Surviving your first set of night shifts as a PRHO

Night shifts are often viewed as the most daunting part of the preregistration house officer (PRHO) job, balancing admissions and demanding wards. Careful preparation can help to reduce your anxiety. Here are our tips.

• Get a good day's sleep. Adjusting quickly will make the whole week better. A big night out before you start your week of nights may help, but if you wake up with a hangover then the night could drag on and on.

• Go to work prepared: your tourniquet will be vital as nobody else will have one. You'll also need a pen, paper, and a decent pen torch to prevent fumbling in the dark for switches.

• Be polite and courteous to the nursing staff. They are experienced and if they are concerned about a patient, you should be too. You should always ask for the latest obs (observations) and what they are normally, and if a patient has chest pain request that the nurses do an electrocardiogram for your arrival (if possible).

• Prioritise jobs: a patient who has fallen out of bed with no apparent injury and stable obs can wait, but another who has become unresponsive cannot. Some jobs can be dealt with over the phone—simple analgesia and fluids can often be “prescribed” verbally and written up later. Make a jobs list, and don't lose it.

• Pre-empt unnecessary bleeps by asking if there are other jobs that need doing when you are on a ward—ensure intravenous fluids are written up until the morning.

• Always document your actions in the notes. It is useful to leave questions in a patient's notes to the day staff on how they want a problem managed should it recur.

• Look after yourself. It's easy to neglect your own needs. Stop and have a coffee and something to eat.

• Don't be afraid to ask for help—support is always available. Now that most people work shifts, the chances are your senior house officer is awake too.