Because?
My night shift will start at 11pm, the first night of four-in-a-row.
Night shift is a mix bag of coffee-induced wakefulness in an artificially-lit building that can range from quiet (rare of course) to crazy. Resource is always limited, hospital staff are somewhat tired and the cafe is non-existent.
With 3+ years experience of doing monthly runs of 3-4 night shifts in a row, I present you my top tips of surviving nights as a junior doctor.
Pre-nights
1. Plan ahead
Knowing that you'll have nights in the next 2-3 weeks will help you mentally and physically prepare for it. If you're working in the wards, your colleagues will love you if you have prepped the discharge summaries of those long-term patients expecting to be discharged during your nights. Preparation also applies to petty things like getting snacks-to-share when they are cheap...
2. Know what you're covering and the resources available
Which ward? Do I have to cover extra wards? Where and when is handover? Who will you get if you call the Medical Emergency Team? How to make a MET call? Do we have 24-hour xray/bloods/CT or do we have to call them in to do it? Working in a provincial hospital for 2 years with only on-call xray service for serious conditions only and CTs for life-threatening/time critical conditions really change the way you manage patients.
3. The day before
I try to teach my body to 'prepare' for nights with this regime (day 0 is the first nights)
Day -1
Skip morning coffee > tire myself with exercise (haha) > sleep in the afternoon > late evening coffee > if I can't resist it, sleep early say 10pm > try to wake up at 2am day 0 > sleep again from 9am of Day 0
Day 0
Continuation of above. Wake up in the afternoon for zohor prayers > do not drink coffee > sleep after Asar or Maghrib (late afternoon) > wake up 1.5-2hrs before the shift depending on travel time > COFFEE! > Showtime!
Nights
1. Minimise error
Humans are not nocturnal species and everybody who have actually done nights can vouch that nights can just be brain-numbing.
Hence, have a set of go-to medical calculators/websites/cheat sheets that you can jog your memory when charting that medicine to check the dosing or contraindications, or just double-check on other life-threatening condition before you discharge that patient with what sounds like mechanical back pain..
My list includes
MdCalc - medical calculator including scoring guides
NZ Formulary - doses, indications and contraindications of drugs
Life In The Fast Lane - ECG reviews and basic management of ED presentations
Don't Forget The Bubbles - Paeds stuff
EM cases - Reviews of ED cases' management
My list includes
MdCalc - medical calculator including scoring guides
NZ Formulary - doses, indications and contraindications of drugs
Life In The Fast Lane - ECG reviews and basic management of ED presentations
Don't Forget The Bubbles - Paeds stuff
EM cases - Reviews of ED cases' management
2. Triage
If you're working in the wards, nurses will page you asking for more pain relief, laxatives, fluids etc.. By all means be nice to them (because if you work long enough, you'll know that nurses run the hospital, just saying....) but pay attention to the distress call or vague 'I don't know what's wrong but this patient doesn't look right despite normal obs'. Uh oh... But don't panic, see next step.
3. Notes, leads and bloods
If you're still a while away to see this 'vaguely not-right' patient, ask the nurses to have the notes by the bedside, do an ECG and send basic bloods. If when you arrive the patient does look sick...
4. People die in alphabetical order - so A, B, C is priority!
I expect my nursing colleagues to ring the emergency bell/call sooner/sounds panicky if Airway and Breathing is ever a problem and so far, the expectation has been met. Trickier bit is the Circulation and Disability (neurological deterioration) which can be more difficult to recognise and even harder to assess. If you can't get past Airway....
5. Basic is best
Basic and Advance Life Support are designed to be simple. Follow it. Simple airway adjuncts like chin lift goes a long way...
6. GET HELP EARLY
Can't stress this enough. Get senior help, mobilise your resources (eg call the xray/CT person earlier) because help might come in person in the next 15 minutes... which is a LONG time if you have a sick patient in front of you.
Post-nights
1. The day after the first night shift
Sleep regime should be individualised - trial and error helps. For a Muslim like me, I have to include performing the Zuhur (afternoon), Asar (mid/late afternoon) and Maghrib (early evening) prayers into my sleep regime.
What I usually do is 'delay' my Zuhur prayer towards the end usually around 4pm to maximise my sleep. And sleep again after Maghrib.
2. Travel
Driving after a night shift feeling sleepy is dangerous.
Do not risk it. People have actually died.
Have a back up plan. Find a place around the hospital where you can 'crash' for a few hours of sleep. Ask around. If all else fails, just sleep in the car with the windows winded down.. Much safer than drowsy driving.
There you go. Hopefully it helps!
