The public’s need for healthcare obviously doesn’t stick to strictly 9–5 “business hours.” The always-on model of our healthcare system is fantastic for anyone who has had a health emergency on a holiday evening, but it can be more of a mixed bag for the healthcare workers staffing it.
If you’re exploring a nursing career, it’s only fair to wonder about the contents of that mixed bag and whether that’s something you can handle. If you’re looking for more info on the potential pros and cons of working night shifts versus day shifts as a nurse, we’ve got you covered. We dug into the research on shift work and spoke with nurses who’ve walked the walk at all hours of the day to gather important insight into the realities of these shifts
Night shift vs. day shift: What is a shift differential?
While not universally offered, one substantial positive for night owl nurses is the potential to earn “shift differential” pay.
A shift differential is additional pay workers receive for working “undesirable” shifts like nights, weekends or holidays. This financial incentive can help employers ensure adequate staffing levels are maintained during these times.
How shift differential pay is calculated will depend on the employer. It’s often either an additional flat hourly rate added on top of base pay (ex: everyone working overnight earns an additional $7/hour) or as a fraction (ex: everyone working overnight will earn their standard hourly rate times 1.25 for that period).
Additionally, the differential amount can vary according to the specific hours. For example, evening or relief hours might include shifts started between 3 p.m. and 7 p.m., night hours might start at 7 p.m. and weekend hours might start at 3 p.m. on Fridays. This means a night-shift nurse working on a weekend might earn both night differential and weekend differential pay, depending on their employer’s terms.
As you can probably imagine, the potential to earn substantially more for taking on unconventional hours can weigh heavily when determining if working night shifts is worth it. Even if you are hired as a day-shift nurse, it’s worth reading up on your employer’s shift differential policies. You may want to pick up hours outside of days for some extra cash.
Night shift vs. day shift: Work culture
While a shift differential can be easily calculated, differences in work culture cannot. Days at hospitals tend to be bustling with providers, consulting providers, physical therapists, occupational therapists, speech therapists, social workers and other healthcare professionals that don’t typically have a presence on overnight shifts. Doctors tend to place a lot of orders during the day. Between placing Foley catheters, prepping patients for surgery, making sure patients get their imaging done and taking their medicine, it might be hard for day shifters to catch a break for lunch or grab a coffee. More people from the management ranks being around during the daytime can also mean more micromanagement—and the minor annoyances that can come with it.
The pacing of work at night varies according to the department. Nurses in the emergency department receive orders and complete tasks whenever patients present to the ER. Nurses on an inpatient floor are mostly tasked with making sure patients get the rest they need to heal and dealing with emergencies as they arise.
While it can be nice having fewer “extra” people around, it also means taking on more responsibility when emergencies do happen.
“With limited resources around, often the nurses only have each other. That bond is very strong,” says Megan Brunson, MSN, RN, CNL, CCRN-CSC and CVICU nurse who has been working the night shift regularly over the span of her career. A smaller crew can also mean stronger friendships. “There tends to be a tighter camaraderie when you’re ordering lunch at 1 a.m.,” says Sean Marchese, MS, RN at The Mesothelioma Center.
Brunson also feels like working the night shift gives the opportunity to practice at her highest scope. Providers aren’t constantly around so when emergencies arise, nurses perform all the nursing interventions they can and call the doctors. “On night shifts, many times I am the sole advocate for the patient,” Brunson says.
With that comes additional autonomy. This can be a great shift for new nurses as they’re pushed to learn new skills and grow more confident with handling the emergency situations that may arise.
Night shift vs. day shift: Sleep
Another important consideration while debating night shift versus day shift nursing is sleep. No matter when you prefer to clock in, sleep is critical to functioning at your best as a nurse. Being alert means avoiding making critical errors and being more aware when your patient’s condition is changing. “Your patients depend on you to get quality sleep just like they depend on you to give them the right medication,” says Brunson.
