Erin Geller rubs her eyes and yawns. “I forgot to wash my scrubs last night,” she says. “So, this is last night’s blood.” Her black scrubs have the faintest trace of a stain near her shoe which is also coated with hospital sludge. “This is from last week’s anal fistula,” she said, pointing to her heel. I ask her what that is. She laughs. “You don’t want to know.”
It is 7 p.m. on Monday, March 12. Most people are preparing supper or getting their kids cleaned up for bed. The nurses at the Mercy Hospital Northwest Arkansas, however, are preparing for a shift change. It is hard to identify who is leaving for the day and who is just clocking in as both groups look exhausted.
Erin Geller, “charting” for the day. This process of recording information can take up a third of the shift. “It’s even worse when someone dies,” Erin says.
Erin is taking a shift report from another nurse. I pretend I’m not paying attention. “Good luck,” the day nurse says to Erin. “He’s been ringing the call button all night.” She rolls her eyes. “Addict.” She hands over paperwork for Erin to file. “I just gave him morphine so that should shut him up for a bit.”
Erin looks relieved. “A pushy addict is the last person you want to deal with at the beginning of your shift,” she tells me. “They can ruin your whole night.”
Mercy Hospital Northwest Arkansas is a Catholic-based, not-for-profit hospital in Rogers, Arkansas. This hospital was recently ranked within the top 100 hospitals by IBM Research, a huge honor considering there are over 6,000 hospitals in the United States.
“Noah’s my aid tonight,” Erin tells me. “Love the kid, but he’s like a bad luck charm. Whenever I work with him there’s always some rectal emergency.” I ask her how often that happens.
“Nightly,” she laughs. “Some nurses have never seen an anal fistula. I’ve been here less than a year and I’ve had three. All with Noah.”
Erin and Noah make their rounds, introducing themselves to their patients and running vital signs.
Noah Hinchcliffe, demonstrating how he uses a thermometer to take temperatures.
At only 19, Noah is a nurse’s aid, taking classes to become a registered nurse.
I can’t participate in this, so I hover by the nurse’s station as the day nurses finish up. I direct my attention to Andi Cullwell, a blonde nurse adding cream to a giant cup of coffee. “This is my fourth night in a row,” she tells me with an eyeroll. “I think I’m still asleep.” Andi just turned 29 and she’s been a nurse for two years. She has two kids at home, ages 5 and 3. “They’re more exhausting than work,” she said. “Crazy bastards.”
After finishing their rounds, Erin and Noah come back to the nursing station to fill Andi in on what they did this weekend. The three of them have coordinated their schedules so they can have the same weekends off, but Andi chose to spend time with her kids instead of going out.
“They needed a break from grandpa,” she says to me. Andi’s dad lives on social security and babysits for her while she sleeps during the day. “I’m glad the weather was nice, so I could get them out of the house. It’s been cold so all they do is drive me crazy.”
Andi is very candid about what it’s like to raise kids on a nursing schedule. “I feel bad because I’m always tired when they’re awake. It’s hard to tolerate all their questions and weird stories.” She said that last week her oldest told her he believes more in aliens than in God. “That’s just not a conversation I have the energy for,” she laughs. “I’ll let my dad deal with that one.”
The night-shift nursing staff on the sixth floor of Mercy Hospital Northwest Arkansas (Andi and Noah are in the back row on the far left). Not everyone is pictured as the floor was busy.
Noah has more energy than Erin and Andi combined. He’s 19-years-old and taking nurses classes at NWACC to be an RN (registered nurse). Right now he’s a nurse’s aid, which mean he does all the nurse’s dirty work, changing bed pans and bathing patients. “It’s fun because I work with Erin and Andi,” he gushes. “Last week Erin brought me Chick Fil A.”
Noah says that he likes working nights because it’s easier. “The patients are asleep so they can’t complain as much,” he said. “And there aren’t any families or doctors, so it’s calmer than days.”
Erin is the newest of the three and seems to be having the hardest time adjusting her sleeping schedule. I asked if she planned on working nights for a while. “Absolutely not,” she answered without hesitation. “I’m asking for days as soon as I move.”
I told Erin about Shift Work Disorder, the mood disorder associated with working at night. Long-term sleep deprivation and abnormal circadian rhythms can contribute to depression and anxiety, worsening any pre-existing health issues. “Well that’s great,” Erin laughs. “No wonder I’m so depressed.”
When I first read about Shift Work Disorder, Erin immediately came into my mind. She had severe anxiety during nursing school, and was prone to seasonal depression, even when she was getting regular sleep. I wanted to see how her hospital schedule contributed to her already existing mental health conditions.
“This was my first winter working night shifts. I’m not doing that shit again. Ever.”
Many people who work at night complain that they miss out on spending time with their families and friends outside of work. Erin agrees with this. “It’s hard because all I want to do during the day is sleep. And when I’m at work, I just want to go home and sleep.”
This Christmas, Erin didn’t have time to go home and see her family in Dallas. “I know I don’t want to do Christmas alone again,” she said.” Because Erin just started at Mercy, she works the shifts no one else wants. That means working on Thanksgiving, Christmas Eve and New Year’s. She laughs, “I even work on St. Patrick’s Day.”
By the end of our interview, Erin said she is “totally over,” the night shift. “You get paid more to work at night, but I don’t care about that anymore. My mental health is worth so much more.”
Working at night makes you more likely to experience long-term sleep deprivation as the light exposure suppresses melatonin that is normally secreted at night, when other people are asleep. Additionally, people who work at night have unusual circadian rhythms, contributing to depression and “sleep debt,” over time.
Her friend, Nicole Melson, transferred to a Mercy clinic last week because she didn’t like the hospital’s grueling schedule. I asked her if she’d consider doing the same. “I mean, I like working at the hospital,” Erin said. “It’s fast and I learn a lot. But it is hard. It’s really hard.”
I reached out to Nicole and asked why she transferred to the clinic. “I just thought you had to work at a hospital right out of school. I hated it. I didn’t know any of the doctors and I never got any weekends off,”
I asked if she liked her new schedule. “I also thought I’d hate working a nine to five, but I love it. I’m just getting my sleeping schedule back.”