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Internship survival guide: Thriving on the night floor rotation

During my first week as an intern, a question weighed heavily on my mind: “How am I going to survive my night shift rotation?” Soon after, another question arose: “How can I make the most of my night shifts and continue to learn and grow?” I reached out to senior residents and faculty members to learn from their experiences and seek their advice.

I understand that you may have similar questions and concerns as you prepare to embark on your night float rotation during your internship. It’s only natural to wonder about the challenges and uncertainties that lie ahead, as many medical interns do. This article aims to provide practical strategies for effectively navigating your night floor rotation, based on my own experiences as both an intern and now as an associate professor at a busy academic medical center.

Effective sign out is crucial.

Pay close attention during verbal sign-out sessions, as day shift interns could be tired and may not always provide vital information about patients. Even if the day shift person did not explicitly mention any issues, make it a habit to inquire about particularly ill patients. This practice will help you be mentally prepared to respond promptly to urgent situations or rapid response calls. By actively seeking information during sign-out, you can better prepare yourself and ensure a seamless continuation of care for the patients under your responsibility.

Check, recheck

Always make it a habit to check for allergies before ordering any new medications, as well as contrast allergies before ordering CT or MRI with contrast. Surprisingly, the electronic medical record does not provide a cautionary alert when clinicians place an order for an imaging test with contrast in a patient with a contrast allergy. Ordering imaging tests with contrast for patients who have a contrast allergy without any premedication puts them at high risk of allergic reactions and can lead to delays in patient care.

During the night shift, requests for antiemetics are very common. It’s important to note that all antiemetics can cause QTc prolongation except for Trimethobenzamide (Tigan). Therefore, always check the QTc interval before ordering antiemetics.

For geriatric patients, remember the rule “start low and go slow.” For example, when initiating antihypertensive medication in geriatric patients, always start with a low dose, as their drug metabolism, glomerular filtration rate (GFR), and muscle mass are much different compared to that of younger individuals.

Senior resident: Call or not to call?

I still remember when my senior resident told me, “Do not call me at night; I want to sleep well tonight.” Don’t hesitate to wake up your senior resident if you’re uncertain about what course of action to take. Always prioritize patient safety above all else.

It’s important to remember that as an intern, nobody expects you to have all the answers or be an expert in every situation. Recognizing when to seek assistance and guidance is integral to safe patient care, residency training, and being a good physician. If you find yourself unsure about the appropriate steps to take, don’t hesitate to wake up your senior resident. They are there to support and guide you, and their expertise can help ensure the best possible care for the patient. As one physician once told me, “It’s better to deal with an angry resident than a deceased patient.”

Respect others; be respected

During night shifts, you primarily work with your senior resident and other interns, depending on the size of your program. It may seem lonely at first compared to the day shift workflow. You will have quite frequent interactions with nurses on your night rotation, and it’s important to recognize and appreciate the invaluable role that nurses play during these shifts. They work tirelessly, sacrificing their sleep and comfort to provide care to patients as you do. Showing appreciation for the hard work of all staff members, including nurses, is essential. When you acknowledge and value their contributions, they, in turn, will likely appreciate your service as well. It’s important to acknowledge that, initially, you may not automatically earn trust or feel a strong sense of respect from all nurses. Building trust and mutual respect takes time and is a gradual process. By embracing this approach, you can foster smoother collaborations and contribute to a more positive work environment.

You need the energy to do your best.

“Self-care is not selfish. You cannot serve from an empty vessel.” – Oprah Winfrey.

The night floor can be quite hectic, making it essential to prioritize good nutrition and ensure adequate sleep during the day. When it’s time to sleep during your night float rotations in the daytime, remember to cover all the curtains in your room to create a dark environment that promotes restful sleep. Upon waking up, before heading to the hospital, take a moment to go outside and expose yourself to sunlight. This can help boost your mood and energy levels. It’s also beneficial to pack some snacks from home to have readily available. Additionally, consider bringing a blanket with you in case the on-call room is cold. Lastly, having a portable phone charger is recommended to ensure your phone remains charged and accessible. By taking these simple steps to prioritize your well-being, you can better manage the demands of the night shift and maintain your physical and mental health. Remember, self-care is crucial to providing optimal care for your patients.

Rapid responses and code blues

As an intern, it’s crucial to understand that the expectation is not for you to lead rapid response and code blue situations. During your initial experiences with rapid response, it’s important to follow the instructions provided by your senior resident. When your senior resident takes charge of running the rapid response, you can support the team by opening the patient’s chart and reviewing the most recent notes and medications. In these situations, it’s essential to be prepared and available to perform CPR if necessary and assist in ordering the required labs and medications as directed by your senior resident. Remember, these situations can be intense and time-sensitive, so staying calm, following instructions, and being prepared to assist within your capacity are vital contributions you can make as an intern.

Document, document, document

As you are aware, there is a well-known saying in the medical field: “If you didn’t document it, it didn’t happen.” No matter how much time and effort you devoted to providing care, without proper documentation, it may seem as if the event did not occur. Likewise, if your documentation is inadequate, incomplete, or delayed, it can create the impression that the event or patient care was not properly done. While it is not necessary to write lengthy notes, it is crucial to document concisely any significant overnight events. This documentation serves as evidence of the care provided, important findings, interventions, and any changes in the patient’s condition. In addition to documenting, it is equally important to verbally communicate these overnight significant events to your team.

Dear sunlight

Shifting to a predominantly nocturnal schedule may sometimes impact your mood, leading to feelings of irritability or low spirits. However, exposing yourself to sunlight can have a profound effect on improving your overall mood. Once you’ve rested and awakened during the daytime, spending time in natural sunlight can be highly beneficial. Sunlight possesses healing properties that uplift the spirit and promote a sense of well-being.

In conclusion, night shifts can be challenging with their sleeplessness and chaotic nature. However, it’s important to take a moment to pause, breathe deeply, and reflect on the reason why you chose this journey in the first place—to make a meaningful impact on the lives of others. Remember that even in the midst of a busy night, each action you take can contribute to improving someone’s life and well-being. With this mindset, you can navigate the demands of night shifts with resilience and continue to make a difference in the lives of others.

Farzana Hoque is a hospitalist.

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