Migraines and hospital night shift mitigation
December 12, 2013 2:50 PM   Subscribe

My friend is in nursing, working in an ER right now, and also finishing up a degree to be a nurse practitioner, with intention to work in a hospital emergency dept. She suffers from migraines, and whenever she's worked a nightshift, she's been hit with a terrible one at 3 or 4 in the morning. It seems like new hires in every position she's found are expected to take on regular night shifts, and that even later on they'll be expected to do that a few times each month. Is there any hope of getting hired in an ER at that level with a stipulation that drastically limits the number of night shifts she has to endure, or is there really no recourse other than to leave the emergency department in order to work. (In her present job, she's been doing regular 12-hour daytime shifts, which has been fine.)
posted by spbmp to Work & Money (10 answers total)
This is in the U.S., by the way.
And a related question.
posted by spbmp at 2:59 PM on December 12, 2013 [1 favorite]

She could look at urgent care - some similar (although lower-acuity) cases to emergency care, typically daylight hours.
posted by jeoc at 3:04 PM on December 12, 2013

Has she tried any natural remedies for migraines/headaches, which would (presumably) not interfere with her ability to perform her duties?

Having worked in the vitamin/supplement industry, I've always received the most positive feedback (from customers) on:

L-Theanine (found in green tea)

Magnesium seemed to offer the most success. Perhaps when suffering from a migraine she could find a dark, quiet room and try one of the aforementioned herbs/supplements to see if it passes more quickly?
posted by stubbehtail at 3:06 PM on December 12, 2013

instead of trying to switch her job around, which sounds like it is a job she wants to have, how about focusing on treating the migraines? has she seen a doc about them? is she under treatment for them? if not, i would say THAT should be the first step instead of leaving the ER.

edited to say: i say all this as a person with chronic daily migraines that are currently being successfully treated, for the most part. bend the migraines to your life, don't let them ruin your life.
posted by misanthropicsarah at 3:08 PM on December 12, 2013 [1 favorite]

The problem might not be the night shifts, but the irregular schedule.

It sounds like night shifts are considered less desirable, so that people have to be forced to take a few of them.

It might be fairly easy to get a regular schedule of only night shifts. Some places might even offer additional pay.

For this to work she'd need to be willing to keep to the same wake/sleep schedule on days off.
posted by yohko at 3:20 PM on December 12, 2013 [3 favorites]

This may be way off base ... but consider the possibility of wearing blue-blocker glasses ... there has been some good research on this specifically regarding night shift workers. I can't link right now, but a search for blue blocker night shift should bring up a number of excellent articles. It seems that the blues spectrum in indoor lighting at night causes certain hormonal fluctuations. Also, of course, look into good management of migraines.
posted by batikrose at 4:53 PM on December 12, 2013 [1 favorite]

I know a lot of ER nurses, at two different hospitals, and almost all of the ones working regularly and full-time (not pool/per diem) have regular schedules. They might be nights, they might be days or swings, but pretty much everyone full-time works a specific pattern of days in a given two-week period, all on the same shift. So this is indeed possible...in straight-up nursing.

The ER docs, on the other hand, all are expected to pick up their share of night shifts or pay into a system that pays a night shift differential IF there are enough people willing to volunteer to do nights for the extra pay. So, if the expectation with her NP is that she's going to function sort of like a low-level doc in the ER rather than like a nurse it seems unlikely she's going to get to work just days. The ERs I'm familiar with do not hire NPs, though, so I could be wrong.

Based on my experience living with an ER doc whose schedule DOES shift around a lot, however, I would second yohko's suggestion that it is worth investigating to see if the big issue in re: the migraines might be the schedule irregularity and not the night shift, per se. If that is the case, it's possible that she might be able to work ONLY nights, which is a great position to bargain from. My husband did this for years and loved it and is kind of sad he can't do it anymore now that he is married to a Person of the Day.
posted by charmedimsure at 5:12 PM on December 12, 2013

If her migraines prohibit her from working night, provided her doctor as tried a few methods to treat them AND is willing to do the documentation this should fall under a reasonable accommodation of the Americans with Disabilities Act.
posted by AlexiaSky at 6:09 PM on December 12, 2013 [1 favorite]

I work with PAs/NPs/APRNs. It really depends on the ER, if you work at a small community place, they oftentimes do not have midlevel coverage for the overnight. The midlevel coverage will be just until 11pm or 1am depending on the volume, from that point on til morning it's single-doc coverage.

At some academic centers or other large hospitals there is midlevel coverage overnight, but there are often people who work that for the most part and then the others just need to fill in here and there. It is possible to try to trade away all your night shifts if you only have one or two per month, but you have to be willing to take other undesirable shifts, like weekends or holidays.
posted by treehorn+bunny at 6:22 PM on December 12, 2013

A lot of interesting ideas, thanks. I imagine being perma-night-shifted would be pretty difficult for her as a mom, if not impossible.
posted by spbmp at 8:04 PM on December 12, 2013

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