Night Shift, Paying it Forward – Follow Up

Firstly, no, I won’t do your night shifts for you. But thank you for asking.

To all those who have taken the time to comment or contact me, to share your own stories of critically ill children and at times heartbreaking loss,  my husband and I have read each and every one of them and are touched beyond words.

Around the clock availability of experienced doctors, nurses and paramedics is essential to providing quality emergent heath care. This in no way, however,  diminishes  the significant physical, mental and social burden of working medium to long term night shift. My article was intended not as an exhortation to suck it up and work when we’re told to, but an acknowledgement of a necessary evil, and a reminder that  “What we do matters”   (Thank you Mel).

Compared to other industries, OHS support of healthcare shift workers is poor. We can improve this, at an individual and systems level, through;

  • Being proactive in managing our own sleep, nutrition, activity levels  and general wellness while working shift work.
  • Best practice rostering which prioritises physical  and social needs of staff, not the organisation.
  • Better staff education  on sleep hygiene, drowsy driving, and reducing the sequelae of shift work.
  • A cultural change that  acknowledges the inherent difficulties  of night shift and sees structured on-shift napping not as ‘sleeping on the job’, but a clinically proven way to improve alertness, mood and cognitive functioning. 

And finally,

  • Appropriate financial remuneration for working night shift, especially for senior staff. Currently in Victoria we receive 25%  shift loading. Mel Herbert from EM:RAP recently proposed a 50-100%  load for emergency physicians working night shift in the United States. (I’m sorry,  I just can’t help myself.  I love you Mel.) Food for thought.

Take care my fellow night warriors. See you at #TeamNightshift.  (Starting next run  on Monday. Sigh.)


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  1. darkness! says

    Hi Kristin. Thanks for your followup to your recent post -- I read it with even more interest than I did the first. I must admit that although I know it wasn’t at all the point of your article, as a fellow emergency medic and night shift worker I was left feeling “but what about my sanity?” perhaps rather selfishly.

    This kind of attitude doesn’t help us and a culture of trying to take things at a sensible pace is certainly not pervasive on this side of the world at the current time… but perhaps at some point in the future there will be enough of us, or enough of us with the correct attitude, to allow nights to be less painful.

    All the best to you and your family!

    • Kristin Boyle says

      Hi Darkness/ Chris.
      Thanks for your feedback. I agree there are huge cultural issues we are battling in creating a kinder, more sustainable workplace culture, but it does seem to be heading in the right direction here, albeit slowly. Cheers, Kristin (written at 1am from ICU)

  2. says

    How does “25% shift loading” work? (sorry if thats a stupid question)
    25% extra for a night or evening shift compared to day shift/ 25% extra for people working shifts compared to those on regular hours? we certainly don’t have 25% extra in this part of the world for ED docs

    • Kristin Boyle says

      Hi John,
      No stupid questions! According to our statewide public hospital award, “Night duty allowance” is an increase in 25% of your normal hourly rate, (which is experience based) for every hour worked of a rostered shift which starts after the calender day it began, or else starts between midnight and 6am. It actually does seem to make nightshift just a wee bit less painful

  3. Hildy says

    In NSW, hours worked (M-F) between 1800-2400 are paid at 12.5% extra, and between 0000-0600 at 25% extra.

    The shift loading should be increased until people don’t complain about working night shift anymore! (or when you don’t need to pay people to take your shifts).

  4. Dan says

    Some hospitals offer special agreements -- variances from the standard EBA -- which pay a different rate for registrars in charge on night shifts. This is to reflect not only the inconvenience of working at night, but the substantial increase in responsibility the position entails.

    I have worked some time in one Australian tertiary hospital that has this arrangement -- $120/hr for 0000 to 0800. It was actually set up by the senior ED medical staff, and at the time (> 5 yrs ago) it reflected the rate that they were paying locums to fill this role. It has remained fixed over time, so it’s relative value has somewhat diminished, but it is still a substantial improvement over the meagre 25% penalty that would otherwise exist.

    I’m aware of similar arrangements in various regional settings, but maybe no in Victoria by the sounds of it.

    From my point of view, it’s greatest value is in the recognition by the organisation of the work performed by night registrars in charge -- they are basically running much of the hospital during those hours.

    Under this arrangement, there is certainly less of a problem “swapping out of nights” although, on the whole, most people still don’t like doing them. The impact on your health (mental and physical) as well as family and social life is profoundly adverse for most of us.

    For me, it is one of the things to look forward to after attaining fellowship, and I anticipate steering away from clinical medicine should Consultants be required to work night shifts in the future.

  5. Jeram says

    I agree there should be higher loading for nights, especially when we’re in charge! In NSW the nurse in charge gets more loading than the ICU or ED doctor in charge does (we currently get $13.60 extra to be in charge of a department over night, not per hour, total!).

    I personally don’t mind nights, in fact all my best shifts and cases I’ll never forget have been on nights! But increasing the loading from 25% to 50% extra per hour would help ease the pain of poor sleep for the week and changing the culture around the night-shift nap as you suggest makes a huge difference. I’ve worked in ICUs and EDs where the doctor napping was encouraged by the nurses, who would actively protect your short sleep period and it makes such a difference in performance on night shifts compared to those departments where a brief nap during a quiet hour (eye of the storm!) is viewed purely as laziness.

  6. Juanita says

    Kristin, I was moved by your first post and it certainly did make me think about the ‘privilege’ of working in our job at any point but especially at night. It embodied the sacrifice as well as the privilege & I thank you for writing it. I agree with your second post wholly & agree that a higher shift penalty would recognise the added responsibility and inconvenience of working nights. It is certainly worse for your health and your social life to work nights than it is to work on weekends and yet weekends attract a higher penalty. Nights are also less supported with no consultants at all whereas weekend shifts at least have some consultants for support.
    Thanks for putting yourself out there!