A Medical Resident’s Guide to Surviving On-Call, Night Float, and Night Shifts

Are you about to embark on your first night on-call? Whether it’s your first (or second or third) buddy or solo shift, you may be worried about what you could encounter, how much — or how little — sleep you’ll get, and if you’ll survive at all. The truth is, you’re not alone (and you will survive!).

Each year, over 30,000 residents match to and enter a U.S. medical residency program, and each year, these new physicians must learn how to manage and survive nights on-call, night float, and night shifts at their program’s hospital. While adjusting to any kind of night shift is no easy task, a young physician’s training during these hours are often simultaneously overwhelming and rewarding, as well as exhausting and exhilarating. Which end of the spectrum you wind up on each night depends on your training, your support system, your personal preparation, and sometimes — sheer luck.

To help you along the way, we’ve compiled tips from actual physicians who, like you, went through residency and survived night float and/or multiple nights on-call — for multiple years. Among these physicians, some even secured hospital jobs as hospitalists after residency, which in their case, means they continue to work various night shifts and night float. So, without further ado, let’s get started with our tips on how to survive being on-call and working overnight as a medical resident (and beyond):

Feel Comfortable

We’re not just talking about donning your comfiest pair of scrubs or shoes here. What we mean is: feel comfortable with medicine. In fact, most night shift anxiety comes from simply not being comfortable with your own medical knowledge. To remedy this — and hopefully alleviate some of the anxiety about what you could encounter during your shift — make a list of the most common or most likely situations that might occur, as well as the most likely questions or pages that could come from nurses. Well before your first night of call, read up on these topics. Then, read some more. Read daily until you are comfortable with your knowledge. Then, read some more. When you do finally reach your date of night call, bring your notes and books and read during any down time you have — that is, any down time that isn’t spent sleeping. Some great, pocket-sized options and apps to carry are (depending on your specialty):

• The Washington Manual Internship Survival Guide
  
  • Check out chapters: “Top Ten Workups” and “Common Calls and Complaints”
• Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine
• Comprehensive Handbook Obstetrics and Gynecology
• An ACLS Algorithm Handout or App
• The MDCalc App
• The Epocrates App

(Hospital Careers is not endorsing, condoning, or being paid to mention any of the above products or brands.)

Get Enough Sleep

Call is stressful enough on its own. Don’t let a lack of sleep make it worse — for you or your patients. In fact, a recent study shows that moderate sleep deprivation — after 17 to 19 hours of wakefulness —can produce impairments similar to those of someone with alcohol intoxication and a blood alcohol content (BAC) of 0.05 percent. Performance equivalencies to 0.1 percent BAC occurred after longer periods without sleep. How can you stave off this seemingly losing battle? Get more sleep days BEFORE your on-call shift starts. Sleep is a rare commodity in residency, but you’ll need to make time for it, day by day, so that your body has enough stored-up for the long nights that could await you. For your night call shift itself, remember to take naps when you can — or stock up on your favorite energy boosters when you can’t.

Don’t Like Coffee? You Will

Staying alert is key to surviving a busy night at the hospital. One way to do it — and when you can’t afford to sleep — is with coffee, caffeine, or an energy drink. There are a variety of brews (and chews) available to help put the pep back in your step, all of which contain a different amount of caffeine. Want to see how much caffeine your brew, chew, or tablet of choice contains? Take a look:

Caffeine Comparisons (per 12 oz. serving, or otherwise noted):

• Starbucks Bold Coffee…………………………..260 mg caffeine
• NoDoz Caplets (1 pill)…………………………..200 mg caffeine
• Generic Brewed Coffee…………………………142 mg caffeine
• Red Bull …………………………………………....111 mg caffeine
• Military Energy Gum (1 piece)…………..…100 mg caffeine
• Black Tea………………………………...…………71 mg caffeine
• Mountain Dew……………………………………54 mg caffeine

According to the Mayo Clinic, “up to 400 milligrams (mg) of caffeine a day appears to be safe for most healthy adults.” Consuming more could have negative side effects, and some people are more sensitive to its effects, so always consume with caution and know what your limits are before your shift begins. Also, be aware that different methods of caffeine consumption are absorbed in the body in different ways, which also changes the duration in which it becomes effective. For instance, drinks that must be absorbed through the stomach lining take 30 minutes, whereas chewing gum is absorbed through the lining of the mouth, which only takes 5-10 minutes. Finally, to stave off fatigue (and possibly caffeine-related jitters), make sure you’re eating and well hydrated with water!

