I Watched Over You as You Slept: Heroes in the Night--the Night Nurses

Jim slept, but he probably shouldn't have been doing so as he was headed for trouble.  Bonnie was also sleeping; she was unaware that her heart rhythm had changed; in the next room, on the same night, David was about to have the same experience.  Andi came to the hospital unconscious; she was unaware of the person who had the courage to save her life.

    And Peter slept silently and peacefully; he was due to be discharged in the morning after having been in the hospital after a car accident.

    Jim, Bonnie, David, Andi and Peter all were unaware of the nurses who watched over them through the night.  Yet each needed the nurse who intervened on their behalf—he/she saved their lives.

Night nurses generally work from 11 p.m. to 7 a.m.  Most of the time, they watch over their patients as they sleep, only awakening the patient if trouble arises, or to check different things like blood pressure or to hear what their lungs sound like.  For the most part, patients do not remember the "night nurse" as in the drowsiness of sleep, the woman or man who tended to the patient gets lost in the folds of a dream.

     But each person who spends a night in the hospital is very fortunate to have a night nurse tending to them, watching over them, ready to assist at a moment's notice just in case interventions need to be implemented.  Here are a few stories of how the night nurses have intervened to save their patients’ lives (names have been changed for privacy):

Jim

Jim, 45, had been admitted through the ER (Emergency Room) in the evening with complaints of heartburn that had started a week earlier and was now causing stomach pain.  He was a veteran truck driver who was mostly deaf and hadn't slept well for a couple of days (due to his pain).  On his most-recent route, the pain became unmanageable so he went to the closest ER fearing that he was having a heart attack.  Once the heart was proven to be unaffected, a chest x-ray was taken, showing pneumonia.  He was subsequently admitted for treatment.

     He had been sleeping soundly, and snoring loudly, when the night nurse, June, came on duty.  As he was newly admitted, the nurse wanted to do a complete examination, so she awoke Jim to take his blood pressure, listen to his heart, take his temperature and listen to his lungs.  Moderate voice level didn't awaken Jim, so the nurse, remembering that Jim was nearly deaf, called his name loudly.  Jim opened his eyes, nodded to June when she stated she wanted to "check him over," then went back to sleep.  The nurse performed her assessment and made a note to check on him frequently throughout the night.

     As a general rule of thumb, the night nurse peeks in on her patients every hour to see if they were doing well, and did one assessment at the beginning of the shift if the person was doing well, more if he/she was not.

     But something in June's "gut" didn't sit right about Jim.  All his vital signs were good; he was breathing well.  But there was something in Jim that didn’t feel right with the nurse.

     As the night progressed, Jim continued to breathe well, his color was good, and his vital signs remained stable.  But he became less and less responsive.  The nurse realized that he could just be very tired, having not slept well for a few days.  The nurse discussed it with her colleagues and they agreed that he was probably just tired as nothing indicated anything to be worried about.

     Still, things didn't feel right to the nurse.

     At 4 a.m., June decided to intervene as she was very unsettled about Jim.  Knowing the doctor would probably yell at her for calling him in the middle of the night without a valid reason, she called Jim's attending physician anyway and told him of her findings, that it was just her intuition that told her that something was wrong.  The doctor told June to monitor the situation and call him in an hour.

     An hour later, nothing had changed, so June again called the doctor, who came to the hospital.  The doctor agreed that there was no obvious sign that anything was wrong; but he ordered a few tests.  Within 15 minutes, it was discovered that Jim's oxygen-to-carbon dioxide ratio was off.  Jim was taken to the Intensive Care Unit (ICU) and put on a ventilator to help correct the levels.

     After finishing her paperwork and report, the nurse put the patient out of her mind as he was no longer her responsibility (and she had 6 other patients to monitor).  Jim's doctor went with Jim to the ICU, and then returned to thank June for her efforts and for not being too afraid to contact him with her "gut feeling."

     June thought about Jim after that day, knowing that she helped save Jim's life.  His condition would've continued to deteriorate through the night had June not have trusted her intuition and acted upon it; he might've wound up with brain damage or worse as the blood-gas levels worsened.

     Three months later, a float nurse (one who isn't assigned to a given floor but can be assigned to anywhere extra staff was needed) had been working in the ICU on the day Jim had arrived.  When assigned to the floor on which June worked, the float nurse told June that Jim had recovered well and had been sent home with a C-PAP machine to help him with his breathing at night.

