Dr. Melissa Yuan-Innes: A Novel Night Shift Experience

While working as an Emergency Room physician and hospitalist in Eastern Ontario, Dr. Melissa Yuan-Innes is also achieving success as a novelist. Her latest medical thriller, Graveyard Shift, is set on a very eerie night shift in a fictional Montreal hospital. Here, this modern Renaissance woman talks about her own night shift experiences, the pressing problem of violence within hospitals, and how she balances resuscitation, writing and rotating shift work.

What was your inspiration for Graveyard Shift? 

There was a crazy case at one of the hospitals I worked at. In the end, a police officer came and took care of it and we avoided what could have been a disaster. But, when I thought about what could have happened if he hadn’t done that, I knew it was my next book. I was already writing a book set on an airplane, but I wanted the next book to be about this domino effect where everything goes wrong, one thing after another, all set up in the beginning. The idea at its core was from a real case.

Often the Emergency Room doctor is the only physician in the entire hospital [at night]. Honestly, I try not to think about it because it would be paralyzing.

I appreciated how you used details about night shift to create obstacles for your characters. How do those same obstacles affect your real life work as a physician on night shift?

It’s a given that you are almost all by yourself with almost no resources on night shift. Everybody’s tired and you’re doing the best you can. For example, I work at a small hospital with no x-rays at night. The only labs we run at night are the ones nurses can run in the Emergency, so just basic things like CBC, electrolytes, INR, trops, calcium. That’s it. You’re not going to get anything else. So our hands are pretty tied. 

That’s why when people come in and say, “Well, I just wanted to come in now because it’s a shorter wait,” they don’t understand that we just can’t handle things the way that we do during the daytime. 

At one point, the book’s protagonist realizes that she is the only physician available and the responsibility feels crushing. Is that a feeling you can relate to when you work night shift?

Of course. Often the Emergency Room doctor is the only physician in the entire hospital [at night]. Honestly, I try not to think about it because it would be paralyzing. At one hospital where I worked, we were being called to deliveries as well, so we were covering Obstetrics, ICU, the Emergency Department, and anyone who happened to code in the parking lot. It just wasn’t physically possible and it was dangerous for us to be trying to cover that much. 

Photo Credit: Ladouceur PHOTO

A lot of frontline healthcare workers are hit and kicked and we don’t talk about it because we try to be patient-centred and very understanding.

Your book addresses the issues of violence within hospitals. How do you think violence on night shift affects staff? And how do you address it as a physician?

I try to be very proactive about potential violence within the hospital, the same we try to prepare for codes in general. I remember one night shift when a very serious case was coming in – someone who was very violent a few days prior.  So I said, “Who is willing to get my medication?” And one nurse volunteered. “Who is coming in with me to the room?” Another nurse volunteered. “Do we have a bed on psych?”, etc. I just try to get everything organized and then go in. When I meet the patient, I start with, “Why are you here tonight?” I try to be very calm because if you’re aggressive, they immediately respond to it and it’s over. 

There is a line in my new book when a nurse says, “I’ve been kicked, I’ve been punched, I’ve been strangled with my own stethoscope – it’s not my first rodeo.” That is a direct quote from a nurse I work with. A lot of frontline healthcare workers are hit and kicked and we don’t talk about it because we try to be patient-centred and very understanding. And while we’re doing that, people who are in the healthcare field are being hurt and we should be addressing that. 

You dedicated this book to Dr. Elana Fric and used it as a platform to speak candidly about Intimate Partner Violence. Tell me more.

There was a Toronto family physician named Elana Fric who was very well-respected. She was a leader in the Ontario Medical Association, a mother of three, and a marathon runner. She was someone who a lot of people loved and looked up to. She was killed by her husband two days after she served him with divorce papers.

As a physician, I already knew about intimate partner violence, which is what we now call domestic violence. The idea is that the Emergency Room especially is a place where you find victims of violence and intimidation and you should be intervening if you can. But it’s not an easy thing to do. 

What I have done since Dr. Fric’s death is broaden my questions. I used to ask people if anyone was hurting them if I suspected violence, but I now I’ve broadened it because the best test is one you give everybody. So now when anybody comes in with an injury, I say “Is somebody hurting you?” 

I will also be donating part of the proceeds of this book to Dr. Fric’s children and some local anti-violence organizations. We have to protect vulnerable women in our society. One way to do that is to give funds to organizations that already exist and know what to do but just need more cash flow.

The idea is that the Emergency Room especially is a place where you find victims of violence and intimidation and you should be intervening if you can. But it’s not an easy thing to do. 

As a wife, mom, physician and writer, how do you find balance while working rotating shifts?

As a hospitalist (in-patient physician), I try and get everything really set up during the day. I view being a hospitalist like being the mayor of the village. I have a certain number of patients – my villagers – and they all need something from me. So I go in and meet them and try to figure out what they need and try to address that during the day. Of course, at night there are still crises but it’s not as bad.

Night shifts in the Emergency Room are tougher. So I am absolutely ferocious before and after my night shifts. I tell people, “Don’t call me!” I put up signs around my door that say “Shhh, sleeping!” If I need to, I’ll get an Air BnB outside my house because I don’t want my kids talking loudly where I can hear it. I’ve even asked my husband to set up my tent outside for me so I wouldn’t be in the house.

