Surviving Night Shifts

Night shifts are not just “day shifts in the dark”.

They are physiologically harder.

At 3–5am your brain is:

  • slower
  • less focused
  • worse at decisions
  • worse at calculations
  • worse at risk assessment

This isn’t weakness.

It’s biology.

Even experienced registrars feel it.

So surviving nights isn’t about working harder.

It’s about working smarter and protecting your energy.

First mindset shift

Stop expecting:

❌ perfect productivity

Start aiming for:

✅ safe decisions

At night your goal is NOT:

  • finishing all jobs
  • perfect plans
  • clearing every task

Your goal is:

👉 keep patients safe until morning

That’s it.

Safety > productivity.

Always.

Before the shift (huge impact)

Good nights start before you even arrive.

Sleep properly (don’t wing it)

Common mistake:
Staying awake all day → starting night exhausted

Much worse.

Better:

  • short nap before shift (90 mins–3 hours)
  • dark room
  • phone off

Even a small nap massively improves alertness.

Eat before starting

Never start nights hungry.

Because once it gets busy, you might not eat for 8 hours.

Eat something:

  • filling
  • not too heavy
  • slow-release carbs + protein

Avoid huge greasy meals → makes you sleepy.

Hydrate early

Dehydration = headaches + poor concentration

Start well hydrated.

Bring water bottle.

During the shift

This is where most people struggle.

Pace yourself early

Classic mistake:

Starting shift at 100% speed → burning out by 2am

Instead:

Work steady, not fast.

It’s a marathon, not a sprint.

You’ll still be working at 7am.

Do a safety sweep first (not paperwork)

First hour:

  • check sick patients
  • review high-risk ones

NOT:

  • discharge summaries
  • admin
  • routine jobs

If you waste early energy on admin, you’ll regret it later.

Protect your energy for clinical work.

Take micro-breaks

You don’t need long breaks.

Even 5 minutes helps.

Examples:

  • drink water
  • sit down briefly
  • snack
  • step outside ward

Tiny resets prevent mental fatigue building up.

Continuous 6-hour stretch = poor decisions.

Eat small snacks, not one big meal

Big meals at 2am → crash and sleepiness.

Better:

  • small snacks every few hours
  • nuts, fruit, yoghurt, sandwiches

Keeps energy stable.

Caffeine strategy (very important)

Don’t drink coffee all night randomly.

Be strategic.

Better:

  • small amounts early (start of shift)
  • avoid caffeine after ~4–5am (so you can sleep later)

Too much caffeine late → can’t sleep post-shift → worse next night

Use caffeine as a tool, not life support.

Cognitive safety (very important clinically)

This is where mistakes happen.

At 4am your brain is slower.

So compensate.

Slow down decisions

Counterintuitive but safer.

Don’t rush.

Especially with:

  • prescribing
  • insulin
  • anticoagulation
  • potassium
  • opiates

Double-check doses.

Fatigue causes calculation errors.

Stick to systems (A–E, checklists)

At night, don’t rely on “clever thinking”.

Use structure.

Always:

  • A–E approach
  • SBAR
  • written job list
  • clear plans

Systems protect you when your brain is tired.

Write things down (don’t trust memory)

Fatigue destroys short-term memory.

If you don’t write it, you WILL forget.

Always:

  • job list
  • tasks
  • plans

Paper > brain at 3am.

Escalate earlier than usual

At night:

  • fewer staff
  • slower response
  • you’re more tired

So escalate sooner, not later.

Don’t struggle alone at 4am.

Senior support exists for this reason.

Managing energy through the night (simple model)

Think of your energy like a battery.

Early night (8–11pm)

High energy → do reviews, big tasks

Midnight–3am

Moderate → steady work

3–5am (danger zone)

Low energy → slow down, double-check everything

6–8am

Second wind → finish safely, handover properly

Plan your effort around this.

Not everything needs to be done at 3am.

Common junior mistakes

❌ no sleep before shift
❌ skipping food
❌ too much caffeine
❌ starting with paperwork
❌ working non-stop without breaks
❌ rushing decisions when tired
❌ trying to “clear all jobs”
❌ not escalating

Most night errors are fatigue-related, not knowledge-related.

Real NHS truth

Even very senior doctors:

  • feel slower at night
  • double-check more
  • ask for help more
  • use systems more

So if you feel tired or slower — that’s normal.

Work with it, not against it.

Simple night survival checklist

Before shift:
✅ nap
✅ eat
✅ hydrate

During shift:
✅ safety sweep first
✅ write everything down
✅ small breaks
✅ snack
✅ slow down decisions
✅ escalate early

After shift:
✅ sleep ASAP
✅ dark room
✅ protect recovery time

Simple habits → much easier nights.

Take-home concept

Night shifts aren’t about being superhuman.

They’re about protecting your energy and making safe decisions when tired.

Slow is smooth.
Smooth is safe.

Focus on safety, not speed, and nights become far more manageable.

Survive the night — optimise in the day.