     June's actions helped immensely in this situation.  Jim never knew the name of the woman who intervened in the nick of time.  But the result was very rewarding for both individuals.

Bonnie & David

Bonnie, 64, was really looking forward to retirement, even when she had slipped on the ice and had landed on her backside.  A broken hip was the result, leading to her hospitalization three days earlier.  She was scheduled to go to a nursing home for long-term care in two days.  All the paperwork was signed, the nursing home picked out, and Bonnie felt ready to leave the hospital.

     Bonnie was a night-owl who liked to go to bed in the wee hours of the morning.  So when the night nurse, Jill, came on duty, Bonnie was wide awake watching a movie on TV.  Jill did a quick assessment then returned to her rounds.  At the 2:00 check-in, Bonnie was fast asleep, breathing well, looking peaceful.

     As Bonnie had been admitted to the Cardiac-Medical Floor (as the Orthopedic Floor had all beds filled), Bonnie was automatically hooked up to a heart monitor as was routine on that floor.  The heart rhythms were monitored by one nurse from the floor.  That night, the nurse was Angela; it was her task to watch all the heart rhythms of those with cardiac monitors, and to give periodic reports to the nurses in charge of those patients.  Angela was known for her exceptional intuition.  At the beginning of the shift, although Bonnie's heart rhythm was normal, Angela placed a post-it note next to her name on the monitor to remind herself to watch the woman closely; she did the same to another patient, David.

     As the shift progressed, Bonnie's heart rhythm remained normal.  But that all changed at 3:00 a.m.  While the nurses were off doing their 3:00 rounds, Angela saw Bonnie's heart rhythm change dramatically--it became a rhythm that would cause death soon (ventricular fibrillation).  Although Bonnie's heart was still beating, time was critical--only an electrical jolt (defibrillation) would stop the rhythm and save Bonnie's life.

     The first action in a situation such as this would be to send Bonnie's nurse to the patient.  However, Jill wasn't around--in fact, no nurses were visible; no one was available to help!

     Knowing she had to act fast, Angela called a "CODE" to direct the respondents to Bonnie's room.  A CODE alerts everyone that a person’s life was in danger and immediate assistance was needed.

     As it turned out, Jill had been in Bonnie's room at the time, working with the patient in the other bed.  When Jill had heard the CODE, she had run into the hall, then had realized it was her other patient in the same room.  Bonnie was still breathing; but she was not responding to those around her.  Jill called Angela to find out what was wrong; when she heard the finding, she understood Angela's actions.  Yes, a CODE was needed to save Bonnie's life.

Ten minutes after the CODE had been called on Bonnie, the other person on the cardiac monitors that Angela had posted a post-it note sported a dangerous rhythm as well (ventricular tachycardia).  His name was David; he was 58.  Again, no nurses or assistants were in the area (they were all in Bonnie's room).  Again, Angela had to call the CODE to direct people to the room of the man who was about to have a heart attack.

     Luckily, his room had been right next to Bonnie's room, and he was also closer to the Coronary Care Unit (CCU).  Nearly all those who were supposed to respond to CODEs that night were in Bonnie's room, so additional personnel had to be pulled from the CCU and other areas to attend to this new CODE.

     Due to the rapid response and effectiveness of two teams of CODE personnel, both Bonnie and David had their heart rhythms altered quickly enough to save their lives and prevent heart damage.  Neither experienced a heart attack because Angela had intuitively known to watch the two patients with great care. Both patients were transferred to the CCU for further care.

     It is unusual for a patient who is about to be discharged to run into serious trouble.  Luckily for both Bonnie and David, a nurse who trusted and listened to her intuition was monitoring them from afar during the night in which they had slept so soundly, unaware that things were going to take a bad turn.  Neither of them had ever met Angela, and in the ensuing days that followed these instances, they never learned the name of the woman whose rapid intervention had saved their lives.

Andi

Andi, 85, had never set foot in a doctor's office, had never taken any medical drugs.  Even the occasional aspirin that most elderly people take was never considered by Andi.  Andi's children knew that she still would've refused medical care had she not already been brought to the ER unconscious.

     The ER had diagnosed her with dehydration and had admitted her for treatment of that dehydration, and also to do routine medical tests on her as Andi was elderly and the doctor wanted to make sure no further medical interventions were needed.

