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Night shift.. you either embrace it or loathe it! In the 20 years that I have been in medicine, I’ve realized that many (MANY) healthcare professionals, including Physician Assistants (PAs), work night shifts! This means that the people looking to become a PA (or other healthcare professional) will end up working night shifts as well, and so I thought I might impose share some of the things I have learned along the way.

Which PAs Are Working Night Shifts?

Emergency Medicine PAs

When I was a Pre-PA, I shadowed an awesome ER PA and was lucky enough to shadow during several of his night shifts. It really opened my eyes to a whole different world compared to when I’d shadowed on a day shift. We had more trauma patients, and so, there were more procedures to watch (which was awesome). I also noticed that the night shift crew was “a little different” than day shift (which was also awesome)… they were grittier, more sarcastic, very down to earth and generally, my kind of people. They truly had “seen it all” and shared some of the craziest stories I’d ever heard.

Then, when I was a PA student in a trauma center, I worked many night shifts in the trauma center during my ER rotation and found that night shift ER personality to be ubiquitous no matter what ER I was working in. I actually learned to suture the most during these shifts. I also learned how amazing it is to work in a busy ER when the entire team works together to save a life.

The “night shift personality” was also confirmed during the first four years I worked as an Emergency Medicine PA in a busy “general” ER, and also in my last 5 years working in a pediatric emergency department. I love the night shift crew (and love my day shifters/mid shifters too!). It’s an accepted fact that if you work as an ER PA, generally (though not always) you will be working some night shifts.

Hospital-Based PAs

PAs working in a hospital sometimes also work on a shift-based schedule, and sometimes that includes night shift! PAs can work in all areas of the hospital on a night shift including

On the medical and surgical floors as hospitalists or working in internal medicine departments
Intensive Care Units (ICU) and all the specialty intensive care units such as Pediatric Intensive Care (PICU) and Cardiovascular Intensive Care (CVICU) and many others.
In any surgical specialty such as Trauma Surgery, General Surgery, & Neurosurgery
In bigger hospitals, PAs working in other medical specialties may cover for the night shift. This list is truly infinite but can include specialties such as Neurology, Cardiology, Radiology, Hematology/Oncology, OB/GYN, Neonatology, the list goes on.

Outpatient PAs are Working Night Shifts Too!

Some clinics and outpatient offices have their PAs cover call for their service as the consultant.. This often means they are up at all times answering calls from patients or another provider.

Night Shift Tips

These tips are based on my own personal experiences, remember that YOU may be different. In the past 20 years, I’ve worked night shifts in some form or another. I’ve worked 24 hour shifts as a paramedic, or 8, 10, 12, and 16 hour night shifts in a variety of roles ranging from ER tech to trauma room paramedic and eventually as an ER PA. These experiences have helped me fine-tune what works best for ME. This should not be considered medical advice and I encourage you to seek out and find what might work best for you.

Get Plenty of Sleep 48 Hours Before Working Night Shift

Many people think they should to stay up late in the 48 hours before working night shift.. to “get ready” for their upcoming night shift.

Nearly 20 years of working night shifts has lead me to tell you this isn’t true. I have actually found that staying up late the nights before makes me MORE tired the following days, and really messes up my sleep-wake cycle. This is especially true (and kind of obvious) when I can’t sleep in! I suggest getting plenty of sleep beforehand.

Nap the Day of Your Night Shift

As a former Non-Napper, I know many of you will think this isn’t necessary. Napping is best but even just lying down, without a phone, TV, music or stimulation can make a huge difference come 4am.

I usually look at trying to nap at least 20-30 minutes and up to 2 hours the day I’m working night shift. I try to aim for around 12 pm but sometimes I end up napping around 2 or 3 pm. Typically, I’ll set my alarm, go in a dark, cool room, and get some shut-eye.

#protip: don’t drink a ton of caffeine the morning of. When you wake up, drink a little less than you usually would. This should help you fall asleep for that early afternoon nap and will save you in the long run. When you wake up from that nap, then enjoy your usual intake of caffeine!

Avoid the Junk Food and Eat Healthy(ish)

So, I’m no health nut (..sigh) but I have found on the days that are more.. ahem… “carb” heavy or full of junk food, I just feel more crappy during night shift. This has only been a recent revelation, to be honest and has definitely worsened in my 30s. This doesn’t mean NO snacks when working night shift, it just means include healthier ones. There’s no judgment here.. I love chocolate and coffee and don’t fit to any strict diet on night shifts.. I just try to make sure I INCLUDE the healthy stuff too.

You all KNOW what I’m talking about, that feeling when you didn’t make the best food choices, really can wreak haovc come the 3am cortisol dump. Trust me on this one.

