Nights in hospital can be one of the most daunting experiences for a junior doctor. The lack of supervision, reduced staffing and the worst of them all, limited cafeteria opening times, just to list a few. Know what to expect with the brief guide below.
Clinical work after hours
Night shifts usually last 12 hours, from 8pm/9pm to 8am/9am in my experience. There are other shifts e.g. twilight shifts that can help bridge the gap between the day team and the night team. Some of the notable changes after hours include:
Reduced staffing levels
Generally there are less people available on site, this is because a lot of the routine day work such as ward rounds are not carried out at night, and you are mainly there to complete any urgent tasks that needs to be completed overnight, or to deal with new emergencies that arise. Bear this in mind as this will form the core of what you should and shouldn't be expected to do.
The benefit of this is that the hospital feels less crowded. I personally feel a lot more productive at night simply because I am able to get a desktop computer to work with on any ward, whereas during the day it can feel like a war zone trying to get a laptop for ward rounds (which by the way, also takes ages to load up and/or crashes at the worst timing possible)
Reduced senior support
This comes with the first point on reduced staffing. Departments that I have worked in generally only have an on call team consisting of a registrar overseeing the juniors (while needing to post take patients and answer calls for advice from other teams) an assortment of 2-4 F1s and SHOs divided into ward cover or clerking roles.
You can sometimes find yourself stuck and complain about how long it takes for your seniors to answer your bleeps, but trust me that they are often just as busy as you are!
The workload at night can be variable but is generally lighter than the day (emergencies aside). I find that for clerking, you tend to get more unwell patients simply for the fact that if patients themselves wouldn't generally seek emergency help during the night, unless they really feel the need for it. For ward cover, the working pattern tends to ramp up immediately after nursing handovers, then it quiets down during the 2am-6am period, before the incessant bleeping at 6am when they start taking observations again and find the patients with reduced conscious level, which turns out to be drowsy patients being woken from their poor sleep in an unfamiliar environment. (Disclaimer: Please still treat all your bleeps seriously, most nurses have a keen eye for unwell patients)
Tips for survival
Eat well and rest well
Food is essential! Similar during the day, take your breaks when you need them. The cafeteria may not be open as long as it is during the day, so consider preparing your own food in advance. Bring snacks too for when you just need a quick energy boost.
Getting sleep during nights is a bit of a debate. It really depends on your body composition and normal sleep patterns. I tend to avoid naps because it makes me less likely to be able to sleep during the day, whereas others would want to get every second of shuteye they can. The important thing is, if you feel tired and you can afford to, give yourself a well-deserved break. After all, you are potentially putting patients in harm's way by not being at your best.
You will inevitably come across unwell patients during your shift. Go ahead and assess the patient and start initial treatment. You may feel out of depth, you may feel confident, but you should always make your seniors aware of these patients as they can deteriorate again. If you are at wits' end, ask your seniors! It is a trial by fire, but still a learning opportunity for you. As an F1, you are only expected to do so much, so never feel like you are being a pain.
As I mentioned above, the purpose of nights is to complete essential jobs and ensure patients survive till the morning. You are not expected to catch up with non-urgent tasks such as writing discharge letters or requesting outpatient procedures. If you have time to spare, by all means help your day colleagues out. But when you feel overwhelmed, those should be the first ones to cross off your jobs list.
As a rule of thumb, your priority list should go unwell patients > urgent tasks > non-urgent tasks. Often you can also find yourself doing multiple at the same time. After starting initial treatment for a sick patient, give yourself time to document and also for the treatment to take effect. Use the time to then work on some urgent jobs while ensuring you are either nearby/easily accessible so that you can return quickly should the patient deteriorates. There can be a bit of a blur between urgent and non-urgent tasks but here are some examples:
Urgent: Requesting CT for a patient with abdominal pain for ?perforation, this can change management and patient can require theatre overnight. Same goes with the group and save + coagulation profile they need for emergency theatre.
Non-urgent: Prescribing sleeping tablets, maintenance fluids
Adjust your sleep schedule
This is a separate tip from actually surviving the nights itself, but to acclimatise your body to the new day-night cycle. I find the best thing to do is to use your rest days to gradually push your sleeping time backwards to coincide with the night shift hours. For example, if I had 3 days of rest prior to 4 nights in a row, I would sleep at 2am, then 4am, then 6am so that I am then prepared to sleep at the end of my shift at 8am the following day.
This may not be applicable for everyone, but because of lockdown and the travel restrictions, I don't really have a need for long breaks. Consider splitting your annual leave to pad out rest days before and after nights so that you have more time to adjust.
Some people have found good use for medications and supplements like melatonin. I have not used them before and I even avoid caffeine, but if you are really struggling, consider trying them out.
Enjoy the quaint feel
I find that nights have a different charm to them. Whilst I enjoy the camaraderie during the day, I also love the working style at night. I personally find the worst part of nights to be adjusting my sleep, and I would even go as far to say I would do all my nights in a row for each block just so I don't have to swap back and forth between the cycles every other week.
Share your experiences and any interesting stories you have whilst on nights!