OOH | The Nerdy Vet

The list of probable detriments to one’s health of working nights makes for rather grim reading, from an increased risk of cancer, diabetes, heart disease and even accelerated ageing of the brain. I was vaguely aware of the research that supported the claims that working night shifts was ultimately bad for us back in the UK when I used to do a lot of overnight veterinary shifts for Vets Now, the out-of-hours provider, and always downplayed the message by telling myself that “I am only doing it occasionally.” The fact that I now find myself coming to the end of a 7-day run of 12-hour night shifts, again, in a veterinary capacity, has inspired me to revisit the subject.

The advantages of working nights – and there are some for sure – are compelling, in my current case the main one being that in exchange for working 7 days in a row (or nights if I am going to be accurate) I get 7 days off. For anyone who is used to working in a normal capacity that equates to having some decent annual leave every two weeks, which kind of rocks! I for one know that I can make really great use of that kind of continuous ‘free time,’ engaging in fun activities when the rest of the world is slaving away at the office and working on my own projects on a schedule of my choosing. Bliss indeed.

The main advantages of night shifts, specifically in the veterinary sector, are the following:

From in-patients to emergencies & OOH consults, there is usually a steady stream of cases & decisions to be made during night shifts.

Autonomy & independence – the camaraderie of working with other vets during the day is great and it is always good to have others to bounce ideas off. However, long-term the danger is that always being able to “check things” with a colleague can lead to a slow erosion of the ability and confidence to truly think and act independently. With night shifts, where it is usually only ever a single vet in charge, there are no others to check in with. Assessments need to be made and decisions executed based on what I believe to be best practice. If I don’t know something then of course I can, and do, check in with trusted sources of information but ultimately I am the one who has to decide and act on a variety of unique cases and clinical situations. Although it can be scary at times, such as my first night on that saw me presented with an aged Boxer dog that seizured pretty much continuously all night, the confidence that gradually comes from relying on your own ability to process information, apply knowledge and skill and ultimately make decisions and take actions that have real outcomes is empowering. For this reason alone I think that doing some night work is very valuable for all clinicians.

Variety – we see and hear it all during the graveyard shifts, that’s for sure! From the full-on emergency requiring all hands-to-the-deck, to the varied hospital cases that seem to swing from one state to another almost by the hour, consults for ultimately simple complaints to downright bizarre calls, we do get variety in our lives. Often the main challenges presented during the night are the human ones, with the most unusual calls coming in, such as one we had at 2am from a lady concerned about whether her sister’s dog was in pain after having been neutered a couple of days ago. My nurse spoke for a short while with said lady before offering an appointment at which point she informed her that the dog was actually in Scotland! (nb: we are in Dubai!) Another classic night-time call is often from an owner who has been sitting on a pet health issue for the last week only to decide that now, in the wee small hours of the morning, is the time to seek advice and assistance and to then act surprised when the cost of being seen is pointed out to be higher than during the day. Just plain odd. Again, from a training in how to deal with people and communicate standpoint, night shifts are an invaluable learning environment. Either that or fertile anecdote-mining terrain for the next book!

Free time – some nights are literally spent working for the entire time, such as the aforementioned fitting dog scenario, whereas a lot of the time things do tend to quieten down after midnight meaning that there is an opportunity to catch up with paperwork, do some CPD or even just indulge in some more light-hearted pastimes such as reading. As someone who is generally busy working on all sorts of personal projects, having the time to sit down during the night is one of the main draws of working these shifts. Of course there is always the risk that a call will come in or something will change with an in-patient, requiring you to switch attention, but generally it seems that there is time available.

The filtering effect of the higher consult prices – it costs more to be seen out-of-hours, the reason being that our costs of providing a service overnight are higher than during the normal working day. The advantage of this fact is that it can, and does, serve as a very effective filter for those genuine emergencies versus those cases where the pet can either wait to be seen when the clinic is running with a full team and the real time wasters. It never ceases to amaze me how what is initially dialled in as a “real emergency” that simply “must be seen NOW” quickly becomes “oh, its okay – I’ll see how we go overnight and then see the vet in the morning,” once the cost of the overnight consult fee is made clear.

