Working the night shift

01 September 2021

Read our helpful guide by Dr Michael Daly to get you on the road to a stress-free night. 

First things first, congratulations! Chances are you’re a newly-minted genuine MD; the talk of the neighbourhood and recipient of a whole summer’s praise from extended family.

Beginning your career as a junior doctor is one of the most difficult experiences out there, no more so than that dreaded first night on-call. Here are some helpful tricks to get you on the road to a stress-free night.

This is my stethoscope, there are many like it but this one is mine

You’re staying over, but this sleepover isn’t the Babysitter’s Club, so pack accordingly. Break out the festival checklist: loads of munchables – Nutri-grain bars and diet Red Bull worked for me (personal preference), as well as a favourite hoodie and iPhone charger, which are undeniable necessities, as are a towel and a few pairs of socks (Think Lt Dan in Forrest Gump – fresh feet are the ultimate fatigue buster). Don’t forget a comfortable pair of your favourite runners, or footwear that you’re happy bouncing around in for the best part of 18 hours or so.

Find out where your hospital stocks scrubs ahead of time – there’s only so many times you can get questionable NG output on your favourite civvies before you give into the scrubs culture, so learn that lesson early and save yourself the dry cleaning bill. I often wore my white coat while on call – it’s got the benefit of pockets, and plenty of them.

A large part of time on-call can be spent going from nursing station to clinic room to bedside, getting cannula kits and searching for that last elusive ABG. You can knock a lot of that hassle out by having three cannulas of varying size, tegaderm, alco-wipes, tourniquet, blood vials and a venepuncture/ABG kit tucked into one pocket, and your mobile, bleep(s) and stethoscope in the other.
Finally, we live in the app age, so ditch the textbooks at home and invest in developing a portable app library for instant reference.

The nice thing about teamwork is that you always have others on your side

The best way to approach ward work is to round. Often. The single most important thing you can cultivate over the course of your time within a rotation is the trust of nursing staff. Trust is a two-way street and it begins with empowering them to do the job they’re trained to do. Do a quick round to all the wards you’re going to be responsible for as soon as you come on duty, being careful not to interrupt handovers if possible.
Mention to the lead sister or supervising nursing officer who you are, and that you’ll be rounding throughout the various wards in a systematic fashion three to four times over the on-call shift an hour or two apart. Harness the awesome power of the job list, explain that all requests for IVF fluids/analgesia/anti-emetics/warfarin dosings and canulas or NG placements that will be required overnight are written down on these lists and you’ll be back in an hour to get them done early.

Some jobs are not on-call issues and are left over from the day, eg, recharting drug charts. It may not be appropriate to dedicate valuable time to this, but if you have the time and are on the ward having a chat with the nurses, you’ll never lose friends by helping out your colleagues. Work with your on-call buddy if you have one. Round together. Olympic athletes will tell you that quality training is done in a group, not alone. You might find your game is sharper with someone else to bounce ideas and differentials off.
Always try to swap the bleeps at 01:00 if the rounds have reduced the pager’s whine to an occasional siren. This way, you both get three hours’ protected sleep a night, which can make all the difference if you’re staying in for rounds and/or theatre in the morning.

“To be afraid of asking is to be ashamed of learning”

If you don’t know, ask. And if you’re wondering whether or not to ask, ask. Help is only ever a pager away. You’re never alone on-call. In fact, in a hospital environment, you’re only ever limited to the amount of support that you choose to employ.
It’s very important to begin each referral correctly and state upfront and directly what you want from the referee, ie. does the medical reg need to drop what they’re doing in the ED and attend the ward right now, or is it just about advice regarding the most appropriate analgesic for the palliative patient with breakthrough pain? A suggested framework is the SBAR approach:

Situation: Introduction and stated request

Background: When and why was she admitted, co-morbidities, current issue/obs and recent investigations

Assessment: “Based on my findings I think the current problem is...”

Recommendation/request: “I recommend we do X, Y, and Z”