Deploying a pager-free sleep period

I have just started the last hospital rotation of my General Practice Training Scheme, phew! However, six years since graduation I am nervous at the thought of going out into the community without the luxury of picking up the phone for specialty advice, and the camaraderie among colleagues and working in teams. I will miss being able to access multidisciplinary team specialists, learning from some of the world’s best doctors and nurses, as well as the buzz of the resuscitation room and the ability to easily book urgent imaging for a patient and receiving the result that day.

Dr Justine Jordan

But I am looking forward to building relationships with patients, establishing myself in a job for longer than four months and continuing to hone my skills in special interests. I will be able to access more predictable working hours, won’t have to carry a bleep (archaic pager) anymore, and will no longer be working 24- to 28-hour shifts (many of us start our working day early and the post on-call ward round can be long).

Long working hours
I have broached the subject of long working hours for non-consultant hospital doctors (NCHDs) in previous articles, and while I sound quite negative at times when I reflect on our working conditions, I do like to mention when things may be improving for us. In this latest job I had heard rumours of four hours protected sleeping time for NCHDs on 24-hour call. I didn’t believe it until I started day one of the new job on-call. With two of us on at night, we can hopefully each sleep four hours with the understanding that if there is an emergency — or the jobs begin to build — then this protected sleep time may not occur. Last night it worked wonderfully.

Within that time period I was able to get at least three hours of uninterrupted sleep without the thought of the bleep going off at any minute. This strategic rest time allowed me to be more productive, efficient, less likely to make mistakes and basically a nicer person in general for the rest of the shift. I was able to attend and actually pay attention at my GP training day post-call and was productive with my day off.

Nervous drive home
More importantly, I wasn’t nervous driving home. I personally know of two colleagues who have been involved in road traffic accidents while driving home post on-call shifts. Thankfully, they were minor incidents, but they are now both adamantly using public transport to get home. I recall in my first and second year at work driving home after a short break for a coffee with the windows rolled down and the radio blaring for fear of losing my concentration behind the wheel. I soon realised how ridiculous this was, and would sometimes power nap before a long drive home. Or when I was commuting to Midland Regional Hospital Mullingar, I would book a hotel or B&B for the day’s post-call. I know it would cost a lot, and perhaps I would work that night just to pay the bill, but I came to the realisation that my life is not worth this job. I also now take toll bridges and tunnels at any time of the day or night in order to get home quickly and safely. Time is precious in our line of work.

Protected sleep time
This protected sleep time, I believe, needs to be rolled out across the Health Service Executive. It is achievable and works well for everyone involved. I know and understand that it requires greater staffing, and it is not ideal by any means, but it does begin to address the fact that 24-hour shifts are unsustainable long-term, it can cause rifts in personal relationships, it can compromise patient safety and it is just plain unhealthy both physically and mentally. I am most certainly advocating for this — four hours of ‘off-call’ time.