If you’re taking on nights at the hospital, avoiding fatigue and providing quality care likely are primary concerns. Here are some tried-and-true tips that have helped residents adjust to practicing at night and safely caring for patients.

When it comes to transitioning from daytime to working at night, establishing a good routine and health are key, according to a special guide from the British Medical Journal composed by and for physicians in training. It offers tips, cautionary tales and lessons learned.

Here are the top five to know for working late nights:

  • Get a good day’s sleep. Learning how to sleep when the sun is out may feel unnatural, but it’s necessary when you need to maintain a successful night routine. To ensure you get the rest you need during the day, “[buy] blackout blinds, use an eye mask, turn your phone on silent, make sure your room is cool, and earplugs are a must,” the guide recommends. Exercising or reading a good book before bed also can help your mind unwind and ready itself for rest. 
  • Sustain your energy by eating before and during shifts. Eating a good meal before starting a shift is important. Doing so is relatively easy because it often coincides with your usual evening mealtime. The more challenging practice to follow is making time to eat and drink during your shift—no matter your workload. “Although you may not feel like eating at 3 a.m., it’s important to fuel yourself,” the guide advises. “Caffeine is tempting, but try not to rely on it; you’ll regret it afterwards.”
  • Don’t be afraid to ask for help. So you get a call at 4 a.m.: A previously stable patient has taken a sudden nose dive. Your care team has run all the tests they can, and you still don’t have answers. What do you do? When treating patients at odd hours of the night, emergencies are likely to occur. In these situations, stay composed, and act decisively by seeking the help you need for your patient, even if that means phoning an on-call specialist or attending. “Never be afraid to ask your seniors for help or advice, no matter how trivial the issue,” the guide advises. “The most dangerous [resident] is the one who doesn’t ask for senior help when it is clearly warranted. Nights can be scary—but they do make us better doctors.”
  • Bring your nighttime goods. Hospitals can be very cold at night, so be sure to bring a warm sweater and additional clothing you may need. This is especially helpful for quiet spells when you don’t have many patient calls and want to feel comfortable. Also bring a stash of healthy snacks to help you stave off early morning cravings.
  • Develop strategies for partnering with care teams and completing paperwork. Residents in the BMJ’s guide cited instances when they were able to improve how well they worked during night shifts by using strategies that save time and maximize efficiency. For instance, one resident devised a system in which he’d touch base with care staff for “mini-job” rounds at three different times of the night. This check-in system allowed him to complete smaller patient tasks—such as writing up fluids or rewriting drug charts—in one sitting, rather than dispersing them throughout multiple interactions. When called to see a patient, another resident said she’d ask the nurse to do a fresh set of observations and other relevant tests while she walked from one ward of the hospital to the next. Doing so ensured she’d save time and have more information prepared upon interacting with the patient. The key to whatever approach you take is using a strategy that fits your style of care, increases team efficiency and minimizes your chance of missing vital patient details.

Want more resident-friendly tips for your next rotation? 

  • Read advice from former residents on how they managed clinical challenges.
  • Learn how to master patient hand-offs with these 7 expert tips.
  • Review the AMA’s Succeeding from Medical School to Practice guide, which features expert advice on clinical and non-clinical issues for residents. The guide also comes with a video library, packed with presentations from health care experts and physicians. 
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