Some Advice On How To Cope
Thankfully first years are no longer allowed to do nights in their first 3 months, and most DHBs specify none in the first 6 months. This enables you to (hopefully) get a good grounding in basic medical knowledge before you are thrust into night shifts. You are not allowed to work on the day that you start your night shift.
How do I change my body clock?
There is no good answer to changing from day shifts to night shifts. There is evidence to show that 7 nights in a row is too many and the maximum should be 3 or 4. Some DHBs already have this so-called “split nights” and the RMOs generally prefer this. Essentially your body is “jet-lagged” for the week of nights and then “jet-lagged” for the next week of days! It is a crazy situation, but unavoidable because of the nature of our work. But be clear about one thing: this is not like doing a once-a-year all-nighter before your med-school exams. You need to be at your most attentive for your patients. One suggestion is to stay up late the Thursday night, and sleep in until about midday Friday. This helps your body clock adjust to the first night, as most people find this the worst shift. Also, if you can, have a nap in the Friday evening before work.
Should I take sleeping tablets?
There is no clear answer to improving your sleep during the day. After a night shift some people have breakfast and fall straight asleep (mmm…serotonin…). Others go for a run to burn excess energy and then pop into bed. Others have a glass of wine. Whatever you choose to do, have a quiet room with dark curtains, and turn off your phone and pager. No-one likes being woken whilst sleeping during the day! Remember you need to sleep, and if you don’t get enough overnight, then you MUST get it during the day. If you think you need a sleeping tablet to help you sleep during the day, don’t prescribe one for yourself. Go to see your GP first. And stay away from the benzos!
What do I do during nights?
Nights are potentially the most dangerous time in hospitals. Nursing staff are tired and staffing is at a minimal level. You may be irritable, tired or not thinking clearly when on nights, this is common. When you are paged it may take a minute or two to make sense of the situation. Make sure you are fully awake when answering questions and try not to defer urgent things. Patients can’t choose when they get sick! And never ever refuse to see a patient if asked; this is medico legally unsafe. Only urgent and emergency calls should be dealt with overnight. If it can safely wait until the morning, let it wait. Catch a nap if you get the chance. These “micro-sleeps” have been shown to assist alertness whilst working night shifts. Many DHBs supply beds for house surgeons during nights. If yours doesn’t, ask them why not, or contact the NZRDA. The “you can’t sleep on nights” view is outdated and is against health and safety guidelines and common sense.
What do I do if I’m busy overnight?
The aims are to control the workload, defer all non-urgent stuff, and provide the best care for the patients and best support for the nursing staff. The first thing you need to do is a round of the wards. Introduce yourselves to the night nurses; often they only do night shifts! Ask if there is anything that needs doing on the ward. The nurses love this and it makes them feel confident they are in capable and responsive hands.
Leave a list on each ward with your pager number on it, so nurses can page you if anything urgent comes along. Otherwise tell them to write the non-urgent stuff on the list and tell them you will be around at 2am and 6am (for example) to “replace leurs and chart fluids”. Ideally the fluids will all be charted for you, or you can do them at the start of the night. When you are busy you don’t want to be running from one end of the hospital to the other just to chart fluids. Using a system like this leaves you free to deal with urgent stuff and emergencies with sick patients.
Remember patients can get very sick overnight! You shouldn’t be called to see patients in ICU or CCU. If you have any questions, no matter how stupid they may seem, ring your senior. They would rather know about things early rather than later. If you need a patient reviewed, ask for a review. Also keep in contact with your colleagues in the ED. They are a never-ending source of information and support. You are never alone.
Finally, know CPR and basic airway / resuscitation skills. That’s all you need to keep someone alive until your seniors arrive!
What about food and drinks overnight?
Keep up your food and fluid intake overnight. Your body naturally dehydrates overnight, so keep on top of this. Make sure the meals supplied for the night house surgeon are reserved for the night house surgeon. There is nothing worse than starving on nights because some hungry day house surgeon has eaten your meal!
How can I help the night house surgeon?
The day and evening house surgeons can help their colleagues on nights by remembering simple things, like charting fluids, charting paracetamol and sleeping tablets, and making sure there is as little as possible to hand over to the night person. Remember the nights can be a busy time and it’s far easier for 4 afternoon house surgeons to do 2 leurs rather than 1 night house surgeon to do 8 of them.
