Surviving the ED Night Shift

6 Tips to Maintaining a Healthy Lifestyle

It’s 4:00 a.m. Your eyes are heavy. The lights in the emergency department (ED) are overly bright and it’s really cold. Physicians, APCs and nurses shuffle up and down the hall, everyone moving as quickly as possible. Monitors beep from all around the department. Just as soon as one stops, another monitor starts. Team members are in one patient room then out. Now, on to the next.

No matter how bright the lights are, how cold the department is or how loud those monitors beep, it doesn’t help you stay awake. You are exhausted. After a quick splash of water to your face, a refilled cup of coffee and a deep breath, you tell yourself, “Just a few more hours.”

Working night shift requires putting unique physical, mental and emotional stress on the body.  It’s no secret these demands can take a toll on a clinician’s overall health and well-being. It could be your first night shift or your tenth year as a nocturnist but that doesn’t lessen the burden or stress associated with working overnight. Your body still has basic needs in order to function properly.

The good news is, you can provide your body with the fuel it needs to keep going. Small changes in your personal wellness efforts can help maintain peak performance and ensure the body’s biological clock is running smoothly overnight.

Celebrated April 7-13, EM Wellness Week serves as a reminder to emergency medicine (EM) clinicians to take time to recharge and reflect on their personal health and well-being. In recognition of this event, our team focused on providing a brief overview of one of the most inevitable aspects of being an EM clinician – working a night shift. Use these six tips and advice from ApolloMD physicians and APCs to help maintain a healthy lifestyle while working at the darkest hours.

Manage Sleeping Patterns

Getting an adequate amount of sleep should be a number one priority for night shift clinicians. On average, adults need seven to nine hours of sleep to function at their very best. Lack of sleep can directly impact a clinician’s performance due to decreased alertness, reaction times and accuracy. If tired enough, a clinician’s lack of sleep also has the potential to negatively impact the patient care he or she provides and, in return, increases the opportunity for error.  

Managing a good sleeping pattern is one way to combat the side effects associated with lack of sleep. There are several easy ways to ensure your body is well rested and ready for the next shift.

  • Do not delay going to bed after a shift and avoid any activities that can make you feel more alert. For example, smoking can keep you awake because nicotine is a stimulant.
  • Eat and drink something before bed. Eat a light, healthy snack towards the end of a shift and stay hydrated throughout the shift. This helps prevent any interruptions during sleep caused by hunger or thirst.
  • Avoid consuming alcoholic beverages before bed. Alcohol can make you feel tired during consumption but often interrupts the stages of sleep and diminishes the quality of sleep.
  • Sleep in your bedroom. Comfort is often key to receiving quality sleep after an overnight shift. Keep the room quiet, dark and at a comfortable sleeping temperature. Cooler temperatures are recommended. If needed, use a white noise machine and invest in blackout curtains.
  • Share your work and sleep schedule with family and friends. This should decrease the number of disruptions during resting hours.

Take a Nap

While sleep should be a number one priority after working overnight, it is not always possible for some individuals to get a consecutive seven to nine hours of rest. Napping is another option to ensure the body receives an adequate amount of sleep.

For those who do not receive a full seven to nine hours of uninterrupted sleep, consider taking a short nap at least an hour before a shift. Naps should be at least 20-minutes but no longer than 45-minutes. Too long or too short of a nap can intensify any present tiredness or grogginess.

Maintain a Healthy Diet

Interruptions in the body’s normal schedule can lead to disruptions in the metabolism. Studies show long term disruption of the body’s internal clock is often linked to obesity, diabetes and other metabolic related issues. Eating meals on a similar schedule each day, especially if working a rotating shift schedule, is one way to maintain a regular metabolic cycle.  

For clinicians who regularly work the night shift, the grazing method is commonly suggested to maintain the body’s biological clock. The idea is to eat light meals and healthy snacks more frequently versus three large meals a day. When following this pattern, choose items with ingredients known to provide natural sources of energy to the body. Any natural energy will help combat fatigue and deliver an extra boost at each meal or snack time.

Meal planning is an extra step which contributes to a healthier diet and promotes greater control over your food choices. By bringing pre-planned and prepared meals and snacks each shift, the chances of making unhealthy choices at the hospital vending machine, or opting not to eat at all, significantly decrease.

During meal planning, opt for well-balanced, high-protein, low-fat meals which also include a complex carbohydrate. Avoid items with a high amount of refined sugar such as candy, cookies or cake. Instead, pick items like dried or fresh fruit to combat sweet cravings to steer clear of a sugar-related crash.

In addition to choosing a well-balanced diet, make a conscious effort to stay hydrated throughout each shift. An easy way to remind yourself to keep drinking is to bring a refillable water bottle with you. When the body is hydrated, mental alertness and physical energy both increase. Consider adding one serving of fruit juice in addition to your water intake to help prevent headaches or fatigue caused by dehydration.

Use Caffeine Wisely

Whether it is a cup of coffee or a soda, opting for a caffeinated beverage is a common decision made by individuals in need of a quick energy boost. However, sometimes it can lead to a heavy crash when too much caffeine is consumed. If you choose to drink a caffeinated beverage or consume another form of caffeine, do so in moderation.

Consider consuming a small serving of caffeine at the beginning of a shift and an additional small serving several hours later. Small servings consumed several hours apart help maintain energy throughout the entire shift rather than just at the beginning. Avoid caffeine consumption four to six hours before bedtime. Caffeine near the end of a shift impacts both quantity and quality of sleep when you need it most.

Include Exercise in Your Routine

Physical activity is proven to increase energy, boost the metabolism, produce better quality sleep, enhance moods and much more. Even knowing all of the benefits of regular exercise, some clinicians find squeezing a trip to the gym into a night shift schedule impossible. However, working a nontraditional schedule does not mean regular exercise has to be completely eliminated.

The best time and degree of physical activity the body requires is different for each individual. If completing a satisfying workout after a shift is not working for you, try to fit one in before a shift. Save weight lifting and high-intensity workouts for your days off.

Moving as much as possible is encouraged to keep your blood pumping. During a shift, there are several ways to be physically active. Take the stairs versus riding the elevator, stretch in between patients and complete low impact exercise such as a brisk walk, arm circle or yoga during a break.

Build Strong Relationships with Your Team

In the ED, the practice environment differs from day shift to night shift. With fewer team members, resources and leadership readily available, night clinicians are required to be more resourceful. In return, these clinicians tend to rely heavily on one another building trust and defining a special working relationship. A strong team bond is often associated with increased communication, productivity and happiness. As a result, team-related clinician burnout is decreased.

Not only should the night team form strong bonds with each other, but with the incoming day team as well. This encourages smooth transitions between shift change, promotes thorough communication and ensures top-quality care is provided.

Whether the fast-paced environment or the broad range of cases, there is a significant reason you committed to becoming an EM clinician. During the middle of the night and in the earliest hours of the morning, you provide care to patients in their most vulnerable times of need. Around these busy times you are so focused on caring for others it is easy to forget to take care of yourself. In order to provide the top-quality care each patient deserves, you too have to be healthy. Small changes in your routine can make a significant impact. Commit to the actions that provide a balanced, healthy, happy lifestyle.

Happy EM Wellness Week!

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