Doctors sleeping on the job? A response to “the email”

Recently, an email has been spreading in the junior doc community that is at best insensitive (there has been an apology).

It’s all surrounding whether junior docs can sleep during their night shift. With claims to punish any who do rest on the job, through increasing workload or removing comfortable furniture, it left many feeling angry. Understandably so.

When we receive emails that are insensitive, especially when we’re already tired and giving our all, it’s normal to feel strongly.

In these times pause before responding.

Take a moment to feel and process your emotions.

Then we can take stock of what we can do next and who to seek help from.

All health professionals are currently under immense pressure, especially JMOs. In the public hospital system, junior docs are part of the foundation. Without a healthy junior workforce, the pyramid of health care would topple over.

Yet why are we treating junior docs in such a punitive and paternalistic manner?

And can docs “sleep on the job”?

The strains

Anyone who has worked in the public health system knows how understaffed and overworked we’ve all been. Before the pandemic, internship and residency was already hard. COVID-19 has just exacerbated the weaknesses already present and clinicians are leaving in droves.

Many are scratching their heads about how to retain such highly trained staff. It takes years to train a doctor, how can we keep them working in healthcare?

The terms “wellbeing” and “resilience” are thrown around, but what action is being done?

We need to care for our junior docs and show them compassion. Junior doctors are our foundation and the future of healthcare, we must nurture them.

Instead of trying to increase productivity through punishment, we should show each other kindness.

The risks of not napping

Night shifts mean covering the whole hospital from about 8pm til 8.30am. It’s usually a 12.5 hour shift done consecutively, up to seven times in a row.

Humans are naturally diurnal, we are more active during the day and sleep at night. Night shifts disrupt and confuse our circadian rhythm.(1) This leads to an accumulation of sleep debt, impaired performance and health.(1)

Our brains and bodies are not functioning at their best during nights and while fatigued. We all know that driving drowsy is similar to driving drunk. How about functioning at work?

It has been proven that our logical reasoning, alertness, communication, coordination, empathy and mood decreases while tired and is at its lowest point between 3-5am.(1-3) This makes it harder to calculate drug doses and react to emergency situations.(2) Night shifts and sleep debt are linked to increased risk of occupational accidents.(1-2) It’s not only dangerous for us, but our patients.

Driving home tired is the most dangerous thing we can do.(3) Studies have shown that half of trainee doctors, consultants, and nurses have had an accident or near-miss while driving home from a night shift.(1,3) Doing 12-hour shifts (day or night) also doubles our risk of car accidents when driving home.(3)

I myself have been the victim of this, waking up at traffic lights with a near miss after a string of seven nights on.

The risks of not napping are evident.

We have all heard the awful stories of doctors who have died when driving home from night shifts. It’s not just one, but many. Dr Manalayil and Dr Connelly are examples. Dr Cusumano who faces court after her fatal car crash, killing an elderly woman while driving home tired from night shifts and Dr Celaire who was jailed for running over a family of three after falling asleep at the wheel are further proof of how dangerous it can be.

We need to make changes to protect our doctors and the community.

Benefits of short naps during night shifts

Jim Horne, a sleep neuroscientist and emeritus professor of psychophysiology at Loughborough University has a lot to say in this matter.

“It’s safer for everyone concerned; it makes the doctor safer to work, it improves patient safety, it reduces accidents, and doctors are happier because they think the organisation cares for them more.”(2)

Professor Jim Horne – sleep neuroscientist

Another professor of sleep, Derk-Jan Dijk, argues that we might not be able to recover sleep even on our days off because of a combination of “acute desynchrony” with our circadian rhythm and chronic sleep loss.(2)

He recommends maximising sleep before the night shift “or even during the night shift.”(2) In his analysis the worst timing of the 12 hour shift would be from 7 pm to 7 am (we work 8pm-8am).(2)

Dr Nancy Redfern, a consultant anaesthetist from Newcastle Hospitals NHS Foundation Trust, is asking that we all have a 20 minute nap during our night shift to keep us and our patients safe.(3)

So napping during night shifts improves cognitive function, combats sleep debt, lowers risk of occupational accidents as well as improves physician performance & health (1-3).

How can we be against that? This means that napping is vital to work at night, not something unprofessional.

Let’s also give doctors some credit, naps are done in rotation (there’s always someone awake) and not the whole duration of the shift. Calls are always answered (pagers are very loud).

Moving forward

To all the junior docs facing difficulties during these trying times, I see you. Your work is valued and essential. Without you, the hospital system would fall apart.

I know you’re responsible and care for your patients. Please continue to care for yourself, including your physical and emotional needs.

Let’s work together to improve self-compassion and compassion for each other.

Let’s strive to create a work environment that allows for us to be human. Doctors need sleep too. (see the viral #yotambienmedormi posts)

Models of supportive hospitals include those that provide nap pods, showers, and taxi vouchers if too tired to drive home. Also offering accomodation for those that cannot commute home after the shift would be safer for all.

This will look after doctors health, improve work performance naturally (through love not punishment), better serve our patients and increase staff retention.

If you are seeking more help, click here for other resources. Feel free to send me a message too.

References

1. McKenna H, Wilkes M. Optimising sleep for night shifts. BMJ. 2018 Mar 1;360.
2. Rimmer A. Doctors should nap during night shifts, conference hears.
3. Wise J. Sixty seconds on . . . power naps. BMJ : British Medical Journal (Online) 2022 Jun 09;377.