Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Top Tips to Make the Best of Night Call


Working nights in healthcare is tough. Five tips highlighted in this piece are related to self-care, and the last one reminds us all to support our colleagues who are covering the night shift.

As we begin to understand the mysteries of sleep, few things have become clear. It is a well-preserved phenomenon across species and tampering with it can have serious consequences. In the world of medicine, working nights is just a fact of life. Over time, night shifts have become the “rite of passage” for medical trainees. Anyone who finds it too challenging is considered “weak.”


I recall my first day of internship vividly. I was on call and had to stay overnight to care for the patients on the oncology floor. As the evening approached, one by one the other interns handed me their sign out lists and wished me goodnight and good luck. The patients on some of the lists were terribly sick. Eventually, the fellow said, “call me if you have any questions,” and left.


I was all alone. As the hallways of the hospital got quieter, a sinking feeling crept in. I was now responsible for everything and a million things could go wrong. The first few times the beeper went off I felt terrified, as it was only a phone number in those days. The most urgent ones were suffixed with *911. Early in the night, I had a chest pain call. I did all the right things—spoke calmly, requested an ECG, and said I would come over and assess the patient. I thought it would be easy—just take a good history and rule things out. The patient said he felt a pressure as if someone was sitting on his chest (“oh, no- please don’t say that, not those words”). I knew the ECG would reassure me—until I saw the ECG . . . hmm . . . now . . . is that early repolarization . . . or . . . could it be . . . an ST elevation? I had no choice; I had to raise the alarm. After a lot of frenzied activity, the CICU fellow reviewed everything and said “false alarm.” He was kind enough to tell me that the ECG was indeed a little tough and I should not feel bad about it. I felt my PGY-1 status was likely to put me to shame repeatedly.


Before the night was over, I responded to everything from “Tylenol” to “cannot breathe,” and I did end up calling the other fellow in for help. I also got two thoracentesis under my belt the very first night. By morning, I was dead tired, barely able to keep things straight, and tried my best to hand off the lists hoping not to miss important details. The only reason I survived were the kind and reassuring nurses who were very patient, gave me confidence, and helped me think through everything.


After that first shift, nights slowly started to get better. I knew how to “triage” the pages and plan my night. Little tips from fellow interns helped save time and effort (I actually carried blood culture bottles in my pocket). Putting in IV lines became second hand and recognizing distress became easier. I got to know the night staff and checked in with all the nursing units each night. I walked the floors all night instead of staying in my team room.


I always came home looking like a ghost. My wife thinks that I still look a ghost after most night shifts and on an occasional day here and there.


Working nights is tough. Some steps can make it a little better. Here are a few things that I found helpful:


1.Don’t postpone the restroom break, and stay hydrated.


2.Drink as little caffeine as possible.


3.Walk the floors and walk them again.

Just checking with the nurses’ station and asking if everything is okay and if anybody needs any help makes a big difference. It helps avoid unnecessary pages and builds teamwork. This might actually get you a few minutes of much needed rest.


4.The drive back home after night shift is notorious for interns nodding off, resulting in bad accidents. Ask for a ride rather than risk driving if you even suspect that you are too sleepy.


5. When you get home, no screen time. Put that phone away. 

This will help you relax and decompress.


6.Watch out for your colleagues.

Nobody is “born tough.” If your colleague shows signs of sleepiness or fatigue, reach out, check-in, and offer help.