I wasn't sure where to ask this, but at its core it's a workplace issue more than anything else.

I'm in university studying medicine, and fairly soon I have to go through a bunch of internships that include working very long shifts (most people I've asked have had to do shifts of around 20 hours, and some horror stories say up to 40 hours). Everyone I've talked to said refusing is not an option, basically you have to do it or you're fired.

As someone who has a hard time sleeping and who doesn't have much innate endurance for long hours, what techniques can I use to survive this?

Apart from that, I really enjoy medicine, so I don't want to drop out and work in something else. I'm a very fast learner, so I get over the academic requirements with almost no exertion. I love the material and I'm passionate about many medical specialties, mostly ones that in themselves don't have extra long working hours, so after the internships and medical residency the problem should go away.

Edit 1: I'm in Canada. I'm not sure what the legislation is, apparently the university says the maximum is 16 consecutive hours, but this is routinely ignored by bosses and attempts at contestation seem very dangerous, career-wise.

Edit 2: I do realize many internships and hospitals will not be like that, but it seems almost everyone has to go through it at some point. My main goal is minimizing the physiological and psychological damage to my person and the risk of making medical mistakes.

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    What location is this occurring? This will highly depend on your area – Twyxz Apr 2 '19 at 7:39
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    16 hours 7 days a week can definitely happen at least in Finland, even though it's supposed to be illegal. I've heard in Norway they do uphold a strict max 8 hours 5 days a week schedule. But it's one of the rare few countries to do that. – Juha Untinen Apr 2 '19 at 7:42
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    @Twyxz Canada. People who have more experience with the healthcare system than I do have told me that I'll sabotage my career if I try to refuse. – Alexbib Apr 2 '19 at 8:36
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    As someone who's completed his residency 4 years ago but in a western EU country, refusing the shift is a no-go. Bringing up legal implications aren't helpful here IMHO. – Xander Apr 2 '19 at 8:38
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    @SolarMike I indeed do not intend to work on the front-line. I'm taking all my options in research-oriented specialties. But in order to complete the diploma I still need to do several front-line internships. – Alexbib Apr 2 '19 at 8:58

Allerleirauh's answer is quite good but I'd like to complement with some personal experiences. I did the whole 24 hour shift thing during my residency and although I didn't suffer from any form of insomnia, sticking to a few basic principles helped.

  • Avoid caffeine or energy drinks. This was stressed out to me so many times and the dehydration and crashing effects of those two aren't worth the short term effect. Unless you go 20 hours drinking red bull and go home to die afterwards. Plus coffee will wreak havoc on your stomach if you don't eat well.
  • Eat healthy. This is like a "duh" moment but eating power bars or crap from the vending machine will destroy you. Bring a container with veggies and fruits from home and make sure you grab a banana or carrot.
  • Exercise! That was a life saver. I like to run in my free time and thankfully my hospital had a small gym with a treadmill. That was my holy grail. I run like 10-15 minutes and then got back into and felt completely renewed. But you can also do stuff like use the stairs instead of the elevator. You'd think that that would make you more tired but it was the opposite.
  • Talk to your colleagues. Quite a lot of my shifts comprised of waiting around for stuff to happen. The other residents are going through the same thing. It's the perfect time to bond and also expand your professional network. Connections are everything!
  • Talk to your family or friends. I found it quite helpful to talk to my family and friends on the phone during downtime. They all probably got sick of me by the time my long shifts ended but it helps keep you focused and not lose yourself.

24 hour shifts might sound terrifying but there are so many positive aspects to them. Consider that you can be there throughout a patient's diagnosis. Usually for us it took around 10-15 hours to get a full diagnosis in non-ER cases and a full 20 hours for treatment. You get the chance to be there and follow through the whole case of a patient rather than leave at 8 hours and come back the next day and read/hear about it.

Taking care of yourself afterwards is also important. Sleep wasn't an issue thankfully but also not wanting to sleep was a problem for me. I finished a 24 hour shift at 8am and I wanted to actually go to breakfast with my friends than sleep, but you have to sleep for a few hours, especially if you have to be back at 11pm.

I think the insomnia thing is a bit outside the scope of this SE (as probably the whole question is) and if it becomes a problem during the long shifts, you really need to talk to your doctor ASAP.

