She stands at the microwave warming her coffee. She's reheated it three times in 2 hours because she hasn’t had time to drink it before it gets cold. She is a night shift nurse. She is Cara Keay.
Keay is a 47 year old registered nurse and works on the third shift at IU Health in Frankfort, Ind. She stands five feet four inches with about three feet of hair contained in an up do. Despite her small stature, she commands the entire hospital floor.
Her duties include patient checkups, charting, and monthly training sessions that help to improve her abilities as a nurse.
Keay’s path to a nursing career began as a case worker in the justice system. Then the 2008 recession hit and she was laid off. After being recently divorced and needing to care for her two children, a six year old boy and a five year old girl, she knew she needed a high paying job.
“I needed to find a job that made sure I didn’t need to rely on anyone else for an income,” Keay said. “My mom had been a nurse for 30 years, and I thought, if my mom can do it, then obviously I can do it too.”
Being in nursing school while caring for two children came with its own set of unique challenges for Keay. Many late nights were spent doing homework after a full day of classes and coming home to take care of her young children.
She said she had to change her usual schedule to accommodate her young family. Instead of beginning school work and studying right away, she had to fulfill her motherly duties and get her children to bed before working on her degree.
“Some days were definitely a struggle,” she said. “I’m sitting in class taking notes and writing down my homework assignments. Then I get home and I have two mouths to feed and hear about their days… I can’t work until they’re taken care of.”
Being a third-shift nurse can be one of the most physically and emotionally demanding jobs. Long and unusual hours, coupled with sparse resources and time away from family can make the med surg floor resemble something more akin to a pressure cooker than a hospital.
Alicia Johnson, one of Keay’s coworkers, said the unique schedule of a nurse is one of the many difficulties that nurses face in the profession.
“You wake up and you’ve got to hurry up, eat dinner and get ready, you know, to come to work, and then you go home, and then kids are already going to school,” Johnson said. “Then it’s bedtime for you and once they’re back from school, you’re still asleep getting ready for your next shift that night. You may see them for a bit for dinner but that’s about it.”
Along with an inconsistent schedule and long hours, there is a common adage known as “feast or famine nursing.” It is not unusual for third shift nurses to experience periods of having no patients in beds. There are also moments where there are no empty beds. “When we have down times you can get put on call and end up not working,” Keay said. “There are also times where it’s super hectic and all the beds are full and we have to call more nurses in.”
When patient count is down on third shift, the nurses have their own ways of keeping busy. Once training sessions are done and charting is finished, the nurses can’t just go home. They must stay and be prepared for any patient that may come onto their floor.
To stay alert and keep their minds sharp, many of the nurses resort to various forms of entertainment to keep their minds ready to go when a patient needs to be admitted.
“We can’t fall asleep,” Keay said. “A good book is good to keep you awake if you don’t fall asleep while reading. We also share shows that we’re all watching and recommend them to each other."
When patient numbers are low, nurses employ bundle care. Waking up patients multiple times a night for vitals and various tests can make them irritable and not have an enjoyable experience.
Bundle care is when several tests are scheduled for one patient. Rather than run the tests at separate times and wake the patient multiple times, the full team of nurses will go in and run all tests simultaneously to only wake the patient once.
“You’ll have a physical assessment due at 4 a.m. and labs that need drawn up and a breathing treatment,” Keay said. “That’s three different departments and rather than wake the patient three times we can give them better care and allow them to rest easier.”
During one of these slow nights on March 11th, 91 year old retired Air Force veteran Jim Caldwell was admitted to IU Health Frankfort. His symptoms included dizziness and high fever. It was later discovered that he had a urinary tract infection that led to sepsis.
Caldwell said that a good nurse can make or break your stay as a patient, but not all the responsibility is on the nurse.
“I’ve always had a good rapport with my nurses,” Caldwell said. “I love it when I can joke with my nurses. But you have to be a good patient too. When you’re getting woken up at midnight I’d rather look forward to it than dread it. You’ve got to have fun with the nurses. They’re just doing their job.”
