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I remember my first weeks of seven night shifts in a row. The first one or two nights were the hardest. My body was out of rhythm and lacking sleep, having spent the day tossing and turning with sleep eluding me.
The first night I survived on adrenaline, by night two, with judicious reversal of living patterns – breakfast for dinner, lunch at midnight and dinner for breakfast, I had turned into a night owl.
I looked after around 120 to 150 patients at a time and by the end of the seventh night I had worked around 78 hours. The European working time directive allows people to work up to 90 hours a week as long as they keep to a 48-hour weekly limit when it is averaged over a six-month period.
When I qualified, I had been bursting with excitement and anticipation before my first ever night shift. I loved the quietness and the dimmed lights and the fact that on the whole it was truly important problems I got paged about.
But after I had done a week of seven night shifts, I sometimes found myself falling asleep at the wheel.
After I had done the week, I had a week of compensatory rest, allocated annual leave, which meant I lost the link to my day time team, continuity of care for my patients was lost as other doctors had to cross cover my enforced shift absences.
Since these early days of my career, I have experienced a variety of shift patterns. Split sets of four weekday and three weekend night shifts were certainly easier but still have an immense impact on continuity of care.
In any shift based system it is difficult to maintain training relationships with your own team and unless a conscious effort is made trainees on shift rotas barely ever see the consultant responsible for their training.
Currently, I do 24-hour on-call shifts. These are excellent for maintaining training relationships and continuity of care for patients. But with unfilled rota gaps, not just in my department but more importantly to critical level in other departments like emergency medicine, we no longer achieve our rest requirement and are being forced into a full shift pattern.
The Scottish government has recently announced that junior doctors in Scotland will no longer be rostered for seven night shifts in a row from February next year, and from the following year no junior doctor will work more than seven day shifts in a row.
I am glad to see the seven continuous night shifts go, and it is important the NHS starts planning for the change now. As well as improving trainee rotas, it is important for hospitals to provide rest facilities and catering for those of us working at overnight and weekends.
Currently, my hospital has no food available for its staff after 7pm on weekdays and none after 2pm on weekends. The exception is a vending machine selling microwavable burgers and Mars Bars. No matter what shift pattern we work, the continued withdrawal of rest facilities, on call rooms and out of hours food provision leaves you exhausted.
What we need are patterns of work tailored to provide excellent patient care and which are safe, offer training opportunities for all junior doctors and that are designed with the doctors working those shifts. Maybe one day we will achieve the right balance and NHS managers will realise that rested and well fed staff are important for safe, high quality patient care.
The introduction of shift working was the start of the deterioration of junior doctor training to what we are left with today. Had to happen but nothing can compensate for the volume of clinical experience obtained with an on call system when you can see the results of your actions and follow a patient through.
My first exposure to the world of work was as a lab tech in a process control lab of a multinational chemical plant. There was a 24hr need cover the production processes with both predicatable work and unpredictable. It worked very well and the company employed FOUR shifts to this. The night segments were 4 nights and 3 nights interspersed with day shifts and days off. I thought all organisations functioned like this.
Then I met the world of NHS clinical care. Increduality would best discribe my reaction. The system then was you worked the day, you worked the night, then the day and you might then get time off. I always thought that shifts be better but perhaps should not be suprised at how they would be introduced. I suspect that the stresses imposed on juniors at the moment are not because of a shift system in itself but because of the sparse resources that have used to apply it.
Night shifts are good if done for short time but if one made it habit or daily routine then could be a big trouble. I find your story worth reading like essay-writing-services.reviews/.../ article which describes students to maintain their grades.
The job of a doctor is very stressful as he has to face many tough and emotional moments throughout the day. Click casinolife.co.za/.../punt-casino to read punt casino review. That’s why I think working hours of doctors should be arranged in such flexible way that could provide them such mental comfort which they badly needed. I appreciate the decision of ending seven-night shifts consecutively.