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    Thank you, that helps! – Alexbib Apr 2 '19 at 9:20

After a short search for "nurses night shift" I found many sites with tips and tricks. Maybe this helps to diminish the problem.

For better fall asleep the term "insomnia" will bring a lot of hits.

survive the shift

I will resume the "survival" here in short (from EveryNurse):

  1. Get an Adequate Amount of Sleep
  2. Use Caffeinated Products Wisely
  3. Make Healthier Meal and Snack Choices
  4. Monitor Your Health
  5. Bond with Your Co-Workers
  6. Find Constructive Ways to Keep Busy
  7. Exercise or Get Active to Stay Alert
  8. Create a Healthy Balance on the Home Front
  9. Learn How to Accommodate the Circadian Clock
  10. Get Home Safely

I assume not all of this tips are valuable for you, but the better part could be. Equal which career level you have or which career way in detail you follow in medicine.

Joint possessions I see:

  • Nurses in night shift have to manage their tiredness
  • They have a lot of responsibility for humans health
  • They have to make important and precise decisions

fall asleep

For this point I can talk about myself: In some phases of my life I had the same problem. I used two strategies to better fall asleep:

  1. Include the time short before going to bed into the "going in bed ritual"

I have searched for some activities that will "slow me down". In my case this is a book, I already had read (for me important, else I don't stop until finish). The way to bed is not a sprint to goal. Because in this case I lie in bed and "hurry is rushing trough my veins". The time to slow down is not lost time. It is part of the regeneration time in almost the same manner as sleep. Value this time this way, helped me a lot.

  1. I tell my doctor

I do not want to use "hard" medicament to fall asleep, so my doctor and I found a drug on plants basic to soothe me before sleep time.

I hope you find a way to follow your passion for this working field!

  • Thank you, these are things I already do (apart from number 1, and my insomnia is pretty resistant to the usual tricks). Also, working a night shift is different from working a long shift: I've always been able to work easily at night (somehow my body finds it easier to sleep during the day and be active at night), but never been able to function properly beyond 8 hours of work. – Alexbib Apr 2 '19 at 8:26
  • So I hope there will be some other with more useful answers for your problem :) – Allerleirauh Apr 2 '19 at 8:38
  • I appreciate your help, thanks a lot! – Alexbib Apr 2 '19 at 8:44

Seeing that most answers go along the lines of "stick to it", I will try a different approach.

You asked what you could do to avoid the long hours but still remain in the same field.

It is likely that you will have to do what the others say and stick to it, even if just in the beginning, for ideas on how to manage it, read the other answers.

Regarding what you can do, careerwise, this is my opinion.

I worked for the PME service (Police Medical Examiners) in the UK, some of our Doctors would be on-call for periods of up to 3 months continuously. This may sound like a lot but the reality is that, in the busiest areas, they were required 2/3 times a day, which meant around 30min-1h travel to and from their house + up to 2h with the patient. In the busy areas, most Doctors did 1 of 2 shifts (12h a day) and someone else would do the other, on quiet areas where we had 0-1 calls a day, they remained on call 24h a day for up to 3 months.

Their salary was approximately 50-75/h + comission on call-out.

You end up having to also attend court for hearings when needed.

PME might be an alternative for you, not sure how this works in Canada but worth having a look at it, you can also look into migrating to a different country (like the UK) where you would not be expected to work such long hours.

The reality is that due to your healthcare being socialized, and the pressure your health system is in, you will be asked to give a little bit extra as they try to keep a low budget by understaffing as much as possible. In the UK this happens A LOT as well. I've known nurses working 12-14h a day and only being paid for 8h....for years!

Look into the possibility of crossing the border to USA, you will possibly find better opportunities there or even within Canada in the private sector.

You will likely need to stick to it for the period you need to finish your degree though...

Good luck!


Two tricks I had up my sleeve when I was a shift worker that I can add to the already good answers:

1) On your first day off (unless you're going straight back to a night shift) resist going to bed until a normal hour in the evening, keep yourself busy, whatever it takes. On your days off try to stick to a normal routine.

2) Standing in a shower with hot water (as hot as you can bear) hitting you straight on your scalp for as long as you can. The rule of thumb was roughly 10 minutes of doing this equates to the revival you'll feel from around 2 hours of sleep.

And to re-emphasise what has been said before: exercise, eat healthy and drink LOTS of water

Water is a far better energy drink than anything man made.

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