Keay said that patients like Jim are what make nursing enjoyable. Helping patients is what Keay looks forward to the most, she says. But what happens when patients can’t be helped?
Patients dying is a large part of the job but it doesn't just include making the patient comfortable. A key aspect of the dying process is caring for the family and answering questions they may have.
In Keay’s experiences, she has said that the hospitals she had worked at previously did not explain the dying process well to patient’s families, still leaving them with many unanswered questions.
“It’s your one experience with this patient and their family that you’ll have with them in their entire life,” Keay said. “I always make sure to answer every question I can however many times they ask. These families haven’t been through the dying process before. I’m used to it. They’re not.”
Slowing down and explaining how death happens and what it looks like can ease the transition from this life to the next.
Keay had a very special connection with a patient’s family early on in her career. She was working at Logansport Memorial Hospital and her patient at the time was showing clear signs of nearing the end of his life.
“A lot of nurses say they can smell death,” Keay said. “I can’t but I can clinically see when a patient is about to die and I can tell within about 12 hours that they’re going to pass.”
Keay had grown close with the patient’s family over the course of his three day stay. She had prayed several times for the family and that gesture meant a lot to the daughters of the patient.
Keay said something happened that she never expected. The family asked her to be a part of the man’s funeral.
“After the man passed his two daughters came out to the nurses station and found me and they wanted me to give the eulogy at their dad’s funeral,” Keay said. “Of course I said yes, knowing that the eulogy is a very small part of the funeral.”
The next day, Keay received a phone call from the funeral home and was told that she was going to be officiating the funeral. Keay was shocked. Keay said she thought, “How am I going to officiate a funeral for a man and family that I’ve only known three days.”
Rather than turn the family down, she accepted the challenge head on. Her answer to this seemingly impossible situation was to ask six members of the family to each come up with one word to describe her late patient. She delved into what each word meant and how each familymember felt it exemplified their family member. After the funeral, she also found out they needed someone to lead the gravesite service.
“I led the funeral service and I thought I was done,” Keay said. “Then I found out they expected me to do the graveside service as well. I really had no clue what I was going to say. But I felt like I just had to. He was my first patient that I had gotten close to who had passed, and there was a sense that I had that I owed it to him and his family.”
On the anniversary of her patient’s death, she received a bouquet of flowers from the family and a note expressing their gratitude. She said it goes to show the impact that a nurse can have on a family, not just the patient.
To add on top of an already stressful homelife, the work environment for a third shift nurse doesn’t get any better. Another unique aspect of the job is the care for patients at night. Keay said that the being woken up several times a night can make the patients restless.
Keay said that this adds yet another layer to the already frantic vibe of night shift on the hospital floor. Due to the restlessness and constant tests and checkups, patients can become irritable and in some cases even violent.
This has caused security to be placed on the shift. There security officers patrolling the shift at all times of the night to ensure nurse and patient safety.
“We’ve had three or four instances of a patient assaulting a nurse,” she said. “On the night shift, it’s like the craziness comes out of people.”
She said one thing that helps is the family feel of the third shift. Keay said that the nature of the shift naturally brings the nurses closer to one another.
Many of the nurses learn to lean on one another in times of need. Where many people will rely on their families, the nurses of third shift trust in each other because their families are asleep when they are awake. So, in their times of need they confide in one another.
Another one of Keay’s coworkers, Nikki Smart, a 48-year-old third-shift nurse, remembers her work family coming around to comfort her following the loss of her mother.
“I think they're the reason I’m still here,” Smart said. “Just being able to talk with them and have comfort from them meant the world to me and showed me they really cared.”
The Nightingale Pledge is a common and well-known oath in the nursing community. It is used predominantly at graduation ceremonies.
“I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.”
Keay exemplifies this in everything she does on the nursing floor. She works to ensure that any patient that comes to her floor will be taken care of, thought of in the highest regard and treated with the utmost respect. Whether it be officiating a funeral of a lost patient or comforting a grieving coworker, Keay truly lives her life as an example of what it means to devote herself to the welfare of those committed to her care.