Leaving as everyone else arrives – despite being tired and very much looking forward to hitting the sack, there is a satisfaction that accompanies being able to head out the door, past everyone else in the world who is heading in the opposite direction to start their working day. One might call it a sense of smugness.

Time off – we touched upon this primary perk above, with the main point being that the reward for working a full week of long night shifts is an entire week completely off work. Brilliant!

The price? Well, there is the small matter of the week of night shifts to get through. No pleasure without pain, eh?! So what exactly is the “pain” of night work anyway?

Dark corridor — It can feel odd being up when the rest of the world sleeps

Our bodies and brains just aren’t used to functioning optimally during the entire night and regardless of the amount of sleep one tries to get during the day it never feels as though it is enough, meaning that, for me anyway, I have spent the last week feeling somewhat jet-lagged. The worst periods are the hours during which I am actually writing this now: 2am – 4am, the real ‘dead of night,’ when every fibre of my being is screaming at me to close my eyes and just switch off. The evidence shows that the body and brain changes state during these hours, meaning that even the food we eat during the night is processed differently to if it was consumed during daylight hours. Increased long-term risk of developing conditions such as heart disease, diabetes and obesity are recognised sequelae. Although there are plenty of articles and sources of advice on how to “adapt” to night shifts, the truth is that you never really “adapt,” especially if you then adjust back to a normal routine. One of our nurses who works nights has actually converted to a pretty much permanent state of nocturnal being, continuing to stay up all night and sleep during the day even on her off weeks, so maybe she has managed to adapt over time but that is not something most of us would be happy to do.

The disruption to the normal rhythm of my life is the main thing I have noticed during the last week, with it proving difficult to really continue exercising normally. By the time I get home in the morning, all I really want to do is get some breakfast and get to bed. Even if I did decide to exercise in the morning, driving to the gym would be dangerous in my sleep-deprived state and although I could choose to perhaps go for a run outside, I feel that I am simply in danger of giving my body very mixed signals by elevating my heart rate whilst it is getting lighter to then expect it to settle into a state of sleep a short while later. As such, by the time I have managed a few hours of interrupted sleep, there is little real drive or time to exercise before grabbing some food and preparing to head back in for the next shift. One thing I am very much looking forward to with a return to normal daytime living is a normal exercise routine!

Socially, night shifts can be isolating with the fact that you sleep whilst others are awake and vice versa making it difficult to maintain a healthy social life during the actual night shift period. Of course there are your night-time colleagues to chat and hang out with but given that nights are usually staffed by a significantly smaller team – such as one vet, one nurse, one receptionist and one animal care assistant – and the fact that it is usually the same people who simply rotate, the truth is that you end up spending a lot of time with the same people. I am not saying that is necessarily a bad thing – after all, I work with awesome people – but given the rather carousel nature of night shifts, social interactions can start to feel very limited in scope. Again, there is the silver lining of the following week off but getting to see friends properly only every second week can, I can see, get testing for all parties.

Okay, so we’ve established some of the pros and cons of working nights. What about the actual logistics? How do you actually prepare for, manage and then readjust from working nights? All I can offer is personal experience and the tips that I have picked up from doing some independent research, but generally I find the following works:

PREPARING FOR NIGHT WORK:

Try to get a little sleep directly before the first night on duty, even if it’s only a couple of hours of rest, preferably in the dark. You’ll still feel tired during the shift, especially during the very early hours, but psychologically I find it better than trying to go straight from being a ‘day-walker’ into being a creature of the night.

Prepare some healthy, wholesome food to take in to work, preferably something you can heat up and have as a ‘proper meal.’ The temptation with night work is to snack, especially on the kind of crap that you wouldn’t normally indulge in often. Snacking on junk combined with the stresses of already being awake all night will gradually have a detrimental effect on your health. Eating decent food is one thing that you can control and giving your stressed body and brain the right kind of fuel will make the process so much less damaging in the long run.

