Night Shift

You’ve (hopefully) settled in, had a few shifts in the chaos of the never-ending beeping and now find yourself on your first run of nights. Maybe you’ve never done nights before. How do you prep? What to expect?

I’m going to write this chronologically, from getting ready for your nights to the shift itself and your recovery after.

The Prep 

There are different schools of thought when it comes to adjusting your body clock. Some people try to stay up late the night before watching TV or playing videogames and then sleep in as late as they can. The other group will have a normal night and then try to nap in the afternoon before their night shift. I have done both, the former when I started out and now the latter as I have a small child at home. Neither work too well, you are going to feel like a zombie anyway. Just try to get as much sleep you can with whatever option you choose.

I find food prep important. I don’t want to worry about any practicals when I’m sleep deprived. I’ll prep a container of food (or recently, veggie burritos) and stash them in the fridge all ready to go for every shift. When I’m hungry and tired at 3am I’ve already got a relatively healthy meal for myself. I also like to have a hot bevvie every now and again. I keep coffee sachets in my bag (they’re marginally nicer than instant) and help when I’m trying to type my notes.

Getting There

I used to drive as usual to night shift but after I found myself falling asleep at red lights, I thought that was probably a bad idea. I now catch the train whenever I can. If I have to drive, I’ll get a drink or some food on the way back to keep me awake. I often listen to a podcast but when I’m really struggling, I’ll put on my own karaoke playlist of emo songs to sing along to while hurtling down the highway. It works.

Beware school zones. You will always drive through school zones on your way back and you might forget to slow down. The tickets usually offset any overtime.

On Shift

The most important bit. Emergency shifts function differently to during the day. Overnight, a senior registrar will run the medical side of things with an emergency specialist on call. There is a skeleton staff and less direct oversight. As a result, you may need to help out in resus more than you usually would, ordering scans, sending bloods, making phone calls and following the direction of your senior.

On nights in Emergency, do not expect to be able to sleep mid-shift as you might on other rotations. The shift is as busy or busier than day shifts. We all continue our clinical work as we usually would.

You will likely see patients as usual and report to the registrar on your assessment and plans. They will direct what you need to do for each of your patients and what their disposition will be – home, admission, ED short stay, etc. You will usually admit stable patients to a team overnight without calling them and then all the emergency doctors will call the admitting teams together at 7am. The emergency registrar makes the decision by themselves overnight if your patient is to be admitted under a certain team which saves waking people up unnecessarily. The trade-off is that teams should not be debating the admission decision with you in the morning, especially not if the patient has moved out of ED. When the patient is on the ward, they’re admitted. No take-backsies. There are exceptions when you will want to wake a team overnight, and your registrar should know when these are.

There are some teams that are in the hospital 24/7 in major centres. In my experience these are usually Mental Health, Paediatrics, O+G and General Surgery. Obviously check what the go is at your local, but these teams can be paged as usual overnight most of the time. If your patient is going to the ward and needs something followed up overnight, then discuss it with the medical registrar on overnight to let them know.

Make sure to eat, take a short break, use the bathroom overnight. If you don’t take care of yourself, you can’t take care of other people. I always hit a little slump at around 5am and this is a good opportunity to get a tea or a snack.

Before you head home in the morning make sure you finish all notes, chart all your patients’ medications and prep (or complete) all discharge summaries if a patient is likely to go home in the morning. Make sure your registrar is happy for you to go home when you finish – you may need to stay for handover or hey may handover your patients themselves.

Rest up

At home it’s essential you sleep between shifts. Some people like trying to get up and do something before their shift but I find it quite difficult. You should not make plans during the day. This is your only chance for recovery, and you need it. Everyone survives on a different amount of sleep – 5 hrs sleep between night shifts is pretty standard for me and 7 hrs is great. Less than 5 hrs and I lose the ability to smile. I still feel like a zombie no matter what.

I find earplugs and blackout blinds very helpful for good sleep on nights. I used to use blindfolds but they’re just too irritating. If you have kids, earplugs work a dream. Try a breath meditation or a sleep podcast if you wake up in the middle of the day. I like the empty bowl– it’s a meditative podcast about cereal. You do you.

Night shifts are a marathon, and you have to take care of yourself. You’ll develop your own routine. Godspeed.

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