn't always work out that was, but I'd never be working more than 4 nights in a row.  

 

The whole job sounds like a good fit overall, except I don't know what to think about working nights.  Could anyone shed some light on what it's like to work nights, i.e. how is your non-work life affected?  I'd really appreciate any feedback!

 

 

Thank you!

[gbrothers98]

I worked a heavy rotation of nights quite a bit from 2001 to 2012 as an EM PA.

Now I work mostly days due to many of the folks I work with wanting nights more so than days for various reasons.

First, you should get a differential for night shift work. It should be a 20-25% premium in excess of your usual rate or salary.

2nd, you need to discuss this in depth with your significant other or family. You will be off schedule from the majority of society. On the other hand, you can get the grocery shopping done very quickly during the week, late at night.

3rd, this will eventually wear on you and make you older. I was good for about a decade, into my late 40s. Some last longer but it can be a drain physically. Lack of proper sleep and mucking with the circadian rhythm can also make one very cranky at times.

On the other hand, lots of autonomy at night, very little administrative contact and night shift folks are usually a fun, very competent but peculiar breed.

I am glad I have this experience, also glad it is behind me, I truly believe it is a young person's game.

Good luck.

George Brothers PA-C

[winterallsummer]

Night shift can be fun and those working it tend to be more down to earth. However major changes and studies are done during the day whereas you are taking care of emergencies and otherwise mostly managing (eg not changing abx, vent protocol, ordering routine studies, etc). As a CNA I worked some nights and it can be a nice experience however id never want a full time night job. It makes having a normal life difficult and is taxing on the body even if you maintain a true "nights" life eg same sleep schedule on weekend.

[EMEDPA]

I do mostly nights and essentially keep the same schedule on days off. much better than 3 days/3swings/3 nights/off 3 which was the alternative.

[ventana]

done nights two separate times in my life

 

1- in the air force,  Sunday through Thursday nights - arrive at 11, off at 7 - -   overall not bad - missed some stuff, but got on a nice schedule and it was tolerable (and I was attending school 9-12 credits per semester) - did for the better part of 3 years

 

2- ER - no freekin schedule, would work 2 nights then a few days then a few swings, and it was horrible - would not recommend anything like this - made it about 3 months before I said this is INSANE and nobody should be required to do this.....

 

so on the schedule side of things - night can be 'okay' but never great....

 

 

the bigger question  --- nights get you the procedures in CC, but their is no one around to train you..... sort of a double edged sword.....  careful with this...

[Dunedain]

I work nights (Sometimes 3 12s in a row, a day off, then it starts again with 3-4 days off).

 

From my observation the nocturnists or night providers manage emergent issues, admit patients from the ED or handle nurse requests for meds/basic orders.

 

Night shift is alright to be honest. For me I get a decent pay differential as an RN but my sleep schedule is jacked and usually one of my days off is a sleep day....

[RachelBu]

Thanks for your response! I haven't been given the job offer, however they did move me onto the next round of consideration after my interview. I will definitely take a look into the differential for night shift.  I'm in my early 20s and as of right now I don't have a significant other/family commitments, which is why a 2 year contract that would be required for this job doesn't seem to scare me off too much.  

I worked a heavy rotation of nights quite a bit from 2001 to 2012 as an EM PA.

Now I work mostly days due to many of the folks I work with wanting nights more so than days for various reasons.

First, you should get a differential for night shift work. It should be a 20-25% premium in excess of your usual rate or salary.

2nd, you need to discuss this in depth with your significant other or family. You will be off schedule from the majority of society. On the other hand, you can get the grocery shopping done very quickly during the week, late at night.

3rd, this will eventually wear on you and make you older. I was good for about a decade, into my late 40s. Some last longer but it can be a drain physically. Lack of proper sleep and mucking with the circadian rhythm can also make one very cranky at times.

On the other hand, lots of autonomy at night, very little administrative contact and night shift folks are usually a fun, very competent but peculiar breed.

I am glad I have this experience, also glad it is behind me, I truly believe it is a young person's game.

Good luck.

George Brothers PA-C

[KMD16]

Nocturnist/ Critical care Hosp PA: Keeping everyone alive until day shift providers comes to the rescue, literally speaking. Are you joining a busy service? If you're, then, make sure they agree to train you for at least 6mo & plan on starting you slowly. This position could be stressful and frustrating for a new grad or inexperience hospitalist PA given that these patients are usually very sick with multiple comorbidity & polypharmacy. Furthermore, i would like to point out that there are usually not a lot of teaching at night (e.g. Ground round, meeting etc). Yes. In some setting. You will admit from ED & inpatient transfer from hospital services to another service. And, answering nonstop pager from nursing staff about a patient on your service whom you haven't even met. In your shoe, I will pursue other interest/position. A two years job contract, to me is a red flag. Good luck.