In addition to some of the obvious things like drinking more water, eating more veggies and avoiding pasta and potatoes on the day of and during my shift, here are some other things that have helped me (links are affiliate links!):

Taking a multivitamin that day (even if I might have missed the dose in the last 30 days).
Drinking a protein shake (either the pre-made tuff or making your own). I really like the premier protein shakes or will make a smoothie with this organic vanilla whey protein powder.
Meal prepping or meals the day before. I like to put leftover dinner in these meal prep containers the days prior so that I have no excuses.
Having snacks prepared AHEAD of time. Nuts, cut up fruit and berries are great to have at 3am!
Bringing chocolate, coffee, and creamer. These can be healthy (or not) but a shift without coffee for me is not a good one so I make sure it’s packed!

Bring a Jacket

Ok, let me start with the fact that I live in Florida. You know, that place that feels like you have stepped into a sauna every time you walk outside 6 months out of the year? That being said, hospital chillers are well known to freeze patients and staff out.. but did you know your natural temperature can (usually will) drop about 2 degrees Fahrenheit around 3 am. This can be due to several factors, including your own circadian rhythm, cortisol levels, and the number of bodies in the department, but I nearly ALWAYS get cold at this time. I found wearing a long sleeve shirt under scrubs on my night shifts usually helps in the wintertime but in the summer, I opt for an outer jacket I can take off.

My absolute favorite jacket is the Ionic scrub jacket from Medelita. It’s warm, but not made of fleece, which gets too hot for me. It also has a vent in the back of the jacket to help with airflow, has lots of pockets and I freaking LOVE their embroidery. I loved them so much that I reached out to their founder, Lara, who is also a PA and I’m thankful to be an ambassador for them, which helps support this website. I also have several of their white coats which I love, but for nights.. the Ionic is my go-to.

Don’t Nap During Your Shift

Ok, this might only be for ER people.. or maybe just me, but if we have a lull, and I close my eyes, even briefly, I’m RUINED for the rest of the shift. Some people find an empty bed to sleep on.. some people have call rooms and are actually able to get a good nap in. I find just powering through it actually keeps me more productive.

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Stay on Top of Your Charting

Again, this might only be for my ER people, but it is SO easy to get behind on a night shift. First off the patient patterns are different, you often walk into a waiting room full of patients and need to quickly see as many as possible, which may put you behind on charting. Usually there is a 2-4am lull which allows you to catch up but if a code or trauma patient walks through the doors all bets are off. Keep up with your charting the best you can because come 5am, you will NOT want to chart, I promise. You will be tired, and looking to go home, and honestly, staying late to chart after a night shift is it’s own form of torture.

Watch the Caffeine Intake

Ok so I feel like this whole post is basically about how I dose my coffee addiction intake but this also was something that took me YEARS to perfect. After I’ve taken that nap in tip #2, I make a large, yummy cup of iced coffee and enjoy it my whole way to work. I usually drink another cup during my shift but I have a cut off of no more than 2 cups and absolutely no caffeine 2 hours before the end of my shift and roughly 3-4 hours before I’m in bed. (4 am for me). This has helped with that “lay in bed and stare at the ceiling” issue that can happen after a night shift. I also found that the 85% Cacao Chocolate squares I’d treat myself with contains a decent amount of caffeine and so the same rules apply with chocolate too. So, to summarize:

Limit caffeine if I plan to nap before the shift
Drink caffeine before and during the shift
Cut off caffeine 3-4 hours before I plan to be asleep

I also use caffeine to help me turn around (Tip #10).

After the Shift, Eat Breakfast

I have found that eating a small breakfast has really helped me fall asleep (and stay asleep). When I don’t.. I often wake up the next day much earlier than I’d like because I’m hungry and used to eating around that time.

I know it’s counterintuitive but I also try to only drink a small amount of liquid after 4 am when working night shift because 6 hours later is a terrible time to have to micturate when you are in full REM sleep.

Sleep in a COLD, DARK, QUIET Place.

Night shifters will absolutely boast about how they’ve caved out their bedroom like it’s a competition. And it’s no wonder.. studies have shown even the smallest amount of light in a room (including that from your phone) can effect your sleep. Combine this with sleeping during the day time and you’ll quickly realize how important your environment is top getting good sleep.

Get it cold. Cranking the AC way down, and blasting the fan on high, then climbing into a soft bed under the weight of a fluffy comforter is my little moment of heaven.
Get the room dark. I have done it all.. Install blackout curtains or pull-down shades and then cover with hanging towels to cover any cracks of light. I have found a good temporary option is cutting an aluminum backed foam board from a home improvement store to fit your window perfectly has been a great (though only a little trashy) solution. It certainly was a savior when I was out of town for my ER clinicals.
- Blackout curtains (We bought these blackout curtains and I love them because they can be temporary)
- Pull Down shade. They are easy to install and in the past, I have used some like these blackout pulldown shades.
- Foil-backed rigid insulation boards like this for around $11 are perfect for temporary uses. If you need something more permanent a less rigid roll of reflective insulation foam for $20 would work if you were willing to tape it up.
- Sleep masks are another way to make sure it is super dark. These sleep masks are comfortable because they don’t smush against your eyelashes (I hate that).
Cut the noise down. If you live alone, this is pretty easy as long as there are no outside interferences (yes, I admit to silently cursing out an apartment landscaping crew at 9am).
- White noise can cover the many sounds during the day. Many white noise apps are free, and a great way to see if you like using white noise. I prefer not to have the noise coming from my phone so, after two kids, I love this sound machine because you can plug it in or it can also run on batteries, which makes it great for traveling.
- Ear Plugs can help (if they are comfortable). I like this style of earplugs because they are the most comfortable, and in my opinion it’s three bucks well spent!

