I’m Jo one of the 10 night nurses for Pride Veterinary Centre. Asked for an overview of a night in the life of a night nurse at Pride, I have to say there is no typical night - expect the unexpected. But here goes...
The Vets At Night Team
On our team there are 3 nurses; Kerry, Georgie or Tara (who share the job) and me. Our night vet is Charlotte, who is in charge of first opinion patients, there’s a rotating intern responsible for the referrals and two animal care assistants; Dean and Roberta.
This may seem a lot but is a huge reduction from staff numbers during the day so we do the work of many people. We work on three-week rota, staying together as a team.
Why I Love The Night Shift I’ve done nights since forever; I like emergency and critical care but I especially love being a small team, some of my favourite people, in fact. The best time of shift for me is when everyone has gone home, it’s the middle of the night and it’s just us and the patients.
A Night In ICU
Today I’m in ICU. The shift begins at 6.30pm and finishes in 12 hours. I arrive and the lights are off and everything is quiet. Is ICU closed, are there no patients tonight? Can we play games then? No! One of the patients is light and sound sensitive and so indoor voices everyone (a challenge for me), and we’re working by lamp light.
First comes the handover from the day to the night team; who the patients are, relevant history and the reason for this stay, any tests or procedures they’ve had and any that are scheduled, the plan for the night including expected or possible complications or changes and who to call when (some cases have multiple disciplines involved e.g. neurology, medicine, anaesthesia), and importantly any particular likes or dislikes such as men or cheese; that’s patients not the nurses – we all love cheese!
It’s quite busy up until 8.30 usually with clinicians checking up on cases before leaving, day nurses finishing up, and handovers between vets, nurses and interns and the odd hospital tour. There are nearly 40 animals in tonight, I have four in ICU. Everyone is 'Ssshed' as they enter or pass-by (vet nurses tend to be fiercely protective of those in their care!) I also get the heads up of a secret stash of Haribo in the drawer and a cake sale upstairs for one of the patients.. Bonus! The vending machine is disappointingly empty this week. 7pm is not my favourite time of day, I’m a bit sleepy still (this is our morning remember) and there are too many people.
In ICU, the animals have much more detailed plans and handover sheets which can take a little navigating. Intensive patients like my favourite girl in currently, might have 30-60 minute checks of vital parameters (ECG, heart, blood pressure, respiration and temperature); it can seem like you are chasing your tail here. There can be multiple constant rate infusions on different rates each on a different machine and sometimes multiple catheters; providing drugs to manage pain, or vomiting, to prevent seizures, alongside different types of intravenous fluid therapy. Great care is taken to provide adequate nutrition (through TPN, naso-oesophageal or oesophagostomy tubes if necessary), to prevent complications of recumbence; regular turning, bathing, creaming, physiotherapy, urinary catheter care, to prevent infections and this is all on top of dealing with the original problem.
ICU patients will often have 1:1 or 1:2 care during the day but this is not always possible during the night. We can keep the day twilight nurses where needed for extra support and have student vets can help with checks and feeding and TLC. The intensive care unit is a great place to learn.
Tonight there are 4 patients in ICU; a Collie and a cat on seizure watch, a post op BOAS Pug (Brachycephalic obstructive airway syndrome) and a spaniel with Tetanus (she’s been in a while and is my favourite). I have a peak at the waiting list to see what Charlotte is up to in first opinion. In true Christmas fashion, a Retriever pup has eaten mince pies, and a Cockerpoo has eaten tinsel, there’s also an RTA cat, and a Frenchie with gastro. It’s feeding and walking time, so the ACAs pop in – Dean and Roberta really are hardcore; keeping everyone in clean beds, everywhere tidy and restocked; not a job for the faint-hearted though a great precursor to veterinary nursing. Kerry my work bestie pops in to update; the cat has been stabilised and won’t need to come into the ICU, the Labrador has been made sick, and the Cockerpoo is going into surgery to remove the tinsel. She’s brought the best coffee and the plan is to get pizza later (Pizza because it’s ok to eat cold whenever there’s a minute be it 2am or 6am).
Our BOAS boy is having a lot of difficulty breathing despite cooling and drugs. His oxygen saturation is dropping and he is getting really tired. The decision is to intubate, the anaesthesia on-call is called. This quickly becomes an emergency situation and it’s all hands on deck to stabilise him. A tube is placed giving him an airway so his parameters improve quickly but he now needs 1:1 constant monitoring - the twilight nurse is staying to help.
Surgery ring down for a kennel to be prepared for the late surgery – a Dachshund with spinal stabilisation who will need warming and close monitoring until she is fully awake and can move onto the normal ward.
The Border Collie has just had a seizure and several of the drip pumps in the ICU did not get the memo about indoor voices. The Spaniel needs re-catheterisation but she’s already had so many, her veins are shot.
Briefly I feel overwhelmed. These are precious family members, we are trusted with their care and they are fully dependent on us. But this is what we are best at, multitasking, sorting the chaos and stepping up when needed. And Kerry (queen of the catheters) gets the IV in in minutes. It’s 1am already. Its break time but Tara is placing a central line in a dog and I really want to learn to do that so I stick around for that before grabbing a drink.
In normal wards, the Labrador pup is causing carnage; having chewed his bed, pulled out his IV, and toileted everywhere twice. The activated charcoal he was supposed to take in food is mostly all over his face. He has been given the buster cone of shame to stop any more destruction and is currently scraping that along the kennel wall in a bid to escape it. The machines in main wards didn’t get the memo either, and everyone is the dog ward is joining the twilight bark. Charlotte, Tara and the students have gone to surgery. Feeling more thankful for my five just now, who are currently all stable and asleep. The pizza is waiting alone next door, we’ll get to it later.
Between 3 and 5am every able dog is walked (some need sling support) and every patient cleaned out. Every IV is checked and redressed and all vital parameters taken. Notes are made for handover. This is a really busy time and the intern, Anastasia takes over in ICU so I can help in main wards. Good decision; I miss my friends and the dimmed lighting is making me sleepy.
The Cockerpoo is back from surgery and recovering well. Lottie’s had to make three incisions into stomach and duodenum but everything looks good and he’ll be back to his rascally self in no time. We have Christmas songs on the radio and a bit of chat whilst we work. Tara has to remind me about indoor voices at one point because we laugh so much. I love our little team!
There are some interesting cases in tonight and some real characters; I didn’t realise being in ICU. Not everyone likes there feet being touched or the thermometer (per rectum I’m afraid) but with fuss and chicken we get through it. We finish in time for 20 minutes of cold pizza and Haribo and a bit of CPR revision (everyone has to know what to do in the event of a crash and practise makes perfect). Then the 6’o Clock meds are due and I go back into ICU. The Pug is extubated now, breathing well on his own with a bit of supplemented oxygen. My favourite girl just walked by herself and squeaked a ball after 3 weeks of being recumbent and for the most part heavily sedated.
This is the best feeling ever after a really long week, and for a minute there’s nowhere I’d rather be. The early nurse arrives at 7am and I handover the ICU patients. Then to home and bed. Correction this is my favourite place!