Run Reviews

Please find below some further commentary on 12 hour night shifts:

12 hour shift patterns in an ICU environment is common, so we can learn something from them. This pattern comes with several significant caveats that cannot be minimized if we are to stay safe.   The following discussion relates to night shifts only but should be noted by all RMOs considering 12 hour night shifts in the face of COVID-19.

Recognition of fatigue. In ICU it is assumed that you will sleep (nap) on your shift and it is actively encouraged by unit staff and SMOs. Making decisions after being at work for 10 hours and no break or sleep is tantamount to making clinician error. This risk will be further compounded by donning and doffing PPE. So nap when you can, better still roster a nap period (see buddy below). And remember that fatigue accumulates which is why you must have sufficient days off between shifts.  When you return to duty it preferably is not to another set of nights. In many instances in ICU those who do a series of nights back to back often have 5-6 days between them.

Work as a team. You have a buddy that works with you, not on the other side of the hospital but someone who for the most part is right beside you. On a busy night you will be tired (even if you slept during the day) and you need to cognitively shift some of the load to your colleague. Particularly in light of Covid-19 you will need more people at night with you to do the work, doing it with the same numbers you had previously will not work. When it comes to napping, one goes to sleep the other holds the fort unless absolutely necessary to wake you; and then you swap over.

Your sleep during the day is going to be noticeably worse. You will probably be getting up at 6pm to have dinner and then start work ~ 8pm. Most folks only get one good session of sleep which can last anywhere between 4-6 hours (hence accumulated sleep debt), very few folks have more than this and you won’t get another opportunity until your nap.

You cannot work more than 4 night shifts at any time. That being said if doing 12 hour nights, work fewer consecutive night shifts if you can. 2-3 is a manageable number; the 4th shift is always really hard – don’t do 5.

Supervision offsets the impact of fatigue. In ICU night style shifts, we meet the SMO at handover at the beginning of the night shift, go through the sick patients and see them, confirm the plan with them, which often includes ringing the SMO when set parameters are met. There is always an expectation that the SMO will attend when you need – no questions asked.

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