[EMEDPA]

On the other hand, lots of autonomy at night, very little administrative contact and night shift folks are usually a fun, very competent but peculiar breed.

this is the #1 reason I do solo nights: call all the shots, do all the procedures, and never see an administrator.

[Febrifuge]

Yeah, not to scare you, but as a new grad it's important to look out for disconnects between what they say they'll do in the interviewing/ courting phase and what they actually do once they have you. I don't think it would be at all out of line to ask for specifics about how the teaching, training, and mentoring are going to work if you're doing nights right off the bat.

 

I had a horror-story experience with my first job after school, with a hospitalist group. It worked out great in the end but it was stressful and makes for a nice cautionary tale.

[PACdan]

I worked only nights as a inpatient tech, we were 7P-7:30A. All I can say is that 3 on in a row is rough. By the third night you're drained and at 50% of baseline.

Think of it this way, between travel time to and from a 12.5 shift, eating, showering, and getting to sleep; you basically get 7-8 hours sleep, get up and go back. I hated 3 in a row. Much preferred 2 on, 1 off, 1 on, 3 off. Breaking it up (for me) was much better.


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[Dunedain]

I worked only nights as a inpatient tech, we were 7P-7:30A. All I can say is that 3 on in a row is rough. By the third night you're drained and at 50% of baseline.

 

Think of it this way, between travel time to and from a 12.5 shift, eating, showering, and getting to sleep; you basically get 7-8 hours sleep, get up and go back. I hated 3 in a row. Much preferred 2 on, 1 off, 1 on, 3 off. Breaking it up (for me) was much better.

 

 

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Too bad my managers don't see it that way :/ I have 3 on 1 off 3 on coming up....

[PACdan]

Too bad my managers don't see it that way :/ I have 3 on 1 off 3 on coming up....

On shoot! That's terrible. Luckily as a full time, night shift employee I got to make my own schedule. But that's also why sometimes there were any number of techs; between 0-2, depending on if they had coverage or if you were floated to a floor with a hot mess.

 

 

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[GetMeOuttaThisMess]

This explains why a local group is having trouble filling an overnight hospitalist position. Seven consecutive days of 7pm to 7am, followed by seven days off.

[LT_Oneal_PAC]

7 on 7 off and nights? My dream job. That isn't sarcasm either in case it isn't conveyed in text. I would love it.

[KMD16]

Working strictly night as an EM PA vs working as a critical care/inpatient PA virtually incomparable. Yes. In either setting, if one is experience, that's a plus & very doable.

[KMD16]

This explains why a local group is having trouble filling an overnight hospitalist position. Seven consecutive days of 7pm to 7am, followed by seven days off.

Absolutely! Not a lot of folks want to do strictly night as a critical care/hospitalist PA. And, there is a reason why. I worked strictly nights as a hospitalist PA few years ago and regret my decision.

[coloradopa]

I've just interviewed for a critical care PA job that is willing to train and take on a new grad.  However the position is for the night shift, 6pm-6:30am.  During the interview they said in a perfect work the shifts would be 3on and 4off 3on.  It doesn't always work out that was, but I'd never be working more than 4 nights in a row.  

 

The whole job sounds like a good fit overall, except I don't know what to think about working nights.  Could anyone shed some light on what it's like to work nights, i.e. how is your non-work life affected?  I'd really appreciate any feedback!

 

 

Thank you!

Most of our new grads start on nights then move on days when positions come available. We train for at least six months and usually nine months prior to being on by yourself. We have a very busy twenty bed surgical transplant ICU. The schedule is worked out by the night shift and it revolves but there is one six day stretch followed by eight days off. We have two people on at night plus the resident sleeping (available if TSHTF). The night crew gets a tremendous amount of autonomy and are integral to keeping things going. As the ICU moves to a 24/7 model they are going to be crucial. One of the things we experiment with is SBT and extubating at night so we can get them out in the afternoon the next day (if it isn't horrendously busy). The downsides are the isolation (most meetings and things happen on days) and the wear of nights on the body. Some people are natural nocturnists but most people only can do it for a while. Our night crew is between 2 and 4 years on the job. They are a very tight group and take care of each other.

 

One thing I would make sure of is the expectations. 3 on 4 off is what we do on days but who fills the hole? Generally you need at least four people on at night so that you are only working every fourth weekend. Otherwise its every other weekend which is a tremendous disatisfier.  One of the local groups works 7 on 7 off but people rarely last a year. Part of it is they don't give PTO. You have to take your time off during your week off and have to trade for other things. I expect them to be perennially hiring new grads. Our differential for nights is $30k. Puts a new grad over $100k to start.

 

I think this is a great job for a new grad, as long as they have a plan for time off (another reason for four people minimum), good training (six month minimum) and good back up (medical director that supports you and staff willing to come in if things get bad).

