Working on-call, especially during night-time, can be one of the most demanding aspects of a surgeon's career. The challenges range from aligning with your body's natural clock to maintaining energy levels, taking breaks, and staying cognitively sharp in the late night while your are operating. It is not just about operating, but also managing new patient take and managing on call team. In this blog post, we will explore practical tips for managing stress during on-call shifts, focusing on key aspects such as planning, nutrition, hydration, and team management.

1. Pre-plan Nutrition: Fuel Your Body:

Pre-plan your meals, ensuring you have enough supplies for a nutritious night. Consider having a light meal before the shift and bringing your own food to avoid relying on hospital vending machines. This helps sustain energy levels and minimizes the impact of irregular meal times. I usually make a delicious meal, so that I can have something to look forward at night.

2.  Carry Energy Bars: Quick Energy Boost

Keep energy bars handy. These can provide a quick energy boost when you might not have the time to sit down for a proper meal, which will happen at time.

3. Know you team: Communication is Key

Ensure effective communication within your team. Have a quick sit down with your team member in the beginning of your shift,   address concerns and educational needs of yourself and your juniors. This will make a collaborative and supportive environment for the entire team. Also, you will know what your team is capable of. Keep a good relationship with your nursing and ED staff, as this will reduce a lot of your stress!!

4. Have a Plan: Prioritize and Delegate a jobs list

When starting your shift, it is crucial to have a plan in place. Prioritize patient cases, decide which ones need immediate attention, and delegate tasks effectively. Having a structured approach helps ensure a smoother workflow, reducing stress for both you and your team. Also, everyone knows what they are expected to do and who is doing what.

 5. Patient Management: Prioritize and Complete Tasks

When managing patient cases, prioritize and complete tasks efficiently. Aim to finalize investigations, book necessary procedures, and address any issues during your shift, minimizing work left for the next day. We all like to leave a clean board for the next team. But what will more appreciated, if the all the tasks of the patients you have seen are completed, like prescribing meds, booking investigation.

6. Hydration: Find a Balance

While some may limit hydration due to inconvenient toilet situations, find alternative ways to stay hydrated. Opt for high-fibre snacks and prioritize water over energy drinks, which can lead to quick energy spikes followed by crashes.

7. Caffeine Intake: Moderate Your Consumption

Limit caffeine intake, especially in the latter part of your shift. Consider switching to decaf after a certain hour to prevent disturbances to your sleep pattern post-shift. However, if I have to start a laparotomy at 4 in the morning, I will have a big mug of coffee, to give me that boost.

8. Take breaks and catch up:

Take breaks, not when you would like to, but whenever you can. Especially for foods and drinks. And if it all quite in all the fronts, then get some shut eyes. If you are like me, can’t sleep at all at nights, even then closing your eye in a dark room will help. Also, I do a lot of my admin stuffs when I am on nights, like writing this blog post!

9. Have fun: if you can

I always play music when I am on night shifts. My SHO and F1s will all take turn playing background music. I also try to take food and drinks (caffeine or otherwise) with the team, ensuing they had food and drinks and also get to know them over the food and drink. This gives a social vibe to the night shift, and makes it less dreary.

10. Prepare for Handover: Last-Minute Checklist

In the final hour of your shift, review patient cases, update yourself on their status, and prepare a comprehensive handover for the incoming team. This ensures a smooth transition and continuity of care. Avoid seeing any new patients, in the last half hour, unless critical. Instead, tidy up the all the loose ends from the night shift.

11. Have Breakfast before Leaving for Home

If you have a long commute, ensure you have a small breakfast before leaving for home. This helps combat hunger and fatigue, making your journey more comfortable.

12. Reduce Commute and Daylight Exposure

Where possible, minimize your commute and exposure to daylight after your shift. This can contribute to better sleep quality and ensure you are rested.

By incorporating these strategies into your routine, you can enhance your ability to manage stress, maintain energy levels, and optimize your performance during on-call surgical shifts. Remember, effective planning, proper nutrition, and communication are key in managing these graveyard shift.