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8 ways to stay alert during a long shift

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I’m an emergency room nurse—straight nights, 7:00 p.m. to 7:00 a.m., often three nights in a row. I’m also in school to finish up my BSN. Sleep is something that I fit in around the rest of my schedule. It isn’t at the top of the priority list. It doesn’t even fall in the top three.

You’re a nurse. You know what it’s like. You live there, or you’ve been there, or you’re on your way.

And yet we can’t be sleepy. Nursing involves performing procedures or giving medications that can kill people if done incorrectly. Your patients’ lives—and your career—depend on your ability to stay awake and alert.

There are many paths to wakefulness. I’ve tried a bunch. Some work for me. Some might work for you. Some don’t work for anybody. Here are eight of them, listed with their advantages and disadvantages.

1. Coffee
Java. Joe. Mud. Basic, brute caffeine without much style or frills.

  • Advantages: Plentiful and cheap (if not free) in most hospitals. Basically zero calories. Low fat. Low carbs. Nothing special, but it will get you through the night.
  • Disadvantages: Most hospitals are not known for their good coffee, at least not the free stuff.
  • Style Points: A paramedic I once worked with had a 2200 ritual where he brought out a personal-size press pot, a bag of fine-grind espresso roast and a silver measuring spoon. It showed a roomful of awed firefighters that in addition to everything he knew about patient care, he’d also be able to beat them on any Jeopardy categories involving coffee.

2. Lattes, Mochas, Cappuccinos
Back in the 1990s, when I was managing an espresso shop and reading the coffee trade magazines, putting a cappuccino cart in a hospital was a new, trendy thing. Now it seems like a coffee stand is almost a JCAHO requirement for a decent hospital.

  • Advantages: Goes down with better taste and more style than regular joe. My shift-starting fave at our espresso cart is the large vanilla latte with an extra shot of espresso.
  • Disadvantages: Expensive! And often fattening! But a lot of hospitals allow you to buy coffee on a payroll deduction. Just don’t let your spouse see that deduction line on your paycheck.
  • Style Points: Support your local coffee shop! Points off for bringing in a McLatte.

3. Caffeinated Soft Drinks
Mountain Dew, with 54 milligrams of caffeine in a 12-ounce can, is comparable to coffee in its power to keep you up all night. Coke has 35 mg of the big C in a 12-ouncer, and Pepsi, 38. We mourn the loss of Jolt Cola, a 1980s innovation that had 72 mg of caffeine per can.

  • Advantages: Low-cost, easy to find, socially acceptable.
  • Disadvantages: The caffeine in a 12-ounce Mountain Dew comes with 165 calories. You’re going to need to do aerobics all night to work off the calories in those 12 ounces.
  • Style Points: The X Games vibe lends Mountain Dew almost as much cachet as cappuccino drinks at a fraction of the price.

4. Energy Drinks
Caffeine! Vitamins! Amino acids! Sugar! WAKE UP AND SHRED!

  • Advantages: Red Bull has 80 mg of caffeine in each little 8-ounce can, along with 110 calories from sugar, plus vitamins and other proprietary ingredients.
  • Disadvantages: Most of these drinks have to be overflavored to offset the revolting taste of all the nasty stuff that will keep you awake. My workmates can smell the sickly sweet citrus-on-steroids scent of my Red Bull across the ER when I crack open my 0200 can.
  • Style Points: Red Bull leads the pack with even more Xtreme street cred than Mountain Dew.

5. Exercise
During a two-week fitness and weight-loss challenge, some of my coworkers got into the habit of running from the ER up a stairway to the sixth floor and back down in two minutes.

  • Advantages: That’ll wake you up! And burn off some calories!
  • Disadvantages: Sweat.
  • Style Points: Fitness.

6. Essential Oils
A dab of lemon oil or peppermint oil on your wrists or neck can give you a renewed sense of alertness.

  • Advantages: Natural, drug-free, non-jittery.
  • Disadvantages: Your choice of cologne may get you some funny looks from your patients and coworkers.
  • Style Points: Organic, natural, crunchy granola vibe.

7. Armodafinil or Modafinil
These narcolepsy medications, studied by the military to keep soldiers and pilots awake and alert, can be prescribed for shift workers.

  • Advantages: Non-jittery, FDA-approved alertness, all night long.
  • Disadvantages: It might take a few tries to find the right dose for you. The full dose gave me a headache refractory to Tylenol and Motrin. It also kept me awake for a full 24 hours. (I just wanted to be awake all night long, not all the next day, too! Half a pill is just perfect to keep me awake all night long.) Also, it’s expensive. And most insurance plans don’t cover it.
  • Style Points: B-2 supersonic stealth bombers fly out of an air force base in Missouri. When they fly a load of bunker busters from Kansas City to Baghdad and back, you can be sure that the pilots have a couple of these in the pockets of their flight suits.

8. Sleep
Can you sneak in a little nap sometime during your shift?

  • Advantages: My wife swears by the 10-minute “power nap.”
  • Disadvantages: Anything less than three hours just makes me swear.
  • Style Points: Orwell said it best (see below). Sleep is the greatest luxury of all for the overworked. At the end of your shift, you can just collapse into bed without ceremony, or you can add special rituals: chamomile tea, eye shades (for sleeping during the day), flannel sheets, white-noise generators….

In his memoir Down and Out in Paris and London, George Orwell describes his life working dawn ‘til midnight, seven days a week, in a Paris restaurant in the 1920s. His thoughts about sleep may sound familiar to shift workers like us: “Work in the hotel taught me the true value of sleep, just as being hungry had taught me the true value of food. Sleep had ceased to be a mere physical necessity; it was something voluptuous, a debauch more than a relief.”

Now, don’t forget to turn off your phone. Sleep tight!

Curtis Olson is an ER nurse in Lincoln, Neb. He is an EMS and nursing instructor. Olson has also worked as a paramedic/firefighter, bookstore manager and barista. He wrote most of this article between midnight and 6:00 a.m.

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Curtis Olson

Curtis Olson is an ER nurse in Lincoln, Neb. He is an EMS and nursing instructor. Olson has also worked as a paramedic/firefighter, bookstore manager and barista. He wrote most of this article between midnight and 6:00 a.m.
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2 Responses to 8 ways to stay alert during a long shift

  1. Maryellen

    I love the articles about caffeine but taking in too much or too late in the shift can adversely affect your sleep time. ALSO= my hospital will fire anyone found sleeping on the job. In any capacity, no matter what.

  2. Kathy Hessler

    A long way from DC! Sounds like you are well, if sleepy. Drop us a line.

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