Firstly, ensure you know your way around the hospital and know where all the wards you will cover are. This is especially true if you are the lucky doctor starting your first job on nights.
Preparation for night shifts is different for different people. You will soon decide what works for you. The general advice is to have a relaxed day n the day of your first night shift and take a nap a few hours before starting your shift. Ensure you have eaten something light and are well hydrated. Some doctors will bring energy bars and fruit to eat while on the go during a busy shift.
One of the most important pieces of advice I received as a junior doctor was to arrive early. Aim to arrive 15-20 minutes before the start of your shift. This gives you an opportunity to settle in, put your stuff away and make a coffee, ready for handover. It also gives you a chance to meet the rest of the team you will be working with on that set of nights. It always helps if you know your senior colleague (the registrar) on with you.
At hand over listen carefully. Make notes, ask questions about jobs that you are not sure about. Personally, I had a grid system when taking hand over with the top left being the unwell patients that the day team are concerned about- they will be my initial priority. Top right will be outstanding cannulae, catheterisations and other procedures. The bottom half of the page is for the more routine tasks such as writing up fluids, chasing up blood test results and such.
After hand over, my immediate priority is the top left patients. I would review these patients early on in order to gauge for myself who is likely to need more support over my shift. It was also a good way of spotting concerns for these patients early and develop plans with the nurses or after discussion with the registrar.
I am a fan of the “one touch approach”. Once you start a task, finish it and associated tasks. This is more efficient than running to and fro between wards all night.
Once the unwell patient on a ward was reviewed, I would ask the nursing staff to bring any outstanding prescriptions, fluid write ups, outstanding cannulae etc for that ward as it may be a couple of hours before I am able to head back. This act would on average add 15 minutes to my visit to that ward.
The nursing staff are always helpful and understand the pressures you may be under. If you ask for help, or develop a system with them, your shift will run more smoothly. There is no evidence that turning up to a ward without being called creates more work. I have always found the opposite to be true.
During quiet periods during your shift catch up on chasing investigations handed over from the day team and review your list of tasks. Make a note of roughly what time requested investigations will be on the system and mark that time on your sheet. I also found this to be a good time to touch base with the registrar and discuss anything I wasn’t sure about.
My advice is try not to sleep during a night shift. Usually, you will not get good quality sleep and the adrenaline spike waking you from sleep when the pager goes off is not fun! Instead, use the time to catch up on some reading, eat, drink and catch up on missed television.
During busy shifts always stay calm. Answer the pager and add to your list of outstanding tasks. Prioritise early and re-assess your list every so often, this will ensure you don’t get caught out and miss something important. This small act will give you a semblance of control. If you are concerned about a patient, take advice from the senior nurse on the ward or contact your registrar.
Eating can be a real problem during busy shifts. I preferred to eat little and often while on the go, some colleagues preferred a complex carbohydrate, high fibre meal about halfway through the shift. In time you will devise a system that works best for you.
Night shifts are hard work, they will wear you down but try not to be too downbeat about them. The other junior doctors are going through the same thing. Talk to them, confide in them and help each other. Your friends are more likely to stay an extra 10 minutes to finish a few jobs if they know and like you. This in itself will reduce your on call and night shift workload.
Night shifts are character building and they teach you to be at your organisational, analytical and logical best when you are at your most exhausted. No one enjoys them, but in time, with a system that fits you and your way of thinking you will master the dreaded night shift.
