Today’s inane image of the day:
Introduction
Night shift is a different beast altogether. My shifts are 14 hours long – technically I’m on service from 1700 – 0700, but there is a lot of preparation that goes into this shift. I spend hours prior to going into the hospital looking over my patients and sometimes pre-writing my notes in order to get a good understanding of what happened during the course of the patient’s ICU stay. Maybe it’s because I’m a new attending, but I also feel like if I get to know my patients better, they receive better care.
Anyway, in my video, I go over some of my strong feelings surrounding how tough working night shifts can be on the body as well as take you with me on a shift for you to get a glimpse into what a night shift in the ICU looks like for an attending.
Keep reading if you want to see an hourly breakdown of what my night shift schedule looks like.
An hourly breakout of what my day looks like
If I’m post-call [worked overnight], I typically take a nap from when I get home [generally around 0730 to 0800] until the early afternoon. How long I nap for really depends on whether I get a chance to go to my call room during my night shift. There are some nights where we get a lot of new admissions [which typically takes time to evaluate, assess, and workup], sick patients whose status is changing, or we get called to intubate [procedure to insert a breathing tube] a lot of patients in the hospital and I never get to see the call room. If it’s a busy night, I’ll be napping during the day for a while.
Anyway, pretending I start my day around 1400, here’s what happens:
1400 | Sip on espresso [I used to have a Keurig but didn’t love the taste of the coffee… so I decided to try Nespresso and have been loving my Breville machine combined with Starbucks Blonde roast pods in these adorable little espresso cups] while reviewing my patient list. Sometimes I start writing some of my notes.
1600 | Start walking to work. I frequently like to pick up snacks or candy to share with the unit on my way to work. Night shift is tough on the body and anything to bring a little joy can make a big difference. Also, I am a big snacker when I’m on nights.
1700 | Get sign out from the day time attending. Most units have two attendings, so it can take a little while to get the verbal sign out from both attendings.
1730 | Pre-round on my patients. I like to talk with the daytime nurses to get an idea of what happened during the day as well as examine and assess my patients.
1830 | Pre-write my notes. Consider getting dinner.
2000 | Start rounding. Rounds at night look a big different because the team is smaller. Typically on the physician side, we have 1 resident per team (2 total residents), 1 fellow, and 1 attending. During the day, for the same number of patients, there are typically 2 residents/NPs per team [total of 4], 1 fellow per team [total of 2], and 1 attending per team [total of 2].
2100 | Send residents/fellow for 9PM meal. This is when my hospital cafeteria opens for its trainees to pick up a meal. I usually tell my residents/fellow to grab a meal and store it in the kitchen until we finish rounds.
2300 – ? | Finish rounding. Rounds take longer when we get new admissions, or if the airway pager [called the RICU pager] goes off and we need to leave the unit. Some patients are more complex and take more time to discuss and determine the plan for. It’s really a wildcard how long it will take to finish.
1700 – 0700 | At any time during my shift, we may get called to intubate [place a breathing tube] a patient. In our hospital, excluding the emergency room, only anesthesiologists intubate. In other hospitals, other intensivists [medical, surgical, neuro-] typically can do their own intubations, unless it’s anticipated to be challenging. Sometimes we get zero pages to intubate, sometimes we get a bunch in a row. Either way, every time we get a page, it disrupts rounds or other work we are doing within our own unit.
2300 – 0700 | If patients are relatively stable and the RICU [airway pager] does not go off, then I will work on my notes in my call room. I periodically walk around the unit and check in with the nurses, residents, and fellows throughout the night. Sometimes, I can get a nap in. Sometimes, I get hungry or cold and go get soup or a warm beverage. Sometimes, I spend some time catching up with the nurses, residents, and fellows in the unit. Sometimes, I do some teaching [this is highly dependent on how much work needs to get done].
0700 | Sign out to the daytime attending. Walk home.
Final thoughts
I hope you enjoyed the video and this post on what a night shift as an ICU doctor looks like! Please feel free to connect with me via email or social media with questions!