The problem of internist doctors and nurses having to work 30- to 36-hour shifts has been ending around the United States as some teaching hospitals and other institutions have initiated 16-hour shifts since 2011. Nevertheless, these people we trust our lives to work long hours overnight. How do doctors and nurses stay awake on the night shift?
The problem really received a lot of attention in 1984, when Libby Zion, an 18-year-old patient, died under the care of residents within 24 hours of being admitted to a New York City hospital. Her father, a New York Times reporter who alerted the media, sued.
Joyce Park M.D. writes at KevinMD.com:
The wheels were set in motion after a public trial that awarded Mr. Zion $375,000. The ACGME, the organization that is responsible for accrediting residency programs, began to set down a series of restrictions that were intended to improve resident work hours and in turn, help with patient safety. In 2003, 2009, and again in 2011, the ACGME put forth new duty hour restrictions. The latest change mandated that interns, freshly minted doctors out of medical school, were only allowed to work 16 hours a day and a maximum of 80 hours a week.
Dr. Park writes that the number of patients rose about 50 percent from 1990 to 2010, and they’re sicker people. But the number of doctors caring for these people has gone up only 10 percent.
And residents in emergency rooms still routinely put in frenzied, harried 30 hour-shifts, Dr. Park writes. She describes a typical night shift of hers and then writes: “By the time I left the hospital at 7:30 a.m., I was pinching myself to stay awake on the drive home. More than a few times, I’ve fallen asleep at a stoplight only to be woken up by the honking of an enraged driver behind me.”
A study of night-shift workers found that driving the next morning is perilous. A blog on AllNurses.com has the headline: “Help! How do you stay awake on drive home after night shift??”
An article on Huffington Post states:
The drive home after a night shift can be hazardous too, confirms a small but compelling new study involving a global team of researchers from Boston and Australia. They conducted daytime driving tests on a closed driving track among 16 night shift workers who had just come off the job. The study found that the volunteers’ driving was dangerously worse after work than if they’d had a full night’s sleep.
“These findings help to explain why night shift workers have so many more motor vehicle crashes than day workers, particularly during the commute home,” said study co-author Dr. Charles A. Czeisler, chief of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital in Boston, in a statement.
Studies say caffeine can counter-effect some of the symptoms of sleep deprivation, but too much caffeine too soon before bedtime can cause sleep loss. Caffeine is also known to enhance alertness and cognition. But having too much of it can be a problem by causing anxiety, restlessness and stomach upset.
To avoid sleep disruptions, experts advise not having coffee six hours before sleep time. To wake up and get energy for your shift, take coffee or tea with caffeine right before you report to work.
WikiHow has a long article with several strategies to deal with sleep and night-shift work. The site advises that people get good nutrition and exercise, sleeping as soon as you get home from work and getting a good amount of sleep at consistent times.
The DTN Home Care blog has an article giving 10 tips on how nurses and caregivers can stay awake during a night shift. Among them:
Make daytime sleep your #1 priority.
Nap. Take a 30 minute nap before your shift begins.
Be careful with your caffeine intake. Don’t drink any caffeinated drinks during the second half of your shift, or they might keep you awake at home when you’re trying to sleep. The same thing goes for energy drinks or drinks with a high sugar content.
The site advises to keep moving, stay busy, drink plenty of water and expose yourself to light to help with mood and staying awake.
QuickBeam wrote a comment on AllNurses.com for the question “Night shift workers—how do you stay awake” that says:
I worked straight nights for over 10 years, 8 hour shifts. You need to make daytime sleep your # 1 priority. I’m completely caffeine free and I never once fell asleep at work (too busy admits [patient admissions] all night). As to sleeping at work, we’ve got miles of threads here with heated debate. I think it is absolutely wrong and never tolerated it when I was a night charge. Others feel very differently.
One thing several of the nurses in that thread at AllNurses.com agreed on: Keep busy. Danissa wrote: “I agree … keeping busy is the key to staying awake.”
As we said in this Viter Energy blog  about the work-life balance, it's a good idea to simulate your commute to work. You don't have to drive in to work, so instead take a walk around the block just before your workday starts and just after it ends. Send yourself a psychological signal.
And if you can avoid it, do not work after your walk around the block. Don't check work email. Don't answer calls from co-workers unless you really need to talk to them (or they are friends you socialize with).
Clinical psychologist Kelcey Stratton of Michigan Health Blog  has some sound advice on finding the right time to work:
If you’re a morning person, try to schedule important work and meetings during the first half of the day. Others may peak with energy in the afternoon. Depending on the type of job you have, try to maximize on these levels as you can.
The first bit of advice is to get up from the computer, turn off your phone, and go get some exercise, do something recreational, prepare a meal, or something other than work, on the same schedule as you did when you worked at the brick-and-mortar office.
If you used to get off at 5 p.m., quit working at home at 5. You might need to check email or prepare a report later that night, but be sure to get away from all electronic communications and computing devices for a while.
Another big tip is to take your coffee breaks and lunch breaks on the same schedule, or at least be sure to take them at some point. Do not skip your favorite part of the day!