Middle-aged anaesthetist’s guide to surviving the night shift | Association of Anaesthetists

Middle-aged anaesthetist’s guide to surviving the night shift

Middle-aged anaesthetist’s guide to surviving the night shift

Night working is an intrinsic part of an acute speciality like anaesthesia, and can get harder as we age. But there are steps we can take to help.

Doctor on night shift illustration

When I was younger and applying for medical school, I never really gave any thought to what working at night would be like. It was just after the ‘New Deal’ for junior doctors was introduced, hours were reducing and anyway as a teenager I was used to staying up through the night studying (or socialising!). 

Even as a new junior doctor, while the nights were terrifying clinically they weren’t bad in terms of fatigue - just something we did and got through. However, as I became older I found that while the work felt more familiar and I gained confidence, the fatigue and sleep became worse. 

I acquired a life and a family that didn’t always fit around my shift patterns, and woke me up at strange hours! I found sleeping during the day particularly hard, and would consider myself lucky if I got three or four hours sleep, making blocks of nights particularly hard. The thought of doing this for over 20 more years is not appealing.

As Chair of the SAS Committee I am often asked “When can I come off the rota?” The answer to this isn’t clear cut; there is no legal or set guidance. And of course anaesthesia is an acute specialty; there will always be babies to deliver at 2 A.M., appendices that need to be removed in the middle of the night, and so on. Someone has to do this work, and if someone drops it then others will need to pick it up. Against this, we know that many SAS anaesthetists are working resident shifts well into their 50s and even 60s, and that sleep gets worse for many as we age. Adaptation to shift work becomes harder with age, often starting between 40 - 50. The Association fatigue surveys showed that this is a real problem for many of our members. I often reply by suggesting that the correct question to ask is “How do we make night work safer?”

Be aware of the impact of fatigue

The single biggest message that I have learnt from the #fightfatigue campaign is that 2 A.M. is NOT 2 P.M.! We are simply not designed to be awake and alert in the middle of the night. And yet we work often longer, more demanding shifts, by ourselves at night than we do in the day. This is not traditionally taught to medical students or trainees, but simply being aware of the issue is a huge start. We shouldn’t expect to work the same way or at the same efficiency at night, and we need to be aware of the risks so that steps can be taken to mitigate them. Conversely, by 9 A.M. our bodies are telling us to be awake and alert, and so sleeping with the daylight and noises of the world is not at all like sleeping at night! There are plenty of simple tips and advice to help with sleeping during the day.

Get involved with designing rotas and job plans

Let’s be honest: being rota-master is a thankless task that few look forward to. Job planning is approached with a similar foreboding. However, I think that it is essential for all doctors on a rota to be engaged with this, and for one to act as the rota lead. Knowing about fatigue helps with designing the rotas and job plans. Knowing about things such as forward rotation (shifts moving progressively later), not front-loading weekly patterns with long hours before nights, and allowing appropriate rest and recovery time can make a huge difference. It is vital that rotas consider the impact on fatigue, not just simply filling slots. The standard SAS and consultant contracts are 10 PA, yet many doctors are on far more than this, often without realising that this can be reduced. This can be a real issue for those new to the NHS. Doing a very intensive clinical job plan can lead to decreased time for rest, and an accumulation of fatigue. This is something that may change or evolve throughout our careers.

Be aware of changes as we age

It’s a common misconception that, as we age, we need less sleep. Actually our sleep patterns and our response to fatigue changes. It takes longer to fall asleep; there is a decline in sleep quality and an increase in insomnia. So it can be harder to fall asleep and stay asleep during the day when working nights, leading to more fatigue. Besides this, as we get older we are perhaps more likely to have family and childcare commitments, which while a joy can sometimes make sleep a little challenging!

Copying the trainee rota won’t work

More than 60% of SAS and consultants in the NHS are over 45. What I have learnt through all this is that what worked when I was 25 may not work when I am 35, and definitely not at 45. And so rotas, job plans and shift patterns need to take this into account. SAS and consultants are a diverse group, with many different ages, other responsibilities and so on. This leads to the next point…

We don’t all need to work the same pattern

Of course it is much easier to have everyone on a rolling rota, working the same pattern, but that’s not mandatory. In our department we worked out our rota pattern the other way, by looking at which shifts had to be covered (nights, lates and weekends), and building the rota around that. The result is that some people work more sessions, and others fewer nights; some people do more nights in a row, others fewer. It has also introduced a kind of escalator, so that as people leave others can move up a slot if they wish. It clearly makes a lot more work for the rota organiser (see earlier!), but the benefits are felt by all of us.

Treat colleagues as individuals, not as slots

When job planning and writing rotas, it is important to get to know colleagues and discuss their requests and issues around the rota. Simply to treat them as individuals, rather than a slot in a spreadsheet, is a great start. Personalising rotas is of great benefit to the individual, but also to an organisation, as it boosts morale and promotes recruitment and retention. As people’s careers develop, discuss with them how the patterns are working out for them. Delegating the rota to ‘Admin’ or HR is a sure way of not achieving this aim.

Look out for one another

Within our departments and hospitals we should look out for each other, especially those on our rotas. Are they anxious about night working or finding it increasingly difficult? Are they worried about making mistakes working at night? Are there simple things we can do to help such as splitting weekends with them, reducing the runs of days, or other ideas? Do other members of the team have suggestions that might help? Night working is one of the less appealing aspects of our career and specialty, but it is a necessary evil for most of us. Although we don’t have a magic wand to make nights disappear or change our circadian rhythms, there are simple steps to make them a little more palatable as we move through our careers. Hopefully some of the tips that I have learnt might be of use to others.

More resources on fatigue

Thomas James
Chair of the SAS Committee, Association of Anaesthetists 
Specialty Doctor, Harrogate District Hospital

Twitter: @SAS_gas_Thomas

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