From medical student to junior doctor: the night shift
BMJ 2006; 333 doi: https://doi.org/10.1136/sbmj.0611422 (Published 01 November 2006) Cite this as: BMJ 2006;333:0611422
- Geoffrey Robinson, physician and chief medical officer1,
- Sharmila Bernau, senior research fellow2,
- Sarah Aldington, senior research fellow3,
- Richard Beasley, general physician3
- 1Capital and Coast District Health Board, Wellington, New Zealand
- 2Capital and Coast District Health Board, Wellington, New Zealand
- 3Medical Research Institute of New Zealand, Wellington
Working through an entire night is now a standard part of most junior doctors' rosters. The competing needs of service provision and limited hours has resulted in the widespread introduction of night shift systems; a junior doctor will cover several hospital wards, as well as manage acute admissions, between the hours of 10 pm and 8 am.1
The doctor may be required to work up to seven such shifts in a row, a system that has been designed to reduce the effects of sleep deprivation on clinical decision making and improve patient safety. 12 However, working at night for a week is inherently stressful and may drastically affect the wellbeing of junior medical staff and their patients.13
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It's not easy
Occupational physicians have long recognised that regular night shifts have a negative impact on physical and psychological wellbeing. Junior doctors work intermittent night shifts only and are therefore not at risk of many of the chronic health effects of regular night work.1 However, intermittent night shift work for doctors is also associated with tiredness, sleep deprivation, low mood, and increased stress.14 Other negative psychological effects of night shifts include a feeling of unwanted, increased clinical responsibility, isolation from medical colleagues, and the stress of covering unfamiliar specialties.1234
Before the shift
Although night shifts are supposed to improve patient care by avoiding 24 hour shifts, working up to seven night shifts in a row often generates serious sleep deprivation.15 Many of the other stressors of night shift are exacerbated by tiredness, so box 146 lists some suggestions to minimise risks while on nights.
Box 1: Tips for before the night shift
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