Nighty Night

A recent article in the Independent caught my eye, as it was on the subject of healthcare workers and night shifts. I assumed that it would be about how difficult they can be and how they have a proven negative effect on the worker but I assumed incorrectly.

Instead it appeared to be quite a venomous piece on the audacity of hospital staff daring to have a twenty minute nap during a twelve hour night shift, and how some are even brazen enough to use hospital linen when they do so. There were frequent quotes from King’s College about how unacceptable this is, including this particular gem:

At King’s, emergency situations are now said to be more common than ever before, and staff have been told to be “alert and able to respond should these occur during their break time”.

To me this is an utterly disgraceful stance for a hospital to have; I don’t believe for a second that any healthcare professional would deliberately ignore a medical emergency, regardless of whether they’re currently on duty, on a break,  or even on holiday in a foreign country. A nurse I once worked with performed CPR on the first day of her honeymoon, before even reaching the hotel.  She could have carried on walking and enjoyed the first day of her holiday, but instead she spent it exhaustingly and ultimately fruitlessly trying to save a stranger’s life.
Most breaks in this context are unpaid, and a lot of the time they’re taken very late, if at all. It’s very common for junior doctors to work a 12+ hour shift overnight, covering an entire hospital, attending crash calls and sudden deteriorations, as well as monitoring patients who were already on their lists, without eating or drinking anything, and breaks can be as mythical as an early handover.

So KCH is expecting staff stay awake during breaks, but if this is so they can be around for emergencies, does it also mean they can’t leave the department? Can’t go to the vending machine (often the only source of nourishment out of hours) or outside away from the fluorescent lights? What about the staff who spend five minutes hiding in a store cupboard during their break because they don’t want their colleagues to see them crying about something they’re struggling with? Why not just force all staff to live on site so they can be nearby at all times, on duty or not?

My advice to healthcare staff working night shifts is this:
If you get the chance to take a break, then do it. Even if you don’t need to eat or sleep, just take the opportunity to get away from things, if only for a couple of minutes. Use your own judgement, and bear your own safety in mind,  as well as that of your patients’. Driving home? Don’t take the risk of ending up back in resus as a patient, it would be embarrassing at the very least. Gone 15 hours without water? That back pain you’re having could either be from muscle ache, or your kidneys shutting down. Dizzy? Lightheaded? I wonder what state your blood sugar is in.

The key message from this is to look after yourself, because you’re no good to your patients if you’re suffering. How you do this is up to you. Some people like a proper sleep if they can get it, others prefer a short catnap instead.

The Royal College of Physicians put out their own guidance for surviving night shifts, and I found it really useful, but when you’re first starting out it can be a case of trial and error.

One Comment on Nighty Night

  1. Nancy
    February, 19th 2014 at 10:38 pm

    Nightshifts can suck balls if you can’t adapt to the sleep pattern, but it sounds like whoever came uo with these guidelines at KCH has never had the pleasure of working them. I can guarantee they never go without meals, or bathroom breaks.

    Sleeping on a break is sometimes a necessity, it’s bad enough when my blood sugar is lower than that of the hypoglycaemic patient I’m dealing with, management wouldn’t appreciate me falling asleep on the patient whilst drawing their blood.

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