Congratulations! Someone out there trusts you enough to manage a hospital full of sick patients overnight! You will be the first port of call for cannulae that slip out of veins, for patients in post-operative retention that need catheterisation, and for urgent reviews of chest pain and shortness of breath. Nights are long. There is the cacophony of bleeps (why is everyone hypertensive at the same time?) punctuated by long stretches of silence where you find yourself afraid to fall asleep because the moment you do, your patient will crash and a code blue will be called. But there are a few simple steps that will keep your night manageable and your sanity in check. 1. Get a proper handover from the evening shift. Yes, it’s tempting to encourage your colleagues to get out of the hospital while they still can, but not getting a proper handover screws you over at three am. Does this patient need more fluids? Why is this patient fasting? This patient is hypotensive, is this there baseline? Asking your colleagues for a brief rundown of each patient’s plan and any expected issues overnight will let you anticipate any major (or minor) dramas. 2. Caffeinate early. By all means, come prepared with a large coffee at the start of your shift. But more than one or two will leave you wide awake at the end of your shift and unable to sleep. Drink your coffee during handover, and then swap to herbal tea/fruit tea. Or better yet… 3. Water. Drink lots and lots of water. I am for at least 1L per shift. Are you writing notes? Fill up your water bottle and drink as you do. Running between wards? Take your water bottle with you. Clerking patients? Drink while you write up their admission notes. 4. Resist the urge to devour chocolate and candy. Yes, I know it’s hard when every ward has a selection of tasty treats at the nurses’ station. But too much sugar leads to the dreaded sugar crash and makes fatigue worse. Stick to low-GI, high protein snacks and you’ll feel much better. My personal favourites are sunflower seeds, pepitas, and nuts. Easy to munch on and don’t weigh you down. 5. Try and eat a proper “lunch”. Having some sort of meal mid-shift tricks your brain into thinking you’re working normal hours. If you have a breakfast before your shift, a lunch during, and a dinner afterwards, it’s almost like working during daylight hours, except not really. 6. Prioritise. Try and do bloods and cannulae in a round before patients go to sleep or when they wake up. Unless they have antibiotics due at 2am, there’s really no need to wake patients up unnecessarily. Also, if they need an IVC for 8am antibiotics, leave it until the morning. They will inevitably tear it out in their sleep otherwise. 7. Ask for help. If you’re not sure, ask. Don’t worry what others will think – it’s better to ask and feel like a fool than not ask and not be able to sleep later. 8. Keep a list. Write down what you’ve done for every patient you see overnight. It makes handover a lot easier, you won’t miss things, and it allows you to keep track of what you need to follow up on. Saw a patient with chest pain? Better write that down so I remember to repeat trops at 6am. Patient had pain? Better remember to ask the home team to review that. Night shifts are a rite of passage for almost every junior doctor. Hopefully this list makes them a little more bearable and gets you through the night! Source