For those more established, or those with kids or roommates this can be a little more challenging. I have some suggestions but recognize that not everyone can do these things

Put an air mattress in your closet! The clothes act as sound absorbers, and it’s usually dark, quiet and out of the main traffic areas. This could also work in a guest bathroom that goes mainly unused. Put a rug down for a little extra comfort if you have a tiled or wood floors. Make it cozy and you’ll sleep like a baby (in a closet).
Cave out the guest room. If you have one, make it night shift friendly with blackout curtains, and a white noise machine.
Got an RV or camper? Use it! If you have one, consider sleeping in your (or a friend’s) camper.. it will get you out of the house, you can make it as dark as you want, and it can be your own private oasis. This is actually what my husband and I do, and how we make both our night shift schedules bearable!
Convert an Outbuilding. This sounds kind of bougie/trashy but hear me out. Sleep is important and if you’ve signed on to work them on a regular basis you need a plan. You may not have a spare guest room or a camper, but if your yard is big enough, you might have room for a Pre-build shed or outbuilding. Find that friend that can install insulation and drywall (properly.. you don’t want leaks) and go get a window air-conditioning unit, and you might just have a little place to call your own. You can use an air mattress or install a simple bed. It can also be an office and serve more than one purpose. Done right, it can be a great solution! Done wrong and code enforcement might be called (no seriously). Choose your investments wisely.

Consider Melatonin

Melatonin is one of those best-kept secrets of the night shift land. For me, it has been a total game-changer and helps with a good night’s sleep! Not everyone responds to melatonin the same way. I suggest reading more and talk to your own healthcare provider, making sure it is safe for you, including making sure no medication interactions, and even considering starting at lower doses. For me, 3mg works best and doesn’t cause me to be groggy the next day. Specifically, I use this Melatonin.

On my first “turn around” days. After working one or many night shifts, I often wake up around 2 or 3 pm and plan to go to bed around 9 pm so I can wake up at the normal time the next day. Because I’ve been awake the nights prior, it’s often hard to fall asleep OR I’ll wake up wide awake at 3 am. Melatonin really helps me stay asleep that first (and second) night I’m trying to turn myself around.
In the middle of a stretch of night shifts. I work a varied schedule, a mix of days and nights and flip-flopping is really hard. If I worked a night shift and plan on going back that evening, then I will occasionally take melatonin to ensure I rest. I will NOT take it when I’m only working one night shift because I like to get up early to turn myself back around.

Turn Around With Intention

Those “turn around” days are often overlooked. I have found that by being specific about how I plan the day after I wake up from night shift, I can make sure I turn around fast (and lets be honest, I’m less grumpy).

Set an alarm and stick to it! If I wake up before it, goes off, I won’t go back to bed. I’d rather be tired and up early than staying up all night.
Don’t plan to be productive. Dinner should be simple, and I don’t schedule anything to do on the day after a stretch of nights if I can help it. This allows me to recover without feeling overwhelmed with life tasks.
Again, use caffeine to your advantage. I usually drink a small amount of caffeine when I wake up, but usually only half a cup, and cut it off by 3-4 pm
Hydrate. I try to drink plenty of fluids when I wake up because I’ve been sleeping all day and limited them before going to sleep.
Eat a filling dinner. On the same thread, if I eat a salad for dinner, it’s usually not enough to keep me satiated since I may not have eaten since 3am (especially if I skip the morning breakfast). I try to load up on healthy but filling foods like healthy fats and whole grains.
Continue the melatonin if it works. For about 2 or 3 days after I’ve worked nights, I continue taking melatonin. It prevents the 3 am wake up!
Relax before bedtime. This is always a good rule but especially when turning aroun, I try to relax 2 hours before bed (no intense movies etc) and set an alarm to go to bed
Wake up at a normal hour. I usually try not to sleep in the following morning, it just makes the pain of turning around worse! I’ll often set an alarm and (usually) get up with it.

I hope these tips have helped you survive working night shift. After years and years of working nights, this is what keeps me sane! Obviously, not everything works for everyone BUT if even ONE of these tips is helpful, I’ll at least know it was worth the share.

-Courtney

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