Take something to do during those ‘quieter’ periods. I always go into nights expecting to be busy all night, with any ‘free time’ ultimately being seen as a bonus. I find this approach much easier to cope with psychologically than going in expecting to have free time only to get all pissed off when I find that 1am emergency rocking up. Whether you take in some reading, a movie or some project work to do, having something on hand to focus on during the occasional lulls will help keep you awake and stave off the attack of the drowsies!

Get in early so that you’re not rushing and feeling flustered before you start, especially if you then end up heading into a busy night. I personally like to arrive about 30 minutes before my shift, change into my work clothes actually at work and maybe even kick back for ten minutes before heading upstairs to find out what fun-and-games await me.

DURING THE NIGHT SHIFT:

Expect to feel tired at some point, even as you get further into the week. I have not had a single night over the past seven days where I have not felt the strong desire to curl up and sleep at about 2am. There isn’t really any way around it unless you choose to make use of stimulants such as caffeine, although I don’t recommend it as a) you simply end up elevating your heart rate, stressing your body at a time when every bit of it’s programming is telling it to be relaxed; and b) unless you process caffeine super rapidly you’ll likely screw yourself over for when it comes time to get your head down at the end of your shift. I do have a small coffee before heading in for my shift, as that would normally be part of my ‘breakfast’ routine, but otherwise I avoid caffeine for the rest of the 24 hour period.

Try and get some rest, even if it does just mean a 15 minute lie down. The restorative properties of simply remaining still and allowing the brain to rest, even for short periods, is established. It’s unlikely you’ll get to actually sleep so I wouldn’t bank on it and besides, any more than a 30 minute nap usually results in feelings of sluggishness and confusion when you come back around, so the apparent advantages don’t really seem to materialise.

AFTER THE SHIFT & BEFORE THE NEXT ONE:

Get a healthy breakfast, avoiding caffeine, and go through whatever morning routine suits you. I personally need about two hours to fully unwind from the shift, getting into bed by about 10am.

Assess whether you’re safe to drive. Extreme fatigue has been proven to have the same effect on driving ability, hazard awareness and reaction speeds as drinking, so if you do feel super tired in the morning then do yourself a favour and get a taxi home. Crashing your car on the way back home would be a really shitty way to end a shift.

GET SOME SLEEP! The bulk of the day should be given over to sleep, not to “getting things done,” as will be the temptation. Creating the right conditions for a decent sleep can help, from making the room as dark as possible or even wearing a mask, to turning the temperature of your room down a little. Even then, it is likely that you will not sleep as soundly, or for as long, as you would normally during the night but that is to be expected. I have aimed for at least 6 hours a day (10am to 4pm) and found that I have been waking naturally just before 4pm anyway. The first day of sleeping and then waking in the evening was odd and it took me a moment to remember what time of the day it was, which was a surreal, almost dream-like experience.

Turn off distractions such as phones. You’re much more likely to be disturbed by various notifications, messages and emails pinging continuously as they hit your phone during the day, especially given that you’ll likely be sleeping less heavily than normal, so turning off any such notifications is wise. Obviously the one notification you will want to ensure you hear is your alarm call and it is for this reason that I personally choose not to use ear plugs.

RE-JOINING THE DAY-CROWD:

The end of the loooooooong week of nights is finally over! Hurrah! Life can return to normal as you transition back to your usual routine.

Get a good breakfast, as with any day.

There are two techniques I discovered during my research that can aid in transitioning back to a normal day-centric routine:
- Sleep for a few hours (e.g. 10am to 2pm) and then get an early night later in the evening, with a normal return to daytime routine the following day. This is the tactic I intend to employ.
- Sleep through for 36 hours and write off the first day in order to start the following day on normal routine day mode.

Expect to feel a bit out of sorts for a couple of days. Much as jet lag can leave you feeling a bit weird for a day or two after returning from a long-haul trip, coming off nights can feel the same. Not to worry though: it’s normal.