 

[GetMeOuttaThisMess]

7 on 7 off and nights? My dream job. That isn't sarcasm either in case it isn't conveyed in text. I would love it.

Probably not in the position that I was referencing.  Pay is easier to obtain in other settings as well ($100K with apparent RVU bonus of unknown amount).  This is not a major hospital/teaching institution with resident staff but is a hospital that serves a suburban (bedroom) community that also handles area trauma that doesn't need to go the extra 25 miles or so where the REALLY big boys (and girls) play.  ED group is the same as the hospitalist group.  I bet that can make for some interesting employee discussions ("Hey jackwagon!  Be a wall in the ED and quit admitting everybody that walks through the door!").

[RachelBu]

Probably not in the position that I was referencing.  Pay is easier to obtain in other settings as well ($100K with apparent RVU bonus of unknown amount).  This is not a major hospital/teaching institution with resident staff but is a hospital that serves a suburban (bedroom) community that also handles area trauma that doesn't need to go the extra 25 miles or so where the REALLY big boys (and girls) play.  ED group is the same as the hospitalist group.  I bet that can make for some interesting employee discussions ("Hey jackwagon!  Be a wall in the ED and quit admitting everybody that walks through the door!")

Thanks for the insight.  I asked a lot about their training program and got speak with PAs who were working after my interview.  She came on as a new grad 3 years prior and was pleased with her training.  She even said that if I needed more time that the 6 months the organize they will extend it, which they had to do for a prior new grad.  But I will make sure to ask for more specifics if need be.

[myironlung]

socially, nights are tough. The first day off you have to decide what you want to do...stay up the whole day , nap for a little, or sleep immediately for a normal sleeping period (7-9 hours). I tried them all and didn't like any (although the 3-4 hour nap seemed to be the best of those options). Then the day you go back into work you have to decide once again what your sleep approach will be to pull out that night shift sufficiently. Over time its draining, some people last longer than others. I lasted about a year and a half. Only thing I liked was that the daily errands were made simple since there's no crowds, and you can schedule things easier like doctors appt's, plumber, etc..You'll feel kinda isolated as well since most of your friends and family will be at work. Not bad for a first job though, you get experience and hopefully can make some bank for those loans. You're young so you can make it work at least for a little, nothing is permanent.

[EMEDPA]

my night shifts have the potential for sleep, so that is a bit easier sometimes. I have a call room. the shift is 7p-7a and usually I can cat nap a bit between 3-7 am, although it is possible to work straight through. I stay up late on my days off and nap whenever the need arises on those days.

[RachelBu]

Most of our new grads start on nights then move on days when positions come available. We train for at least six months and usually nine months prior to being on by yourself. We have a very busy twenty bed surgical transplant ICU. The schedule is worked out by the night shift and it revolves but there is one six day stretch followed by eight days off. We have two people on at night plus the resident sleeping (available if TSHTF). The night crew gets a tremendous amount of autonomy and are integral to keeping things going. As the ICU moves to a 24/7 model they are going to be crucial. One of the things we experiment with is SBT and extubating at night so we can get them out in the afternoon the next day (if it isn't horrendously busy). The downsides are the isolation (most meetings and things happen on days) and the wear of nights on the body. Some people are natural nocturnists but most people only can do it for a while. Our night crew is between 2 and 4 years on the job. They are a very tight group and take care of each other.

 

One thing I would make sure of is the expectations. 3 on 4 off is what we do on days but who fills the hole? Generally you need at least four people on at night so that you are only working every fourth weekend. Otherwise its every other weekend which is a tremendous disatisfier.  One of the local groups works 7 on 7 off but people rarely last a year. Part of it is they don't give PTO. You have to take your time off during your week off and have to trade for other things. I expect them to be perennially hiring new grads. Our differential for nights is $30k. Puts a new grad over $100k to start.

 

I think this is a great job for a new grad, as long as they have a plan for time off (another reason for four people minimum), good training (six month minimum) and good back up (medical director that supports you and staff willing to come in if things get bad).

 

I had a chance to look at the schedule of the night shift during my interview, there were approximately 6 PAs on the night shift, one of whom was still in training.  On night shift they typically have 2-3 PAs working, it's can be a busy service. The training is 6 months, they broke down the whole process to me.  If I feel I need more training they can extend it.  One of the PAs is actually still in training, 2 months more than the 6months they offer.  Thanks for your insight!

[MICURN]

Nights are pretty hard - for me at least. The thing is, once you're on that schedule, it's hard to function as a normal human. There are certain things you have to do during the day. It'd be like waking up at 3 in the morning because you have to go to the bank. And if you're married you'll be going as your SO is coming home. That wasn't fun.

 

The aspects that make night shift worthwhile are as listed above: no admins, the shifts are generally calmer in the ICU at night, etc.

 

The ICU is awesome. Nights are not.