How to Survive a 24-Hour Shift During Your Medical Residency

Call shifts are a hallmark of residency and an important hurdle to conquer prior to becoming an attending. If you’re approaching your first call shift soon, you’ve probably racked your brain wondering: how do I survive a 24-hour shift? Caring for hospitalized patients, making important medical decisions, and answering questions from nurses, patients, and families all on your own can be anxiety-inducing. Here are a few tips to relieve some stress and make your experience much smoother overall.

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Pack properly

As someone who’s been in your shoes, here’s how I survive a 24-hour shift: I treat a night at the hospital like an overnight trip away from home. Instead of a tranquil vacation, you may have a night bombarded by calls, pages, and hospital alerts. To make the shift as comfortable as possible, I recommend packing the things that you would want to have during an overnight trip (within reason). 

The first thing I pack are good snacks. 24 hours is a long time to be in the hospital, and hospital food isn’t usually great. Besides, you may be so busy that you won’t have time to run to the cafeteria. Your favorite snacks can keep you energized and boost morale when you’re running on limited sleep. Stay hydrated during your shift with some good drinks as well.

Next, I recommend bringing your own cozy blanket from home. While you most likely will have a call room, you may find yourself trying to cat nap on a chair in a work room. Having your own blanket rather than one from the hospital will make sleeping in a chair as comfortable as possible.

Lastly, I would pack some toiletries and a change of clothes. While most nights will go fine, you never know when you will need a spare set of scrubs or to take a shower.

Taking care of yourself for these 24 hours will go a long way, so having your favorite snacks, blanket, and your own toiletries will greatly increase your comfort level and decrease your stress.

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Rest well

First, if possible, get a solid night’s sleep before your call shift. Getting a good night’s sleep the night before can optimize your energy for the next day and keep your mind sharp during your shift.  Starting fresh will go a long way when there’s a long night ahead of you.

While it’s common for residencies to provide a call room for overnight calls, chances are low that you’ll get a restful night in that room. There will be spurts of downtime, 30 minutes here, an hour or two there. The issue is that your quiet time will be disrupted by pages, phone calls, and announcements. It will not be restorative sleep.

When you do get a chance to rest during the 24-hour call, try to get some sleep. You never know when a call or page will come in, so take advantage of the quieter moments to get some rest.

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Ask questions on sign-out

During your 24-hour call shift, you’ll be caring for more patients than usual. You may have to cover multiple services with new patients, which can be challenging when issues arise.

When you receive sign-out from the primary team, ask questions. If something doesn’t quite make sense, ask. If you’re unclear on a plan, ask. Most residents use the I-PASS system. Make sure you know it and sign-out should occur accordingly, with a plan for “what-ifs” in place. 

Remember, you are the doctor overnight. You are in charge of keeping your patients safe, so learn about them and learn from them. When in doubt, reach out, as there should always be an attending on-call to answer questions and support you. Don’t be afraid to call them when things are difficult—it’s their job to be your backup!

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4. Floor nurses are your friends

Caring for patients while on call is challenging. These are new patients for you and you’re a new physician for them. A common practice in medicine is to establish a baseline.

Let’s say one of your patients has a fast heart rate. Talk with their nurse, who has been with that patient longer than you have. Is this heart rate their baseline, is the patient in pain, and when was the last ECG done? Need labs stat? The bedside nurses are indispensable with their knowledge and experience, so be kind to them and treat them with respect. Patient care is a team effort, after all.

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5. Use your post-call day to rest

It can be tempting to schedule errands and appointments for your post-call day. It’s rare that you get a day off, especially on a weekday. However, make good use of your post-call day to get some much-needed rest. 

You’ve been working for the last 24 hours taking care of patients, which is both physically and mentally taxing. Any sleep you got was likely not sufficient as you were in the hospital and always on alert for the next call or page. A post-call day allows you to rest and relax before returning to the hospital or clinic.

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6. Be flexible

When you’re worried about how to survive a 24-hour shift, one of the most daunting parts is the unknown. The best thing you can do going into your first shift is to keep an open mind. You’ll have many shifts to come, and not all will go as planned, so focus on preparing as best as you can.

What works for one person might not work for you, so be ready to change strategies during your shift if something isn’t working. Finding the strategies that work for you will help you make it through this shift and set yourself up for success in your future shifts.

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