     Tom was working that night when a still-unconscious Andi arrived.  He took report and did his own examination.  IV fluids were running smoothly and a urinary catheter was in place so he could monitor her output from those fluids.

     Andi remained unconscious with no change in her urinary output or vital signs.  But at 2:30 a.m., Tom noticed crackles in the lungs indicating she was retaining fluid in the lungs--a dangerous situation; when there is fluid in the lungs, less oxygen finds its way into the blood.

     Tom immediately called the attending physician who ordered a chest x-ray.  The x-ray showed that Andi had pneumonia.  Tom called the doctor who came to the floor to tend to Andi.

     Strong antibiotics were ordered.  Still, Andi's condition was deteriorating rapidly.  The doctor advised that Tom should call the family to be at Andi's bedside as death seemed imminent.  As Andi was a NO-CODE (meaning she was not to be resuscitated should she die), the doctor issued no further orders; he left to attend to other patients.

     But something didn't sit right with Tom.  The woman only had dehydration upon admittance; yet within a few hours of being hospitalized she developed pneumonia; and, her urinary output was still zero.  Tom asked himself:  "What if all that fluid she's receiving is going into her lungs?"

     So Tom took a chance and called the attending physician to discuss his theory.  As many doctors don't like to be questioned by nurses, Tom knew he might get reprimanded.  After listening to a few tense words, the doctor gave Tom an order for a diuretic.  Diuretics are designed to remove fluid from the body via urine.

     As the anxious family looked on, Tom administered the ordered diuretic via the IV.  Anxiously, he watched the urinary catheter to see if urine would flow.  It started as a trickle, and then flowed rapidly.  Tom listened to Andi's lungs--they were clearing.  All present began to breathe easier, including Andi.

     Andi stayed in the hospital five more days.  Tom had been her night shift nurse for 3 of those days.  Andi had regained consciousness on the fourth day of being in the hospital.  She never met the man who saved her life; she may've never even learned his name.  But she lived because he had the courage and strength of will to call a medical doctor and voice his opinion.

Peter

It had been a long recovery for Peter, age 10.  He and his family had been in a car accident one icy winter day.  It was now late spring and he was excited to be leaving the hospital in the morning.

     Peter's nurse this night was Alexa, a recent graduate who had passed her Boards and received her license about 1 month ago.  Peter talked briefly with her at the beginning of her shift, then he fell asleep, dreaming about the big welcome home party the next day; all his friends had been invited.

     But Peter never saw Alexa again.  In the middle of the night, Alexa noticed that Peter's color was off and he seemed to have a darker appearance and a puffy or congested face.

     Knowing something was wrong, Alexa immediately tried to awaken the boy.  She was unsuccessful.  His vital signs were weak; his pulse thready.

     Immediately, she called the attending physician who issued orders. 

     It was determined that Peter had a blood clot that found its way into his brain, causing a stroke.  Because the nurse had found the change in Peter’s condition right away, the measures taken to restore blood flow to the brain were successful.  The quick interventions by Alexa kept Peter from having any residual brain damage after the incident. 

These are but a few stories of interventions by night-shift nurses that have saved the lives of their patients.  Every nurse, no matter what shift he/she is on, has similar stories to tell.  But the big difference between the different shifts is that people rarely know the nurse that tends to them at night.  Often the patient has a vague recollection that someone talked to them in the night; but often the night passes with the patient sleeping soundly. 

     Night nurses also have great fortitude and courage, possibly even more than those of other shifts.  It takes a lot of courage to wake a doctor in the middle of the night to discuss a patient’s care.  It is easier if the patient has signs that something is definitely wrong; but it take a lot more courage to call a doctor, awaken him, and tell him that something isn’t right with no actual proof, but the doctor should come in right away anyway.

     Most patients fair well at night and never need the interventions mentioned in this article.  Still, their nurse is available and caring for them, even if they sleep soundly through the night and never see or remember the nurse.  Perhaps the patients sleep soundly because they are aware that they are cared for by a wonderful person who watches over them while they sleep, and who will intervene if something was to happen.

This article is dedicated to all those nurses far and wide who work the night shift.  To be trusted with a precious life while the person sleeps is a great honor.  Your courage runs strong within you; thank you for your dedication.

Best wishes,

Dr. Ronda