A guide to working nights for new doctors

Working nights is a standard part of most new doctors’ rotas, involving covering several hospital wards and managing acute admissions

On the one hand, night shifts are a great learning opportunity for new doctors. You can cover unfamiliar specialties, have increased clinical responsibility and deal with acutely ill patients for the first time. But working nights is also linked with sleep deprivation, insomnia, disorientation and irritability.

It might seem harsh, but in the medicolegal world, a mistake by an overworked and tired doctor is still a mistake. Exhaustion is no legal defence for poor decision making.

By taking these steps to properly preparing for a night shift you can minimise the risks for you and your patients, and reduce the likelihood of slipping up.

Before the night shift

1. Get organised

Before your period of nights starts, make sure you see to all your life admin. Plan meals, pay bills, run errands. Don’t give the future you extra things to worry about.

2. Be active

Night shifts can have a negative effect on your health. So look after yourself generally by staying active and making healthy choices, to counteract some of the damage nights can do.

3. Prepare for common problems

There are clinical problems that patients commonly experience at night, including shortness of breath, chest pain, hypertension and hypotension, confusion and agitation, fever, hyperglycaemia and hypoglycaemia, pain and common postoperative conditions. Be prepared to deal with these issues.

4. Make sure you get plenty of sleep

It can take time to adapt, but it’s essential you sleep during the day before your shift. If you don’t, you could be working having been awake for 20 to 25 hours. This kind of sleep deprivation can have an effect on you similar to that of alcohol. You wouldn’t work drunk, so don’t work tired.

5. Avoid your bedroom when you’re awake

If possible, keep your waking activities to other rooms. It can be hard to adapt to sleeping during the day, so getting your brain to associate your bedroom with sleep and little else will help to change that pattern.

6. Socialise whenever possible

Night shifts can be isolating and impact your mental health, so make plans with friends that work around your rota, even if you sometimes don’t feel like it.

During the night shift

7. Eat and drink properly

Follow a pattern like you would during the day. Eat a meal before you start, have lunch halfway through, and make an easily digestible meal for when you get home. And don’t forget to stay hydrated.

8. Double-check

Your responses are not as sharp when you’re awake during the day, so repeat calculations, double-check drugs, and give yourself an extra second to think through decisions wherever possible.

9. Know the situation

Although MDTs are becoming commonplace there are still fewer nursing staff on the wards during a night shift. Be aware that patients are not as closely observed as they would be during the day.

10. Ask for help

There is no shame in utilising the experience of those around you and asking for help in tricky situations. It’s better to risk bothering a grumpy colleague than having an adverse incident that leads to a patient coming to harm.

11. Watch that caffeine intake

Your body’s natural rhythm hits a particularly tired spot between 03.00 and 06.00. You may feel like hitting the coffee hard during that time to keep awake, but remember that caffeine in the last 4 hours of your shift can make it much harder to get to sleep.

12. Nap

Short naps can be great for shift workers, as long as they’re kept under 45 minutes. Set an alarm beforehand so you don’t fall into a deep sleep. If you take a small dose of caffeine before your nap you should start to feel the effects when you wake up, which can help overcome the grogginess you will normally feel after a nap.

13. See the light

Maximise your exposure to bright light, as this can have an alerting effect on the brain which improves your performance.

After a night shift

14. Trick your body

Your body’s natural rhythm can be at odds with your environment, especially light, making it harder to sleep. You can help ease this disparity by wearing dark glasses on your way home, using earplugs and eye masks, installing blackout curtains, and avoiding looking at your phone.

15. Be extra vigilant

Consider the risks of driving or cycling home after a night shift. Are there alternatives you could use? Make sure you’re putting your safety first.

16. Don’t be tempted by sleeping pills

They can make you feel horribly hungover and can have addictive effects. Never self-prescribe, and consult your GP if you think they are absolutely necessary.