How to survive your first night shift as a doctor
With tomorrow being 'black Wednesday', the day in the UK where the new round of junior doctors start work, we asked Dr. Henna Anwar to write a piece about how to tackle your first night shift!
If you are just starting work as a Doctor; first of all – congratulations! Welcome to what I can only describe as the best and worst job* in the world. You are just getting into the fitted seats of the rollercoaster. Fasten your seat belt. Sit back. Get ready. Enjoy the ride!
Secondly, you have probably never worked a night shift before, this can feel scary and daunting. So I’ve come up with this post, giving you some tips on how to survive your first night shift and those to come.
*I say worst, as you will save lives, but there are others that you won't be able to save - and that's hard, but you'll learn to cope and deal with it (most of the time)!
Before the shift
- Prepare! If you can, whilst you are a student or before you start your Foundation Year 1 (FY1) job, try and do 1-2 night shifts with an FY1. This is probably the best thing you can do in preparation. They will teach you things that you might not have even thought of (like which ward always has biscuits stashed somewhere!)
- Check the rota – make sure you know exactly what shifts you are down for!
- Find out the shift times/pattern.
- Know exactly what time you start each shift.
- Know what time handover is and where you need to be for this.
- If you can – find out/know who are working with. If you meet them during a day shift you can mention you will be on nights with them – this may help you feel relaxed knowing you will see a friendly (I hope!) face when you arrive for your shift.
- Familiarise yourself with where important equipment is kept (ECG machine, ABG analyser) and where to send bloods.
- Make a list of (or at least think about) common medications you will be asked to prescribe (such as analgesia). Do you know where to find the local antibiotic guidelines?
*Important* If you can – try to make sure all your passwords/logins are working
The day of your night shift
- Have a lie-in in the morning before and then try and get some sleep before the shift. If you have never done this before, sleeping during the day can be hard!
- To help with your sleep consider buying aids such as blackout curtains, earplugs etc.
- Don’t have caffeine during the day to allow you to nap before the shift. You can have a coffee before you go into work.
- Make sure you are suitably dressed for work. This includes thinking about what you are expected to wear. Do the Doctors on the night shifts wear scrubs? Do you know where to get these from?
- Bring food and drink with you. The hospital is a very different place at night and there may not be anywhere you are able to buy any food from.
Arriving to your shift
- Don’t be late!! PLEASE! This is so important! Arrive 15 minutes early so you can compose yourself and be ready for handover.
- Know the handover procedure – do you need a pen/paper to write or electronic device?
- Pay close attention at handover and make sure you get all the important details from your colleagues going off duty. It's much harder to find these facts at 3 am on a dark ward when the notes are missing.
- If you are not sure of something – please ask! For example, If someone has handed over a patient saying “Bed 11 Ward 10” – don’t be afraid to ask “What’s the patient’s name and ID?” – patients can be moved and you don’t want to lose a patient you are meant to do an important job for, during the night!
- Prioritise your tasks. You need to deal with the acutely unwell patients first and everything else later and if you can't get things done, hand over to the day team.
- Even if you are busy, respond to your bleeps/tasks. Let the person, who is trying to get a hold of you, know that you are currently busy and will get back to them soon.
- When prescribing DO NOT just write something down when you get asked if you are not sure. It is YOUR name going on the prescription. Do not be afraid to say you will prescribe it after you have checked. Use the BNF.
- Remember that trusts will have their own specific guidelines for antibiotic prescriptions. Use this.
- DO NOT FORGET TO CONFIRM ALLERGY STATUS
Managing Unwell Patients
- Learn your ABCDE. You are NOT expected to know how to diagnose and manage every medical condition under the sun BUT you are expected to know how to assess an unwell patient.
- Try and identify major problems or likely ones early in the shift. Deal with these first, preferably before midnight, so that if you need to call someone, such as the consultant, at home it is before they go to sleep. Despite this, never ever be afraid to call for senior help in the early hours. In the long run, you can only be criticised for not doing so.
- Be proactive in looking for potential problems, I don’t think it’s true that “jobs just appear” when you turn up to the ward (some doctors think this). If you visit the ward early in the night and address any concerns when patients are awake and the lights are switched on, it can save you a lot of trouble later on.
- If you are with a very unwell deteriorating patient ASK FOR HELP sooner rather than later. No one will mind if you call them for help. Use the SBAR mnemonic to help you relay information accurately and quickly.
- Please DO NOT try to manage everything on your own – this is why you have a senior team.
- Make sure you know how to contact your senior team – FY2/Core trainee/Specialist trainee.
- Do a quick eyeball round of the patients. Identifying a problem early saves a lot of time later. A quick, more formal ward round of your patients on ITU and HDU is usually helpful.
- Make sure you take a break!
- Find out where you can get a coffee at 4 am and where you can sleep in a corner if you need to! Although, when I do sleep on the shift, I find the quality of my sleep is poor and it makes me grumpy when I get woken up! Also it’s awful to be woken up to the cardiac arrest bleep going off!!
- Graciously accept jobs that should have been done during the day but weren’t, there’s no point starting the shift angry. After some time, if it does indeed look like you have a lazy colleague - this can be addressed officially with advice from a senior.
- Don’t commit to things during the day (friends/family/pets/anyone) because daytime people expect you to – you are living their life in reverse. Don’t plan meeting up with someone in the afternoon or arrange a delivery in at mid-day! You need your sleep!
- Don’t drive if you are sleepy. This can be a risk of having a road traffic accident. Consider requesting an on-call room or having a nap before setting off, especially if you have to commute a fair distance.
- Don’t forget to drink water. I remember nights when I think I had forgotten to even take a sip of water! Try not to get dehydrated. Carry a bottle of water around with you.
- Prevent sugar crashes. Avoid high sugar foods.If you can, eat a high fibre complex carbohydrate meal before your shift and bring one with you to have during the shift.
- After your last night on a set of nights – suggest breakfast with the doctors you just did the shifts with , which can be an opportunity for debriefs and bonding.
- Try not to become too despondent. You are not alone. In all honesty - night shifts can be awful, everyone knows that, and they can cause severe fatigue. Try to enjoy them as much as you can, I have some fond memories of night shifts where I have actually enjoyed time with people I have been working with.
- Manage your acutely unwell patients first (yes, I am mentioning it once again because it’s important).
- ASK FOR HELP EARLY (sorry I can’t say this enough)
The most important thing I can tell you about starting a career as a Doctor:
Be nice to everyone! (and I mean everyone – doctors, nurses, pharmacists, domestic staff..), it will get you a long way.
Best of Luck to you all, here are a list of useful resources:
- Oxford Handbooks.
- Your hospital intranet will have lots of useful information.
- Induction: this is a phone app, which you can link directly to your hospital.
- NICE online guidance for where you can't find relevant hospital guidelines.
- ToxBase: for accidental or non-accidental poisoning. Your hospital will have it's own username and password
- The BMA website has some some great articles.
- BNF (book, website and app)
- Renal handbook (website)
- Microguide (app)
- Breastfeeding network: when prescribing for women that are breastfeeding (website)
- MDCalc (app and website)
Dr Henna Anwar
BSc(Hons) MMedSci MBChB
GPST3 Pennine Scheme
Former Medical Registrar after completion of Core Medical Training
(before change to Accreditation of Transferable Competencies (ACTF) pathway GP training)