A few years ago my family medicine residency program, realizing that duty hour changes(*1) were coming soon, decided to start a night float system (*2). The new duty hour limits were not in place, so residents worked 14 hour shifts for 14 nights in a row (*3). (Then we got one day and one evening off in preparation to return to work - on day shift.)
In case you were wondering, this was a horrible idea.
Just a few generalizations about night shift - when you work nights, you never, ever feel good. You always feel tired, like you need to go to bed, or like you just got up from an ill-timed nap, or like you desperately need a nap regardless of the timing. You feel disconnected from society – just as people are going to work, you are headed to bed, and just as the kids are getting home from school, you’re trying to wake up again and get ready for another workday.
I know that six nights in a row can be difficult and taxing but 14 were just monstrous (*4). By the second week, I started to lose perspective. I was crying every night on the way to work. I left home with my child in tears as well and my husband frustrated at being thrust into single parenthood with a very angry roommate.
I was angry – initially at the program directors, but gradually at the nurses, the other residents, and ultimately the patients. I wondered why I was getting so many stupid pages, and why none of the other residents could do their own work without dragging me into it, and mostly why all these stupid people had to choose tonight for their shortness of breath/chest pain/drug overdose. Not a good attitude. Add to that the directors’ insistence that no one ever, EVER nap on nights even if all the work was done (“Because you have all DAY to sleep”) and their refusal to consider putting a day off in the middle (“Because it would disrupt the sleep schedule” (*5)). By the end of that two weeks, I honestly hated my program and was wishing heartily that I’d gone with my second choice.
Then I reverted back to days and life improved tremendously. I still had a chip on my shoulder for a while, though.
*1) No longer allowing interns to work 30 hour shifts.
*2) “Night Float” means that a handful of residents take care of the hospitalized patients all night so that no one has to work a 30 hour-shift.
*3) Yes, this means a 98-hour work week. As long as they averaged the first week of night float with the week before it and the second week of night float with the week after it (and each of those weeks were electives), we still satisfied the ACGME requirement of <80 hours per week average.
*4) I don’t want to sound like I think I had the most difficult job in the world – I just want to make a few points about how badly it went for me personally.
*5) By this logic, no one should ever take weekends off, because most people sleep in on those days thus disrupting the sleep schedule. However, the program directors did not forego their own weekends off.