New to Nights

Working and preparing for the night shift during residency

The night shift can be challenging, but some advance planning and strategizing can help. Three DOs offer their advice.

Editor’s note: This story was updated with new information on June 19, 2018.

Gerald O’Malley, DO, a professor of emergency medicine and toxicology at the Sidney Kimmel Medical School at Thomas Jefferson University in Philadelphia, can recall working 11 night shifts in a row last year. Signing up to work some nights is part of the agreement for those specializing in emergency medicine.

“I was nearly washed out at the end of it,” Dr. O’Malley says. ” It was a scheduling issue and that was the only way I could arrange things.”

The night shift, or night float, comes with challenges. To help conquer the stress, residents can prepare physically and mentally. Here are tips on how to best get ready for the shift and how to manage sleepiness while working:

24 hours before:

1. Avoid sleep disruptors

Substances like alcohol, caffeine and sedatives can disturb a body’s metabolic abilities and prevent you from a good night’s sleep before working a night shift.

2. Spend time with friends and family

Because you’ll be sleeping during the day when most people are awake, Dr. O’Malley suggests preparing for some feelings of isolation.

“You naturally become socially isolated, almost like a ghost,” Dr. O’Malley says.

Enjoy some time with loved ones before a shift to combat this feeling.

3. Finish up academic work

If you have a string of nights coming up, Dr. O’Malley suggests trying to finish up any academic work in advance. After completing a night shift and sleeping during the day, he says it’s hard to focus on nonclinical work, whether it’s editing a paper or preparing a lecture.

“If you think you’re going to get up the next day and work for two or three hours before your next night shift, you’re crazy,” Dr. O’Malley says. “Try to get it done before.”

Jedidiah Ballard, DO, a former U.S. Army Ranger and emergency medicine physician, gives his best tips to stay awake when you're tired.

In the thick of working:

1.  Napping

If given the opportunity, the best thing you can do during the shift is nap.

“The best strategy to deal with sleepiness and decreased alertness during shift work is to schedule half-hour naps throughout the shift if allowed,” says Camilo Ruiz, DO, the medical director at Choice Physicians Sleep Center in Fort Lauderdale, Florida.

But sometimes napping could have consequences. Dr. Ruiz recommends limiting naps to 30 minutes to avoid sleep inertia.

“It could be hard to wake up, and you might feel groggy if you get a page, but overall you might have better focus if you can take that little nap during the shift,” says Smita Patel, DO, a senior clinical educator at the Pritzker School of Medicine at NorthShore University HealthSystem in Chicago.

2. Know your limits

There is no shame in asking your attending to put your head down for 30 minutes if you find yourself falling asleep while standing at the patient’s beside.

“We’ve all been there,” Dr. O’Malley says. “The smart thing to do is to step back.”

Most attendings would appreciate that honesty and maturity from residents watching out for the best interest of the patient and team, Dr. O’Malley says.

“Safety should be our No. 1 concern,” Dr. Patel says.

Residents shouldn’t go into every night shift expecting to sleep for an hour or two, Dr. O’Malley says. If they find themselves unable to stay awake, they might need to re-evaluate how they are preparing for the shift.

3. Staying alert

While napping is the best way to reduce sleepiness, sometimes that option isn’t available. Dr. O’Malley combats sleepiness by:

  • Splashing cold water on the face
  • Walking around the hospital
  • Engaging in conversation with your team or patients who are awake

4. Caffeine

Drinking a couple cups of coffee during your shift can help with sleepiness. Dr. O’Malley stops drinking coffee after midnight so he’s able to fall asleep when the shift is over.

“Caffeine consumption should be kept to a minimum and particularly used during the middle of the shift to allow the effect to dissipate prior to the end of the work shift and not interfere with their expected sleep opportunity,” Dr. Ruiz says.

Caffeine does have limits and it usually won’t wake someone up who’s exhausted, Dr. Patel says.

“Caffeine can help you with some of the that lag and lull, but it doesn’t replace the actual sleep you need,” Dr. Patel says.

5. Energy food

Chinese food and pizza may be convenient delivery options, but eating a heavy meal can make you feel sluggish. Instead, Dr. Ruiz suggests eating multiple small meals.

Snack ideas:

  • An apple with peanut butter
  • Hardboiled eggs
  • Trail mix or nuts
  • Protein bars (RX bars or KIND bars suggested)

Further reading

5 tips to stay awake when you’re tired

Q&A: Arianna Huffington on physician burnout

Advice for physicians struggling with burnout or mental illness

One comment

  1. Sean

    All very good advice. Thanks for the info and some recommendations from faculty who’ve been doing this for a while. Good to know attendings can feel like this too, and it validates how residents feel. Most of us want to be on our “A” game, but don’t feel as fresh at hour 10/14 as we do at hour 2.

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