While it can certainly be a rough transition, some nurses are easily able to adjust to sleeping during the day. Many nurses tend to be tired enough after an 8- or 12-hour shift to fall asleep without changing things up too much. That said, any and all of the following can help night shift nurses maintain a steady sleep schedule:
- Investing in blackout blinds
- Sticking to a routine for falling asleep
- Reading a book before bed
- Wearing wax earplugs
- Avoiding blue light before sleeping
- Avoiding spicy foods before bed
- Having a small “breakfast” before bed so a growling stomach doesn’t wake you up
- Drinking only light caffeine and water during your shift
- Reducing food intake between midnight and 6 a.m.
- Owning a loud, reliable alarm clock
Most important, plan out your sleep, especially if you’re someone who switches back to being awake during the day on your days off or you have a rotating day/night schedule. Brunson recommends writing your sleep time down on your calendar or in your planner and not scheduling anything over it. “Your sleep needs to be protected at all costs,” says Brunson.
If that seems like it’s just way too much to deal with, it doesn’t mean you’re out of luck—there are plenty of nursing positions that don’t require working at 3 a.m. While they may be harder to find in a hospital setting, stay open-minded and consider doctor’s offices, clinics or surgical centers that are only open during the day. You’re better off tailoring your search to roles with schedules that work for you than being exhausted and out-of-sorts.
“I’m a better nurse and person getting good sleep at night and having improved mental health by being able to socialize during the day,” says Jenna Liphart Rhoads, Ph.D. RN, CNE advisor at Nurse Together.
If you’re looking for a good in-between, look for evening-only positions that consist of 8- or 12-hour shifts where most of the hours occur between 4 p.m. and midnight. This can allow you to have a more “normal schedule” without having to be there bright and early in the morning.
Night shift vs. day shift: Health considerations
Besides sleep, there are other health concerns to think about before becoming a long-term night shifter. While trying night shift for a shorter period of time won’t necessarily have a long-term effect on your health, there are some studies to consider if you plan on being on night shift for years.
In a recent National Toxicology Program report, it was concluded that there is “high confidence” that persistent night shift work that results in circadian disruption can cause cancer.1 Night shift work has also been associated with increased risk for type 2 diabetes, heart disease, stroke, metabolic disorders and sleep disorders.2
While those risks are hard to think about tangibly, you can take stock of how you’re doing after a few months on the night shift and consider what changes you can make if you enjoy being on night shift but may not be feeling your best.
“With years of night shift work, you can start to feel the effects on your mental and physical health,” Marchese says.
Night shift vs. day shift: Social life
If you choose to start working the night shift, you may encounter some new challenges with your social life. Some parents find it easier to be involved with their kids without having set obligations like work hours during the day. Especially if the kids have school or childcare until the afternoon, it can be easier to get your sleep after getting off work.
If you’re looking to go out, it might be easier to stay up late with friends. On the other hand, if you have social obligations with friends or family in the morning after you get off, it can be very hard to stay up after working all night. “I usually just turn into a zombie at that point,” says Sean Karbach, BSN, RN, CCRN and creator/host of the Nurse Dose podcast.
Chances are also good that you’ll meet great friends during your shift that you can see outside of work when your schedules line up. “I’ve met some of best friends on night shift,” says Karbach.
Are you cut out for nursing?
There’s a lot to consider when it comes to a potential nursing career. Unconventional shift schedules, and how willing you are to adapt to them, is just one small piece of the puzzle. Nurses take on a wide array of responsibilities and challenges in healthcare—and it’s not always easy to tell if it’s right for you. Our article “ Would I Be a Good Nurse? 11 Questions to Ask Yourself” can help you get a better feel for whether this is the right field for you. Additionally, check out our article " Nocturnal Nurses Uncover the Secrets of Working the Night Shift", to learn more about working night shift.
1Ruth M. Lunn, Pamela J. Schwingl, Stanley T. Atwood, Suril S. Mehta, Gloria D. Jahnke, Sanford C. Garner “NTP Review of Shift Work at Night, Light at Night, and Circadian Disruption” National Toxicology Program, April 2021. [Accessed February 2022] https://ntp.niehs.nih.gov/whatwestudy/assessments/cancer/completed/shiftwork/index.html
2Rosa D, Terzoni S, Dellafiore F, Destrebecq A. “Systematic review of shift work and nurses’ health” Occupational Medicine, June 24, 2019. [Accessed February 2022] https://pubmed.ncbi.nlm.nih.gov/31132107/