(HospitalCareers is not endorsing, condoning, or being paid to mention any of the above products or brands.)

Eat Well and Stay Hydrated

Like sleep, eating and drinking enough water — and not to mention going to the bathroom — are hard luxuries to come by when you’re a medical resident, especially one who is on-call at the hospital. However, just like sleep, you need these things to function properly and make sound medical decisions.

Our physicians’ best advice is to take care of yourself by starting and maintaining healthy eating habits now — even while on call. Junk food, pizza, and other quick bites are easy, but you and your own personal health will regret it in the long run. Instead, prepare your own meals ahead of time or opt for the healthier take-out order. Remember, the hospital cafeteria may be closed or it may only offer a limited selection of food at night, so come prepared with something you feel good about eating. Your next task is to stay hydrated. Stash a water bottle in your call room or in various break-rooms, or simply drink at every water fountain you pass.

Develop Camaraderie + The Buddy System

Develop a good, helping relationship with other physicians, nurses, and staff, working throughout the hospital, who are also on-call or working night shifts or night float. Be kind, and help when you can. Form friendships. This act of camaraderie — or bond, if you will — can be the single most helpful element of your night, as the reciprocal action of help can be your saving grace when you’re suddenly overwhelmed with issues, complications, and admissions.

If you do get too overwhelmed, seek out your buddy — a supervising resident who may or may not be on-call with you, your supervising attending, or another medical resident/attending who is also on-call and qualified to answer your questions. Finally, if you need more hands on deck, don’t be afraid to call in the second-call (or backup) resident.

Be Proactive

Whenever possible, try to figure out what your next task will be — before it happens. Knowing what to do, how to act quickly, and what’s likely going to be best for your patients — early in your medical career as well as in any future clinic or hospital jobs — often requires you to be proactive. Doing so, along with reading and feeling comfortable with your medical knowledge, is another great way to reduce your on-call stresses.

Before you start your on-call shift, and while receiving checkout on the patients you will be covering, try to ask the day-shift resident, who is providing check out to you, what problems they foresee or expect to pop-up overnight, as well as what they would recommend doing for that problem. As you gain more experience on the job and on-call, you may not feel the need to ask such questions anymore, but doing so can help you build your knowledge base, about the patient and any possible solutions to their problems, from a more experienced resident. An additional bonus is that this knowledge will better prepare you for the night, should something happen.

Post-Call Tips

Recovering from a single on-call night or several night shifts can be grueling, as medical residents often only have a half day — at best a weekend — to do it. Try your best to get back on a nighttime sleeping schedule with blackout curtains, earplugs, and by turning off your phone. Avoid sleeping pills and their hang-over, addictive effects; if necessary, consult your general practitioner, but never self-prescribe. Finally, be extra cautious about driving home after a night shift or night call. Call a spouse, family member, friend, Uber, or a taxi to take you home — or simply return to your call room to take a nap (just make sure there’s time for the next on-call person to get setup for their shift). Finally, if you have a chance to take a shower, do it before morning rounds — you’ll thank yourself for it.

Deep Breaths… You’re Not Alone

No matter what happens on-call or on your night shift — for example, a code or a rapid response — always take a deep breath before you enter the situation, and to paraphrase one of the Laws of The House of God (a satirical novel that follows a group of medical interns): the first pulse you take should always be you own. Stay calm and enter the situation knowing you’re fundamentally prepared to assess and attack the situation, or call for support.

Before you ever have a chance to land your dream clinical or hospital job, you and your fellow residents must graduate from your residency program, and that, among other things, includes surviving night shifts, on-call nights, night float, and/or 24-hour shifts. Be mentally and physically prepared, be proactive, take care of yourself, and before you enter any stressful situation, take a deep breath and be ready to activate your buddy system, because remember, you’re not alone.