Maintaining Sanity on Night Float.

My sister recently started her sub-internship on night float (side bar: my sister is in her last year of medical school?! Cue the quarter life crisis) and it brought me back to those good old days when I was a wee intern….

And didn’t sleep, froze my butt off every night, and jumped out of my skin with every page, even the ones that were just asking for a Tylenol order. 4 years later, I have a weird appreciation for working in hospitals at night- the quiet hallways, being able to chat with patients and their families uninterrupted, and getting so tired you start laughing at the most nonsensical things with your senior resident. I figured I’d write this out for my sister (if she reads this blog, she might be too cool for this kind of thing. LOL) and any other new interns or almost-interns about to dive into their first experience working nights at hospitals.

Get comfy. Night float shifts are often long, lasting anywhere from 10 to 14 hours. Many nights you’ll be on your feet a lot, and won’t be spending a ton of time sitting or resting, so good shoes are key. Many healthcare workers swear by Danskos; a well-fitting pair will last you for ages ( one nurse I work with has had hers for 7 years,) but make sure to try them on before you purchase, as each pair is handmade and therefore will fit slightly differently. I personally have loved wearing my Allbirds and have also used my running shoes in the past; both worked fine for me.

Another thing people don’t realize off the bat is that hospitals are cold, and they get even colder at night. I would walk into work wearing fleece leggings pretty much from August through mid-June. A fleece or zip-up jacket plus cozy socks and you have a semi-tolerable work environment. Some of my colleagues even had a hospital blanket stowed in their lockers.

Have a sleep strategy. I have never been a good sleeper. I am one of those people whose brain likes to play the game of ‘lets dive into your most cringe-worthy memory or deepest regret!’ as soon as my eyes shut, and breaking routine can really exacerbate my insomnia. I generally had two approaches to sleeping on call- I would prioritize trying to get REM sleep in at least once; at my hospital I had to follow up on midnight and 4 am vital signs, which meant I could sleep for 4 hours in between if my brain would settle down or I was tired enough. If sleep wasn’t coming easily, though (like, say, if I was having the recurring nightmare of the code pager going off and my legs turning to jelly. That was a fun one.) I would hammer out some work- either easy readings, life stuff that I’ve been procrastinating on, or mindlessly running through a few board prep questions. About half of the time these activities were boring enough that I’d eventually nod off.  

There were definitely nights I wasn’t going to be able to sleep; you just have to accept that you’re being paid to work no matter what, and that being paid to sleep is a kind of bonus perk that happens once in a while, but isn’t guaranteed. This mentality helped keep me from getting too stressed out if my grand plans didn’t work out.

Another semi-related tip for interns: do your own night rounds. You certainly don’t have to see every patient, but walk through each unit shortly after nursing sign out to check in, see what’s going on, provide updates and change or correct orders as needed. I would even bring a computer around with me to change orders in real time. This does two things: first, it shows the nurses that you are attentive and care about their contribution to the patient’s care plan. Getting friendly, recognizing names and faces and even engaging in small talk really does go a long way. Second, it reduces the number of pages you will get at 2 am to change that Tylenol from round the clock to as needed, or other non-urgent matters. 😊

Time your caffeine boluses. I tended to be sensitive to caffeine. It made me jittery and jumpy, and would occasionally exacerbate an essential tremor that came out of nowhere in residency. I would usually drink a half cup of coffee before work, then, depending on how the night was going, either plan to lie down and sleep and have another coffee or tea before signout, or on PICU nights when I knew I’d be up, time an 11 pm- midnight coffee to keep me going until signout.

Maximize your home rest. I think of this as two parts- creating a cozy environment to sleep in regardless of time of day, and balancing the need for sleep with the need to maintain a normal circadian rhythm. For me this usually meant blackout curtains and ear plugs (you’d be surprised how noisy it can get during daytime hours at home) plus a 3-4 hour nap, then getting up to do errands or enjoy some sunshine, have dinner, and go to bed early so I was rested enough for the next day. I always found days that I slept much longer than 4 hours led to trouble sleeping later in the evening that could worsen my insomnia for days.

Others I’ve worked with have used working out right after call to ensure they get really good sleep, taking melatonin, or just pushing through the day and going to bed early in the evening. The bottom line is you have to figure out what works for you, but in general if you go into REM sleep for too long, your brain is going to be confused and think you need to be awake every night.

New Year's 2016, celebrating with sparkling grape juice in the pediatric ICU

Have fun. No, really. While there are definitely plenty of rough nights to be had in residency, there's also some true camaraderie to be had on night shifts. Some of my deepest conversations with colleagues and coworkers occurred on night float. Some of us had ‘family dinners’ where all 9 people on the floor teams at night would order Thai food and hang out/chat for half an hour. Sometimes we got together and watched Harry Potter marathons on the fuzzy-screened box of a TV in the heme/onc signout room. A curmudgeonly older nurse would break character on Saturday mornings and make French toast at 4 am for anyone passing by. For one intern’s birthday, we raided the supply closet, made her a birthday crown out of the weirdest supplies we could find, and celebrated with ginger ale mocktails served in plastic pink cups at midnight.

Hope this is at all helpful to someone, and best of luck to all the new interns who started this summer and the sub-interns trying on this role for the first time!