Surviving night shiftsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7532.s7 (Published 07 January 2006) Cite this as: BMJ 2006;332:s7
- Douglas Noble, senior house officer in general surgery,
- Ellen Funnell, preregistration house officer in general surgery
If you've just started work as a doctor you've probably not worked night shifts before. Here are 12 tips you might find helpful.
Arrive 15 minutes early so you can compose yourself and be ready for handover.
Pay close attention at handover and make sure you get all the important details from your colleagues going off duty. It's much harder to find these facts at 3 am on a dark ward when the notes are missing.
Graciously accept jobs that you think should have been done during the day; you can't change it now, and you don't know what the day shift was like. If in the long run it looks like you have lazy colleagues, sort it out when you are a day worker once again. There's no point starting the shift angry.
Make sure there is a filter coffee machine in the doctor's office. Currently, Argos sells one for £7.99. Smooth filtered coffee is stronger and tastes a lot better than “instant filth.”
Phone all the other on-call doctors you're likely to work with or refer patients to, informing them that the filter coffee is for all. This makes subsequent referrals and opinions easier to obtain.
Try and pre-empt problems. Some doctors don't like to go to the ward unless they're called as they think jobs appear just because they're there. We haven't found this and visiting all the wards you cover allows the nurses to raise issues when the ward lights are still on and it's easier to address their concerns.
Do a quick eyeball round of every patient. Identifying a problem early saves a lot of time later. A quick, more formal ward round of your patients on ITU and HDU is usually helpful.
Try and identify major problems or likely ones between 6 and 7 pm. Deal with these first, preferably before midnight, so that if you need to call someone, such as the consultant, at home it is before they go to sleep. However, never be afraid to call for senior help in the wee small hours. In the long run you can only be criticised for not doing so.
Don't sleep on the night shift; try and stay awake if it's quiet. Do some reading or watch TV or write an article for BMJ Careers. The sleep you do get is poor and it's only likely to make you grumpy if you do get woken up. Sleep during the day and try and make your room as dark as possible, but leave a window open so it doesn't get too hot.
If you have to commute home a significant distance, consider requesting an on-call room and putting up with life in the hospital for a week. It's a good chance to catch up on film watching. Otherwise drive home after sleeping to catch up with friends and family and reduce the risk of an RTA.
Eating can be a real problem and dehydration is nearly inevitable. Try not to snack, but eat high fibre complex carbohydrate meals—one before your shift and one halfway through. Carry a bottle of water around with you religiously. It's best not to eat before you sleep, but sometimes it is unavoidable as it's the only time you feel hungry.
Try not to become too despondent. You're not alone. Night shifts are awful, everyone knows that, and they do cause severe fatigue. At least being aware of this can help you to focus and get the week out of the way without too much stress. ■