Working the night shift in a hospital is a whirlwind of multitasking, prioritising, and making quick yet careful clinical decisions. From responding to admissions and code greys to managing a patient load that requires constant prioritisation, each shift is an exercise in balancing responsibility and resourcefulness. Here’s a closer look at how to manage these unpredictable nights.
Starting the Shift: Pages, Evaluations, and Responding Thoughtfully
As the shift begins, pagers buzz with requests, often for patient monitoring or tests. For example, if there’s a page about a low heart rate, the initial response might be to check past records for patterns, such as a history of bradycardia. However, it’s essential not to jump into action by simply adjusting monitoring parameters; a thorough assessment is crucial. Even if the patient seems stable, getting a current ECG and evaluating it against past records is a necessary step to ensure there’s been no change. Such cases emphasise the importance of not only clinical care but also the medico-legal responsibilities tied to every decision made.
Admissions Workflow: Balancing Urgent and Non-Urgent Cases
During night shifts there are a whole range of tasks that crop up including patients requiring admissions, UCRs (urgent clinical reviews), other medical emergencies like MET calls or code blues as well as less urgent tasks like charting regualr medications or enacting the post op orders for a patient after their surgery. It's all about balancing urgent tasks with non-urgent tasks and ensuring that you communicate that with people, especially nursing staff and patients. The clearer the communication is the less problems will arise and the smoother the shift will be. Sometimes night shifts can be very busy and it may just be your job to put bandaids on issues that require more staff and expertise in the day time. So, as unsatisfying as that may be, it is sometimes the only way to survive the night shift and get through as safely as possible. Remember you are not likely to get in trouble for waking someone up overnight or asking for help, but you will probably not be looked favourably upon if you try to be a hero overnight and make big management decisions in terms of a patient's care.
Code Grey Situations: Prioritising Safety and Collaboration
In addition to medical cases, behavioural challenges can arise, requiring non-medical interventions like a code grey, which is a call for security when a patient’s behaviour becomes unmanageable. Unlike emergencies announced hospital-wide, for some organisations code greys are silent pages, bringing security discreetly to handle disruptive situations. During a code grey, collaboration with the nursing team and security is vital to ensure the safety of everyone involved. This collaboration demonstrates the importance of soft skills on night shifts—de-escalation, communication, and teamwork are as essential as clinical expertise.
Task Prioritisation: Mastering the Art of “Triage”
One of the most critical skills on a night shift is task prioritisation, often referred to as “triage.” With multiple responsibilities constantly flowing in, it’s vital to assess and rank tasks by urgency. Admissions, patient monitoring, and team coordination all need to be done, but tackling them all simultaneously isn’t feasible. For example, deciding to let a non-urgent task sit for a bit often means that it might resolve on its own. Tonight, a broken ankle case slated for admission was ultimately cleared for outpatient care, saving time and resources. Learning when to hold off and when to act immediately is essential to avoiding burnout and ensuring patient care remains thorough.
Effective Communication: Calming and Managing Expectations
Not every page represents a critical or urgent issue, yet balancing patient expectations with realistic timelines is vital. Pages for non-urgent matters, such as patient questions, may seem lower on the priority list. However, repeated pages indicate growing frustration or concern, which can escalate if left unaddressed. Even a quick check-in with the patient or nurse can prevent small frustrations from becoming larger problems. Communication is invaluable, offering clarity that keeps everyone on the same page and calms patient anxieties, making a major difference on night shifts.
Wrapping Up: Appreciating Small Wins and Self-Care
After the intensity of admissions, handling code greys, and monitoring patients through the night, night shift rewards can feel like small luxuries—a cold coffee from earlier in the night, or the anticipation of a post-shift bagel. These moments of self-care, however minor they may seem, are essential. They act as small milestones that provide both physical energy and mental refreshment. Taking time for these little rewards prevents burnout and offers a moment of normalcy in an otherwise high-stress environment.
Working a night shift is often an exercise in endurance and prioritisation. While some hours may be quiet, others are relentless, filled with pages, patients, and problem-solving. In balancing these responsibilities, the skills learned—clear communication, strong task prioritisation, and adaptive decision-making—become second nature. At the end of each night, reflecting on these skills and recognising the importance of resilience, teamwork, and perspective is what transforms these night shifts from gruelling tasks into fulfilling parts of a medical journey.
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