I’ve been asked to write about my experiences working on night shifts as a doctor and how to adapt from day shifts to accomodate night work (tips below). I am currently working night float for all of January 2019 which means 5 nights a week, roughly 14 hour shifts (7pm-~9am Sunday night to Thursday night). In the past, the maximum amount of nights I worked in a row was 5, when I worked a week of nights in the Penn Trauma Bay then I did a month of nights covering Vascular and Plastic Surgery.
I actually enjoy night shifts for the most part because it is quiet, there is no distractions and you have more autonomy over patient care and placing orders. When I worked in surgery, I used night shifts to study for my final USMLE exam (United States Medical Licence Exam Step 3) so the quietness overnight was to my advantage! I also found that during night shifts, you usually have a few very sick patients to follow up on regularly otherwise, about 50% of the patient list is generally stable and hopefully sleeping aka no nursing calls about them.
I’ve had to adapt to different styles of night shifts over my last 3 years of work through different countries and specialities. It is also currently very different to when I worked in Ireland, as here in the US, I rarely see other doctors around. In Ireland, we would only do a week at a time of night shifts at a time and there would be other interns and senior residents on call too, so there was other people to talk to, run questions by, hangout with etc. On surgery, it was just me and a senior resident or fellow who was on call from home, so I sat and did my work alone every night and rarely called them only if a patient was acutely crashing or needed an emergency intervention. On family medicine right now, there is one second year resident with me on call but they’re generally doing their work independently to me so again, I find myself alone most of the time.
Before answering some questions that were asked of me via blog/instagram followers, I want to say that I am in no way an expert about converting from day to night shifts, these are just my experiences and what has helped me get through!
Here are some of my tips:
Sleep well during the day !
I have blackout curtains and an eye mask that I use daily. I also have super good ear plugs which I use depending on how loud it is in my building/outside. At the start of night shifts when I am still converting, I sometimes take 3-6mg of melatonin to help me switch over. Taking melatonin also helps if you are jetlagged!
When you get home, take a warm shower to de-stress you and calm your body.
I always do that first thing when I get home no matter if it is day or night shifts. After that, I change into PJs and I relax in bed to calm my brain before sleep. Some people find relief with essential oils/diffuser so if that works for you, then do it! Other people also restrict their screen time which means, getting off their computers/phones/tvs, but to each their own, I am on some sort of screen always and it does not affect me in a significant way. One person asked me about essential oils – I personally do not use any but there are studies out there that show beneficial results so give it a go! Make sure you are buying good quality oils though, that are pure and organic if possible.
I find it really useful to think of the hours as opposite.
So for example, I think of 7PM as 7AM etc, and that way I just train myself to adjust. So when I get home and it is 9AM, then I think of it as it being 9PM and so I rest for an hour before sleeping at 10AM and I generally set an alarm to get up at 4:30PM-5PM so I can workout if I feel up to it, or sometimes I snooze till 6PM hehe. I even maintain the same cycle on my days off so that I don’t flip flop and confuse my body clock.
Eat Less and Hydrate More
I switch it up, sometimes I eat a larger meal before coming to work if I know it is going to be busy and I won’t have time to eat. But for the most part, I tend to do more liquids/light meals for the first half of the shift and then have breakfast food like oatmeal or a bagel in the morning at the end of the shift before heading home. So usually only one ‘heavier’ meal and the rest are very light. I find that eating light helps me to stay focussed and more awake. I also sleep better during the day if my stomach is light. I also find that I get more reflux/GERD/gastritis overnight if I eat so I’ve started to do more liquids and I found it really helps. It is also important to allow your body/gut/bowels to adjust to a different sleep/wake cycle, so be patient with your body’s natural functions going a little wacky before it settles.
I used to do redbull/espresso/lattes in the past, now I only have 1 cup of tea sporadically, not daily. I also do not drink caffeine on a daily basis but just stay in tune with your own body and its needs. If you’re someone who drinks caffeine on a daily basis, it may be difficult for you to convert over, but try to ease into it until you are able to flip your schedule around completely.
Don’t allow yourself to get isolated/lonely.
Try to keep busy, reach out to friends you know are awake, start a new book/movie/tv show. I go crazy from time to time when there is nothing else to refresh on your IG feed, no one is awake to snapchat you back and you’ve exhausted all the good shows on netflix haha! So when you have time off work, try to spend it with friends or do something that will help fill the void that you’ll experience on night shift. I also occasionally go for walks around the hospital to keep moving if it is a quiet night so I don’t feel isolated in a call room alone.
Don’t nap during the shift unless you absolutely have to.
I find I am less cranky/irritable if I am awake the entire night. I am also more able to think clearly when I am alert. I find that resting/lying down with your eyes closed, only makes you drowsy and plus when the pager goes off when you’re just about to doze off is the worst!
Try not to get overwhelmed.
It can be easy to freak out when you’re getting many calls/pages at once and have to deal with a lot. But remember, you are only human and you can’t be in more than one place at a time. Triage nursing calls from the most severe to least and create a list of things to do. Once you get organized, pace yourself through it, take some deep breaths and don’t stress out. If you need help, ask a colleague, call a senior, call an attending or consult, ask for help always, don’t be scared to do that. I usually update the nurses something like “Ok I have to take care of some other more urgent matters but in the meantime let’s do X, Y, Z” or alternatively, just call and update them that you’re seeing other more ill patients first and that you aren’t ignoring them and will be there when you can. It will help the nurses understand what you’re doing and it will help you keep your tasks in order in your own head.
Keep a countdown on the amount of shifts left.
I always have a countdown to the last day of night shifts. It helps me to feel accomplished and I like to see the progress I’ve made over the past few weeks. It can get hard to work week after week and feeling like it’s never ending, but having a countdown or crossing off days on a calender helps me feel more settled.
These are just some tips that have helped me get through my many many weeks/months of night shifts. It definitely is not easy to adapt at the start but stick with it and you’ll feel and do better! If you have any comments or tips that you want to share, please leave me a comment below. Good luck!
IG: @yashodasingh & @beauty_itsYlife