How to survive the night shift

Learning how to manage a night shift will protect you and your patients, says Sara Dawson

Working nights is a great learning opportunity for new doctors to cover unfamiliar specialties, have increased clinical responsibility and deal with acutely ill patients for the first time. But a lack of sleep can strongly impair human functioning.

A mistake by an overworked and tired doctor is still a mistake. Exhaustion is no defence for poor decision-making. Doctors who adequately prepare for a night shift minimise the risks for themselves and their patients, and reduce the likelihood of making errors.

Before a night shift

• Be organised – Sort out personal issues, such as paying bills, before starting night shifts.
• Be healthy – Generally living a healthy and active lifestyle may reduce the negative effects of working nights.
• Be prepared – Several common clinical problems occur on night shifts, including shortness of breath, chest pain, hypertension and hypotension, confusion and agitation, fever, hyperglycaemia and hypoglycaemia, pain and common postoperative conditions.
• Get plenty of sleep – A doctor who has no sleep during the day leading into a shift will have gone 20-25 hours without sleep. This could reduce the level of their psychomotor performance.
• Socialising – See your friends or undertake a sporting activity. 

During a night shift

• Eat and drink properly – Follow a similar eating pattern to the one you follow in the day. Eat a main meal before you start, have “lunch” halfway through the shift and an easily digestible meal when you get home.
• Double-check – Your response is not as safe as it is during the day, so repeat actions such as calculations, and double-check drugs and doses.
• Remember – There are fewer nursing staff on the wards, so patients are not as closely observed as they would be during the day.
• Ask for help – Grappling with a difficult specialist is better than having to deal with an adverse incident that leads to a patient’s death. The one thing you don’t have is experience.
• Caffeine – The circadian nadir is between 3am and 6am, so it may be tempting to drink more coffee to keep awake, but remember if it is consumed four hours before the end of your shift it will make it harder to sleep.
• Take naps – Short naps have shown to provide positive benefits for shift workers, but they should not last more than 45 minutes. Set an alarm beforehand to prevent you falling into a deep sleep. By taking a small dose of caffeine before your nap, you should start to feel the effects when you wake up, which may help overcome the sleep inertia you will feel after a nap.
• Maximise exposure to light – Exposure to bright light has an alerting effect on the brain and improves performance.

After a night shift

• Limit the effects – Our bodies are controlled by our body clock, situated in the suprachiasmatic nucleus (SCN) in the hypothalamus. It generates circadian rhythms that regulate the physiological processes in the body. Working nights causes a mismatch between the circadian timing system and environmental synchronisers. Circadian rhythms are strongly influenced by natural light and dark, so wearing dark glasses on your way home, using earplugs, blacking out curtains and turning off your phone, will limit the effects and make it is easier to sleep during the day.
• Be extra vigilant – If you’re planning to drive home, consider the risks of doing so. If in doubt, make alternative arrangements.
• Sleeping pills are not recommended – They can cause hangover-like symptoms and may be addictive. Consult your GP if you think they are necessary; never self-prescribe. 

More support from Medical Protection
If you need advice, contact a medicolegal adviser at medical.rsa@medicalprotection.org
or 0800 982 766.