As a junior doctor, night shifts are inevitable. They can also be daunting for a number of reasons. This guide aims to help allay your anxieties and prepare you for working at night.
It’s 7pm and it’s just starting to get dark. You’ve recently woken up and it’s time to get ready for work. You’re feeling nervous. What will the hospital be like at night? Should you have breakfast or dinner? Will you have to take blood in the dark?
Night shifts are daunting for a number of reasons. Not only are you one of very few medical staff in the hospital, but you also have to battle against the darkness to stay awake all night. Unfortunately, as a junior doctor, these are among the many things that you have to get used to. Before you start night shifts, it is normal to be nervous and to have questions - this guide is designed to answer them.
If you’re a medical student contemplating how you can prepare for your first night shift as a junior doctor, it may be advisable to try one or two night shifts now, while you’re still a student. This would allow you to get a feel for what it’s like being in the hospital after dark, and what it feels like to be awake all night, but without the pressure and responsibility that comes with working a night shift as a junior doctor.
Before your first night shift, it's a good idea to try to sleep during the day so you are not awake for a full 24-hour period. Some people may find that staying up late the night before the first shift helps to get them into a routine. Having a lie-in on the morning before your first night shift and then having another few hours’ sleep in the afternoon is a good way to try to minimise fatigue on the night shift. Sleeping during the day can be difficult, as you are not programmed to be tired when it is light outside; however, there are useful tools that can help, such as blackout curtains, earplugs and eye masks.
During the night
It is not natural to be awake at night; as we all know, melatonin is released in response to darkness. This makes you feel tired, regardless of the amount of sleep you have had during the day. Some people may find it useful to take 30–45 minute naps to help with this fatigue. Prolonged periods of sleep, however, are not as advisable because this may prevent you from achieving good-quality sleep during the day. Also, sleeping for longer will lead to a deeper sleep, causing you to feel groggy on waking, which certainly is not ideal if you are bleeped to an emergency!
It is also common to feel sick at first, as your body is not used to the change in routine. In this scenario, you are unlikely to want to eat. However, it is important to have regular meals. Make sure that you eat enough food and stay well hydrated, otherwise you will feel more drained and nauseous as the night goes on.
Depending on the size of the hospital and the number of staff present, there may be some quiet periods at night. It can be difficult to stay alert during these periods, so it is worthwhile finding something to occupy you. It may be a good chance to catch up on your e-portfolio or to do some audit.
Help at night
Support at night time is something that most people are concerned about. You may feel more alone and have greater responsibility at night because there are fewer staff in the hospital. However, most hospitals will have a hospital-at-night team there to support you. Members of the team range from clinical support workers, who can insert cannulas and take blood, to highly skilled night nurse practitioners who have a wealth of experience and can assist in assessment and management of unwell patients. The hospital-at-night team is a very valuable resource and can give you a lot of support.
Don’t worry about asking for help, and if you feel that you are out of your depth, always ask someone to assist you. Depending on the size of the team, there may be a foundation year 2 (FY2) doctor or core trainee you can speak to if you want advice or assistance. There will also be a registrar on call. In some hospitals they may be at home but, even if this is the case, it is their job and, if you feel it is necessary, you must phone and speak to them.
After the shift
It is important to try to ensure that you sleep well following the night shift, especially if you are on a long stretch of nights. It is advisable to go to sleep soon after returning home, otherwise external stimuli, such as sunlight, are likely to keep you awake for longer. If you feel hungry, however, make sure that you have something to eat, as you do not want your sleep to be interrupted by hunger.
Finally, it has to be said that night shifts are often brilliant for gaining experience and seeing some real medicine. Some of the more mundane tasks, such as writing discharge letters, are not usually done at night. You are only normally called in the middle of the night to see patients who are unwell, or those whose cannula has tissued. It can be a great opportunity to see and manage some acute problems. With this in mind, try to make the most of it, and good luck.
Dr Jenny du Feu, MBChB (Hons)