surviving ER night shifts as a physician assistant

5 Tips for Surviving ER Night Shifts (as a PA)

One of the most challenging parts of working in the ER is doing night shifts. 

But you can’t avoid them 100% (in most cases), so it’s worth figuring out a few strategies to make things easier. 

In this post I’ll share 5 tips to help you prepare for–and thrive during–night shifts in the emergency room.

I’m a physician assistant, so this is kind of geared towards PA’s. But really these tips apply to anyone who works night shifts. 

Let’s dive in.

1. Adjust Your Body Clock in Advance

Probably the biggest challenge associated with night shifts is that you’ll be jet lagged. 

In other words, if you’re not already adjusted to the new schedule, then you’re going to feel groggy–just like you would if you flew halfway around the world.

So if you know you have some night shifts coming up, see what you can do to get adjusted in advance.

For example, you could stay up a little later, and get up a little later, so your body starts getting adjusted to that later schedule. 

Naturally, this is kind of awkward to do if you’re flipping back and forth between night shifts and day shifts constantly, but hopefully that’s not the case.

If it is the case, you should probably look for a new job (or talk to your scheduler). Because that’s just terrible for your health in the long run. 

But if you do have a little bit of advanced notice, or you know you have a string of night shifts coming up, see what you can do to get your body ready.

In addition to sleeping a little later, you can also try to adjust your light exposure so that you get bright night in the “morning” (the beginning of your day), and avoid bright lights in the “nighttime” (whatever would be the end of your day).

And some other strategies that I’ll mention below…

2. Use Caffeine Strategically (but not too late)

Here’s an obvious tip. Get some caffeine on board near the beginning of your shift. 

But here’s the flip side of that: 

Don’t have any caffeine during the last 8 or so hours that you’re awake. Or a little longer if you can swing it.

using caffeine strategically helps with night shifts

Caffeine has a half-life in your body of about 5 or 6 hours, so you don’t want to have any of it too close to when you’re going to sleep.

So while caffeine can help you stay awake during the night shift, if you drink it in the second half of your shift you’ll probably be doing more harm than good in the long run (unless you’re fine with being groggy the whole next day because you didn’t sleep well).

Something to think about. 🙂

3. Avoid Sunlight after Your Shift

Depending on when your shift ends, it may or may not be light outside when you finish.

For example, if you finish at 5 am, it’s probably still dark outside, and you could head home in the dark and get ready for bed.

When I was doing night shifts full-time, some of my shifts ended at 5 am, and some of them ended at 6 am. And of course, sometimes I got out late regardless of what the planned end time was.

So if the shift ended at 6 am, it was often already light outside. But when you’re finishing a night shift, the last thing you want is bright sunlight. 

Here’s why:

If you get bright sunlight at the end of your “day”, it makes your body think it’s the beginning of a day, rather than the end. So your body will not be preparing for good quality sleep.

This is a common mistake I see night shift workers make. Oftentimes the nurses I worked with would go out for breakfast after their shift, which inevitably meant they would get exposed to a lot of bright sunlight before and after their meal.

If you’re trying to adjust your circadian rhythm to a night shift, do your best to avoid all bright sunlight the morning after your shift. Try to stay mainly in the dark, let your body produce some melatonin, and then go to sleep.

4. Try to do Night Shifts Consistently for a While

Ideally, instead of flipping back and forth, you would simply do night shifts full-time for a while.

Of course, this depends on your family schedule and other factors, in terms of whether it’s realistic or beneficial for you.

But when I did it, I spent a full year just doing night shifts (while working full-time). And on my days off I mainly stayed on that type of schedule as well. In other words, I still went to bed around 5 am, give or take, even when I wasn’t working.

The benefits of this approach should be pretty obvious:

It allows your body to adjust to that sleep schedule, so you don’t get constant jet lag and have to always be shifting your circadian rhythm.  Not only do you feel better, but it’s better for your health when you’re not constantly jet lagged.

So if that’s a possibility, give it some thought.

5. Don’t Eat any Food After About 2 am

This one may seem a little counterintuitive.

But ideally, try to avoid eating anything towards the end of your shift, or after your shift.

Here’s why: 

Along with the timing of light exposure, the timing of when you eat also regulates your circadian rhythm.

avoid eating after your ER night shift

In other words, when you start eating, and when you stop eating for the day, that kind of tells your body when you’re supposed to be awake.

Ideally, you want to give your body at least a few hours to digest your food before it’s time to go to sleep. So don’t go out and load up on a bunch of breakfast food right before sleep time. Especially not some crazy buffet with a bunch of junk food.

When I was doing night shifts, I certainly wasn’t perfect at this–

But I made a pretty good effort for quite a while to avoid eating during the last 3 or 4 hours of my shift, and then not to eat anything after my shift either.

And when I did that, I think it was beneficial for my health, and also helped me adjust to the night shift schedule.

Final thoughts: Surviving ER Night Shifts as a PA

There’s no getting around it: night shifts kind of suck.

Don’t get me wrong, there are some nice things about them too. The staff is more laid back, and there are no administrators around. It’s just kind of chill in some ways. 

But in terms of the physiological impact, it’s just not ideal.

But if you apply some of the tips that I shared above, you can at least make it a little more manageable than it would be otherwise.
So see which ones may apply to your situation, and it will probably help you survive working night shifts in the ER as a PA a little bit more easily than you would have otherwise.