Your first night shifts as a resident physician may be unlike anything you’ve faced before in medical training. The stakes are high, your responsibilities are greater, and with fewer other members of the care team available, the workload can be particularly heavy. But with education, planning, solid fatigue mitigation strategies and proper sleep hygiene skills, you can learn how to thrive in the new environment.
The Accreditation Council for Graduate Medical Education limits a single night shift for residents to 24 hours, with an additional four hours allowed for patient handoffs and debriefs. Even within those regulations, though, residents must deal with inevitable fatigue.
Other physicians who have been through the experience as residents themselves offer tips about what worked for them for minimizing fatigue and maximizing sleep during the transitions on or off night shifts.
Dealing with a different type of shift
Christopher Wong, MD, MSc, is a fourth-year resident in a combined internal medicine and pediatrics program in Texas. He remembers his first night shift coming about four months into his residency training.
“I had very limited nights experience in medical school,” said Dr. Wong, who is also a delegate for the AMA Resident and Fellow Section. “So, I knew that going into it, it was going to be a bit of an adjustment. And the first few nights, I was really, really tired because I hadn't adjusted to the night schedule yet.”
Every experience on a night shift is different, Dr. Wong said, “depending on the service, depending on how busy it is and the time of year,” among other factors. Typically, though, there will be far fewer people around you.
“The nights team is always much more bare bones than the day team,” Dr. Wong said. “Whereas there are usually a total of 10 to 12 residents taking care of people during the day at our program, there are only three at night. So, it's just you, your co-intern, an upper level [resident] to supervise and then there's always an attending for backup.”
Cut yourself a break
There are isolated night shifts, Dr. Wong noted, and rotations during which you’ll be on nights for a longer length of time. Getting through a one-off night may be mostly about arriving for the shift well-rested and fed, then using caffeine judiciously. When you’re on an extended period of night shifts, he said, manage your expectations—of yourself.
“On nights, you really pare your life down to the most important things,” he said. “You go to work, you sleep in the morning, you wake up, maybe have lunch, you work out, you shower and then you go to work.”
He said not to expect that your days to be full of activity, though you can “build up your well-being beforehand” by sleeping well, exercising and eating as healthy as possible in the time before a rotation on nights.
Find ways to manage fatigue
Fatigue and sleep deprivation come with the territory of night shifts. But understanding how your body can function best while meeting the demands of these shifts can be an asset.
Use sleep-hygiene skills like maintaining as consistent a sleep schedule as possible, limiting exposure to blue light, using caffeine strategically and creating a dark, cool room to sleep in can help.
Some residency training programs offer help with sleep strategies and make specialists available to medical students and residents. They may be able to help you brainstorm ways to increase the amount of restorative sleep that you are getting, whether you’re on day or night shifts.
Watch out for sleep deprivation
Though some fatigue is to be expected on a night shift, check in with yourself periodically to see if you’re suffering serious effects from long-term sleep deprivation.
A module on sleep deprivation in the AMA GME Competency Education Program lists some of the signs.
Fatigue. This might sound obvious, but serious sleep deprivation can result in your being so tired you literally cannot stay awake. Physicians who are fatigued “space out” of conversations and activities and often nod off, even during important discussions with other members of the healthcare team.
Severe mood changes. This includes things such as snapping or yelling at other residents, nurses or even patients; getting angry more quickly than normal; and laughter and amusement at inappropriate times.
Weight gain. A lack of impulse control can be a sign of sleep deprivation. A lack of sleep will affect hormones related to hunger and contribute to a lack of energy, which can in turn result in fewer calories being burned.
Struggling to reason and make decisions. Information takes longer to process when you are deprived of sleep, and you can sometimes forget what the next steps should be.
If you are dealing with sustained sleep deprivation, take breaks and naps, and seek help from fellow residents, senior residents, residency program directors or a mental health professional.
Expect some turbulence
No matter how prepared you are, though, night shifts will be an adjustment. Other physicians understand that. Nobody expects you to hit the ground running on day one.
While at times, you might feel like the only one who has been exhausted working your first night shift, innumerable residents before you have gone through the same experience. And, like them, you will make it through, coming out on the other end a better and more prepared physician.
