How do doctors and nurses stay awake on the night shift?

The problem of internist doctors and nurses having to work 30- to 36-hour shifts had been ending around the United States as some teaching hospitals and other institutions initiated 16-hour shifts since 2011. The decision was later reversed in 2017, and now young doctors could be forced to work up to 28-hour shifts.

Many people think it's foolish to require these people we trust our lives to work long hours overnight. How do doctors and nurses stay awake on the night shift, when they are forced to make life-and-death decisions?

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 [1]:

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.

But later, the board overseeing the young doctors' hours reneged, and now they may work longer shifts.

Working up to 28 hours straight

In 2017, a board overseeing graduate medical education decided young doctors could work shifts up to 28 hours long, the L.A. Times reports [2]. The story says in part:

The new rules, which begin on July 1 [2017] relax work restrictions put in place in 2011, when mounting evidence showed that exhausted residents — the term for doctors in training — were endangering both patients and themselves. Currently, first-year residents are restricted to 16-hour shifts.

Leaders of the Accreditation Council for Graduate Medical Education said the work limits for first-year residents, known as interns, needed to be extended to match the 28-hour shifts now allowed for more experienced trainees. They said it was harming interns’ education by reducing their time in the hospital. 

Some doctors criticized the 2011 rules and said some residents were leaving the operating room in mid-operation. A national consumer group called Public Citizen called the decision to lengthen hours to 28 hours reckless.

Doctors in training still will be limited to 80-hour work weeks.

Residents and internists complained about the rule change. Eve Kellner, president of the Committee of Interns and Residents at Service Employees International Union, told the Los Angeles Times:

As a medical resident, I’ve seen firsthand how exhausted and accident-prone my colleagues are during extremely long shifts. As a patient, I fear putting my life into the hands of a first-year resident physician who has been awake for 28 hours or longer.

More, sicker patients, fewer doctors

The number of patients rose about 50 percent from 1990 to 2010, for example, and the patients are sicker people. But the number of doctors caring for these people had gone up only 10 percent.

And residents in emergency rooms were still routinely putting 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 [3] on AllNurses.com has the headline: “Help! How do you stay awake on drive home after night shift??”

An article on Huffington Post article [4] 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.

Caffeine can help—to a point

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 or Viter Energy Mints [7] with caffeine right before you report to work.

WikiHow has a long article [5] 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.

You can get caffeine from Viter Energy Mints during a busy shift, when you may not have time to sit down for a cup of coffee or tea, at https://amzn.to/3jb7Gwg. The mints taste great and also have B vitamins in addition to 40 mg of caffeine per mint. 

Tips on staying awake during the night shift

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.

• Get 7 – 8 hours of sleep. Don’t let others talk you into skipping sleep for other things.
• Have a suitable sleep environment; keep the room dark and as quiet as possible.
• Maintain a regular sleep schedule. When you’re off, stay up as late as you can. When you go to bed, set your alarm to wake up early. Get up, stay busy and go back to sleep in the afternoon. By doing that, you’ll stay up later at night and sleep more during the day.

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.

Keep busy to stay awake

QuickBeam wrote a comment [6] 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.”

Sources

[1] https://www.kevinmd.com/blog/2015/08/the-problem-with-resident-training-hours-the-numbers-dont-add-up.html
[2] https://www.latimes.com/business/la-fi-medical-resident-hours-20170310-story.html
[3] https://allnurses.com/help-how-stay-awake-drive-t128795/
[4] https://www.huffpost.com/entry/driving-after-a-night-shift-is-seriously-dangerous-confirms-study_n_5679ed6ce4b06fa6887f6533?guccounter=1
[5] https://www.wikihow.com/Work-Night-Shift
[6] https://allnurses.com/night-shift-workers-how-do-t166245/
[7] https://www.goviter.com/collections/viter-energy-mints