On days like today, when I've screwed up my sleep schedule heading into three consecutive overnights, the game becomes one of minimizing damage.

I tried to take a nap a few hours before I start my pre-work routine, and with only an hour left on the nap clock, I've given up. I won't be sleeping before work. I won't be sleeping until tomorrow morning when I arrive home. This is the reality I created when I didn't nap yesterday on my day off and stay up late to acclimate myself back to the night. Nothing I can do about that now.

So, the focus now is on whatever I can do to make myself feel good before my shift makes me feel not-so-good. Since I've got the bed to myself, I'm stretching--paying attention to tight spots and getting a really good stretch in despite this lazy venue. I do my brow bone massage that scares away tension headaches, self-hand and foot massages, and some square-breathing for calm.

All this before I've even gotten out of bed.

It's my way of apologizing to my body for putting her through another long stretch of wakefulness.

Here is a short list of other things I do to keep myself awake during those long, long night shifts.
(Disclaimer: some nights are so busy you don’t get to sit or even think about how tired you are. Other nights are slow and torturous.)

`1. Avoid Excessive Caffeine. Wait! Don’t close this tab! I take it back…sorta. I’m no SuperWoman. I may have a coffee or an iced espresso drink on my way into work. I’m not a machine. BUT I work really hard not to chase one coffee with another, cut myself off at a time that will let me still sleep after work, and to remain hydrated.

2. Speaking of Water. It’s hard to stay hydrated on a busy 12-hour shift. It’s even harder in the time of COVID when our faces are covered by masks and shields. Taking sips isn’t as easy anymore. Not only do I make a conscious effort to get my water in at work, but I also hyper-hydrate the day before my shift. I also try to avoid sodas and energy drinks which hype me up and then drop me on the floor.

3. Stretch it out. I find little pockets of time here and there in my shift to move and stretch my body in ways that don’t make me touch the floor. Whether I’m stretching out my hands, arms, and shoulders at the nurses’ station, to doing some quick calf stretches while I’m waiting outside the bathroom door while my patient pees… I find little bits of time to wake my body up.

4. Stay physically engaged. Don’t just sit idle and quiet. If you’re dozing, move. If you need to chart, find a standing work station. Clean. Stock. Do laps (as long as there aren’t any call lights and you’re pals are also doing ok).

5. Stay mentally engaged. Those rare nights when patients sleep are great, but they’re challenging when all the nurses are tired and no one is talking. We all struggle to be alert on some nights. In this case, I try to get engaged mentally. Talk to people. Organize a messy area of the unit. Look up things you read in your patient’s chart that you’ve never heard of before.

Set alarms to keep you on task if you are forgetful when you’re tired.

6. Use your tech to your advantage. If you’re tired and forgetful like I am sometimes, set alarms on your smartwatch or work phone, whatever you have access to that has an alarm. The silent buzz on my wrist keeps me awake and on task. I usually set alarms for certain time marks like 2200 (intake and output), midnight assessments, etc…

7. Avoid big, carb-heavy meals. Everyone has to make their own meal plans for their shift. Some nurses don’t eat on the night shift at all. some snack and some eat full, regular meals. If I eat a big entree, I’m doomed to feel full and heavy. I want to curl up with my food baby instead of doing my rounds. I’m a snacker and a grazer. I’d rather have a few hi-protein, hi-fiber snacks that are easy to eat on the run. Leave the mashed potatoes at home, if you ask me.

8. Do more for your patients. Crazy, I know? If you’re sleepy, there’s not a whole lot going on, check-in with those who might need your attention. Find the sleepless patient, give ‘em a backrub, talk with them, whatever it seems they need to settle and feel better. I recently combed out and braided some very tangled hair of a patient who had been hospitalized for weeks. So see where you can put your focus. You’ll remain active and another human will benefit from your attention.

The upside of tough, tired nights like this is that I will hopefully be so tired in the morning that I'll be asleep before my head hits my pillow.

What do you do when you know you're not going to get enough sleep before the shift? Share your damage control tactics in the comments- both good and bad.

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