By L.R, Midwife, VIC

Shift work is something that all nurses and midwives experience. It is part of our working contract, and something that we have all agreed to do. Shift work can be demanding – on our bodies, our family life and social life, but do we need to let these demands affect us or is there a way to go with the flow and live in a way that supports us throughout the working week and our working lives?

What does shift work entail?

• The hours and timings of shift work change regularly within a week, whether working early shift, afternoon shift, long days or nights and from roster to roster the shifts are different.
• Sometimes when the hospital is super busy or people are on annual, sick or long service leave and casual agency staff are not available, we may be called in to work at the last moment or asked to do a double shift.
• We come to rely on doing extra shifts when available – to pay off the bills, pay the mortgage and/or provide our children with the best education we can afford.
• We can plan our day to go to work, only to be told that patient numbers are down and you won’t be required to come in today.
• We need to be flexible, and open to working in different areas of expertise, especially if it is a small hospital.
• We have to work as a team – putting aside individual differences.
• We are required to adapt to the different layouts of wards in the hospital and learn the different routines and procedures expected to be done.
• We have to adapt to using various documentation, which often changes between every department – medical, surgical, maternity, theatre, outpatients etc.
• Then there is the unpredictability of whether you will have a super busy shift or a quiet one – all dependent on the numbers of patients admitted onto the ward or the deliveries in the hospital. For example, babies are born any time in the day and night, and on any day of the week. They don’t always go by the mother’s due date.

Many nurses/midwives soldier on, unaware of the physical, mental and psychological effects shift work can have on our body. Sometimes it can take an illness or accident to make us come to a complete stop – offering the opportunity to review the choices we have made in the last days, week, month or year, with the consequences being felt or seen in our body.

The toll of shift work on the body differs from person to person. Some complaints experienced are:

• Exhaustion
• Tense/ tight shoulders
• Lower back pain
• Aching legs, especially at the end of the shift
• Feeling racy in the body
• Craving chocolate or sweet things when feeling a dip in energy
• Needing caffeine to start the day or to keep going through the day
• Insomnia following night shifts
• Feeling out of sorts/out of rhythm
• Increased rates of illness and disease like obesity, diabetes and heart disease

However, is it fair to totally blame it on the shift work? Is it possible the missing link is lack of true self-care?

There are different levels of self-care we can live, depending on our picture of what self-care means to us and how much we value our health and wellbeing.

In my 20’s, when I started nursing (hospital based) and then later midwifery, self-care meant getting to bed before midnight on my days off and cutting down on my caffeine intake – I would drink 3 cups of coffee a day: upon rising to kick start the day, at morning tea to keep me going until the end of the shift, and in the afternoon a cappuccino, as a treat, with my husband. It was not until I couldn’t get to sleep at night because my body was so racy and wired that I decided I would drink tea instead of coffee, believing this was a healthier choice. It was not unusual for me to drink 5 cups of caffeinated tea each day, not realising there can be as much caffeine in a cup of tea as there is in a cup of coffee. And only when I started getting tinnitus (ringing in the ears) did I decide to cut down on my tea intake and start drinking more water.

In my 30’s after having 2 children I returned to work part time, instead of full time – this to me was self-care. However, I was also studying part time and after a day at work I returned home to look after the children, cook meals, do housework etc.  I took pride in believing that I could be a ‘supermum’ in ‘go, go, go’ mode but eventually the pace took its toll on my body. I suffered from adrenal exhaustion, mild chronic fatigue, anxiety and depression, mood swings and hypoglycaemia – I craved sugary foods to give me a quick boost of energy throughout the day; however this did not sustain me for long and was not sustainable in the long term.

Self-care included de-stressing techniques for example:

• attendingweekly group meditation classes. My body felt light so I thought it was benefitting me, only to later realise that it was because I had checked out and left my connection with my body.
• doing aerobics classes 3-4 times a week – believing exercise is good for you and it would reinvigorate me, but my body ached all over and I felt more exhausted following each class.
• I then chose to see my GP to rule out any major health concerns, combined with seeing a naturopath who gave me natural remedies for my ailments. My health then started to improve. However, I was still making the same choices in my daily living that had led to my health problems in the first place.

In my 40’s my life took a complete turnaround. It started with attending a Gentle Breath Meditation class by Serge Benhayon – the focus was on breathing my own breath; it felt so natural, like returning to how I breathed as a baby. What happened was quite amazing for me – I felt reconnected back to me. I could finally feel my feet. My body felt more expanded and warm. As I registered the tension that I felt in different parts of my body and allowed it to surface, it then started to slowlydisappear of its own accord, as I continued with the Gentle Breath Meditation technique. This was the start of my return back to my true essence. I practised this technique before getting out of bed, when I returned home from work and before going to bed. As I started to honour what I felt in my body and made more loving choices in how I nurtured and cared for myself, then slowly my disregarding and harmful behaviours, like pushing myself beyond my limits and eating comfort foods to compensate, started to drop away.

Today in my 50’s, my understanding of self-care has changed.  How I prepare myself for the day depends on what shifts I am rostered on and where I am working in the hospital.

• On an early shift – the evening before I make sure I go to bed early, usually by 9pm.
• I prepare a nourishing meal to take to work and bring my own herbal tea bags or water bottle.
• If I have an early shift followed by a late shift – I have a shower before going to bed and feel the hot water clear what I may have taken on in the day as it flows on my body. I then lovingly and tenderly apply moisturiser on my body. I make sure my bed is pre-warmed, especially in winter, and I snuggle into bed & tuck myself in – I feel so cosy, I fall asleep instantly like a newborn baby.
• If I have a late shift – I wake up and feel what my body needs, for example what and how much to eat for breakfast. I occasionally still go for comfort foods but I don’t give myself a hard time if I choose this – there is no perfection in self-care.
• I also make sure I don’t overdo it in the morning with many activities, so I don’t turn up for work already feeling exhausted.

What has changed regarding shift work has been my attitude towards it. I see it more as an opportunity to go with the flow – be flexible, bring order, and surrender to what presents in the day, instead of needing to control what happens. In this way the magic of God happens! I may be asked to work an extra shift, and the mother/s I am assigned to assist, needed exactly the advice I had to offer, as it was from my own lived experience of parenting or breastfeeding. They are left feeling more confident and empowered as women.

I realise now that shift work doesn’t have to be a burden, feel like a punishment or something to dread. By taking some time out to physically and mentally prepare ourselves for the day, with more self-loving, self-caring, nurturing choices we are then able to meet the demands of the day and feel the value that we have brought to our shift. By valuing the qualities that we each bring to others, be that caring, gentleness, love, playfulness, stillness, steadiness, listening … we confirm ourselves and others.

When we all harmoniously work as a team and do not see our differences as a hindrance but an opportunity to understand each other more, then judgement, comparison and jealousy don’t rear their ugly heads to divide us. Instead we stay united with the same purpose – to be of service and work to the best of our ability in whatever areas of nursing, midwifery or any other area where shift work is required.

I feel that deep down we all love people, love the work we do and shift work just happens to be a part of it. Being open, ready and flexible to do shift work is the key.

Read more:

1. Sleeping and shift work: a practical approach to self-care. 
2. Self-care: the key to coping with shift work.