Beating the night shifts

No-one likes night shifts. The sleep deprivation along with being out of sync with the rest of humanity can be pretty demoralising.

Why they suck

Along with the well documented evidence that it leads to mistake-inducing fatigue, dodgy drives home and concerning long-term health outcomes.

Other, more anecdotally down-points include the social isolation that occurs as you work in the upside down. This can be particularly acute if you work in a job that involves less teamwork (I remember when I was the sole ward-cover for a small hospital- wandering around solving minor problems on my own could get pretty lonely).

Sleep deprivation is particularly devastating. The insult to your circadian rhythm can not be underestimated. Awareness of this the first step to dealing with the inevitable fatigue.

Some people just do it better than others. Non-morning people, younger folk, and, more surprisingly, certain personality traits such as extroversion. However, it certain lines of work they are a fact of life. So we should look at the positives and how best to deal with the shitty fact of life.

Some up sides

There are benefits to be had as well. A tight-knit staff team tends to develop as pointed out by this short but wonderful guide for nurses. The few against the many mentality is very binding and if that 4 am lull develops it’s the time to talk some silly nonsense with some people you don’t know that well (yet!). Plus, breakfast after the last in a set of nights has been some of the most frontally-inhibited fun I have had without alcohol.

Personally, I also enjoy the informally that develops overnight. With the managers and bosses all tucked up at home. The shared office becomes your office, whatever ridiculous aspect of the uniform policy someone is trying to enforce this week no longer applies and you can wander the halls freely unencumbered by day walkers.

Secondly, the educational opportunities are not so obvious, but actually working out of hours stretches you just enough, forces you to take that extra half a step in decision making that means you are becoming better at what you do. However, the longer I do this the more decision I realise can be put off til the day- when you realise the tricky decision you are wrestling with is not urgent it is incredibly liberating. Caveat being; if in doubt- ask for help (even if that is from the boss at home asleep).

However, I do think thriving is a little ambitious and most of us would settle for survival. Everyone is different, but here are some handy tips from a variety of sources

The best of the net

The st-emlyn’s guys have a great selection of top tips. Annoying as it was, I had to take on board there advice to not indulge in ethanol the night before (unfortunately getting knocked out, isn’t the same as good quality sleep)

As mentioned earlier, some nurse-specific tips , which is a very upbeat collection with good emphasis on keeping yourself busy and bonding with colleges.

The BMJ has a typically evidence-base approach to getting the best sleep possible. In short, sleep before, nap if you can and no caffiene 6 hours before you likely hours of sleep.

The Emergency Medical trainee association has launched a campaign #rest. This is a good resource to delineate you rights as a trainee; including the right to a 30 minute uninterrupted break. These focus on you not being a hero, generally good advice.

For podcast fans, this smacc talk talks nicely about the circadian rhythm and the interesting idea of casino shifts (basically shift that either finish or start in the wee hours (2-6 am) so everyone gets some sleep in the middle of the night.

My tips

Everyone has there own method, it is good small talk to discuss what works for others and find out what works for you. For what it is worth this is how I have survived over the past few years

  • Stay up a little late the night before, then have a decent lie in morning off.
  • Try and have a normal day leading up to first shift, it is hard when you are thinking about work but you are about to take a hit of free time so need to use it.
  • Post-dinner, pre-shift coffee, then I avoid drinking coffee at work . These avoids me getting too wired and means most of the caffeine has worn off by the time the shift so you can day sleep a bit better.
  • Eat good food. By these I mean stuff you enjoy, good solid meals, not just constant sugary snacking for twelve hours- these self-rewards just don’t last long enough to be worth it and they make you feel worse long term.
  • Don’t make any difficult decision in the last hour of the shift. Seriously, this is the most important one. Discharging patients home, ethically awkward decision, difficult procedures. A lot of these can all wait another couple of hours for someone whose brain is fully intact.
  • Prepare you room for day sleeping. Blackout blinds are a great investment, tell the people you live with, negotiate with builders next door in advance. Get somewhere quiet and dark. Get as many hours as you can in. They when you wake up do whatever makes you relax, watch t.v, go for a run. Enjoy the hours before work in a non-responsibility driven way (it always helps if life admin- washing and stuff, is done week before the shifts!)
  • Go do it again. If you have are lucky enough to self-roster I would do 3 or 4, and less not worth the disruption, any more really wears you down.
  • I have not really managed a way to come off a run nights effectively. The best way is a team breakfast whenever this practical. I generally end up sleeping in the day too much and then having weird evening of wanting to go to bed but being wide wake at 2am. Not good.

Some people are made for the 9-5, some people have to adapt to the strange.
Although the abstract ideas are not that much comfort at 3 am, the fact that you are in a job that is so important it requires 24 hour coverage is something you should be proud of.

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