I really do hate night shifts and the disruption before and after. The only good thing is that I will usually try and eat something I like and read and relax before – I use it a reason to take better care of myself. It’s some “Me Time” that I’ve cleared. I also try to write more before to stockpile words. 

I wish people were more proactive about protecting their sleep and thinking about it like an emergency.

Any advice for new night shift workers?

I wish people were more proactive about protecting their sleep and thinking about it like an emergency. Sometimes people tell me, “I’m post-call, but my kids’ friends are over and jumping in the pool so I need to get up because that’s dangerous without me.” And my response is: “Never have extra little children in your house after a night shift!” 

For me, it’s about looking after yourself. I am ferocious about it. People who know night shifts are quite respectful about it. For example, I’ve had a doctor’s office e-mail me because they didn’t want to call in case I was working night shift and that was really cool.

But other people don’t get it, so you should silence your phone and turn off all notifications. In the last few years, I’ve sometimes taken medication to really knock me out.

Finally, will night shift workers be scared to work their next shift after your reading your latest book?

They might, but they also can take comfort in knowing that it cannot possibly go as wrong as it does in Graveyard Shift

Follow Dr. Melissa’s literary adventures on her website [click here]and sign up for her newsletter. Her latest medical thriller Graveyard Shift will be available November 1, 2019. Find out how to grab your copy [click here].

Photo Credit: Ladouceur PHOTO

Erin Abraham: Shifting Mood Through Food

Erin Abraham, 31, is a holistic nutritionist and the wellpreneur behind Nourished Root. In this interview, Abraham shares nutritional advice customized for shift workers – from the importance of meal planning to why protein energy bites are a night worker’s secret weapon.

–– As told to Lauren McGill.

You work as a certified nutritional practitioner, culinary nutrition expert, and cooking instructor. Where did all of this interest in food come from?

My passion for food came from family traditions and cooking in the kitchen together. My father was Lebanese, so we had a lot of food traditions. When we would get together in the kitchen and cook, then sit down at the table and share meals together, those were good times.

How did you get into holistic nutrition?

Through my own health challenges. In my early twenties I struggled with mental health, and I realized the way that I was caring for myself could be better. I returned to my roots of growing, and cooking solely with whole foods.

After a few months of incorporating my traditional eating habits, I noticed a positive shift in my mental and physical health and overall wellbeing. I love to learn, so I dove into the research which lead me to the concept of holistic nutrition and the importance of a whole food diet. 

Tell me about your approach to working with clients.

It’s very individual-based. Everybody is different. Everybody has different needs and so it’s about understanding what is going to be balancing for them.

Understanding their lifestyle, understanding their current habits, understanding their goals and what empowers them to want to take charge of their health – that is all part of it. We basically break it right down to what they are currently doing and look at how we can foster positive changes.

When you are working at night, your digestion is not working at its peak – during the night your body is in its rest state.

What are some of the specific challenges you address with shift workers?

My mom actually worked shift work when I was a kid and with her it was all about routine and scheduling. I see shift workers struggling with not having enough time to set themselves up to succeed when working. It’s not just about meal prep, or not making your lunch. It’s taking the time to set yourself up with a schedule for a well-balanced lifestyle and stick to it in order to avoid bad choices, and bad habits.

When you are working at night, your digestion is not working at its peak – during the night your body is in its rest state. To keep it working optimally is hard and often difficult to maintain. A routine and schedule will help your digestion, and help your metabolism run more smoothly.

During the night shift, it is helpful to eat every few hours. Smaller meals can encourage your metabolism to function more effectively.

Can you give us some specific ideas on how to eat for night shift?

It can be helpful to schedule your meals this way: when you come home from your nightshift,  have your breakfast. When you wake up from your sleep, have your lunch. And before going to work, have your biggest meal.

During the night shift, it is helpful to eat every few hours. Smaller meals can encourage your metabolism to function more effectively.

Throughout the night, try snacking with protein – I highly recommend protein energy bites. The protein and fat in energy bites work together to sustain energy and to also fuel your cells. If you snack instead of having a heavy meal when you’re on the night shift, you are more likely to sustain your energy and it’s easier on your digestive system. 

The protein and fat in energy bites work together to sustain energy and to also fuel your cells.

What about caffeine at night?

I suggest that if you need to have coffee, have one coffee but have it four to five hours prior to when your shift ends because coffee can sustain you and give you energy. When you go home, you don’t want to be wired. You want to be able to eat breakfast and have your sleep.

Any foods to avoid at night?

I highly suggest staying away from anything that has sugar additives, like pop or energy drinks. Those foods don’t do anything good for you. If anything, they’ll make you crash and burn. The night shift already impacts your internal clock and you don’t need to consume sugary, processed foods which will make matters worse. 

I would suggest consuming carbs in moderation at night. So if you’re going to have a sweet potato, maybe try half a sweet potato instead. Use your palm to gauge portion size for things like nuts and seeds. Certain carbs can be heavy, so just be mindful of how it makes you feel during the day, because carbs will also make you feel like that at night.

Use your palm to gauge portion size for things like nuts and seeds.

You speak often about how intimidating nutrition, meal planning and cooking can seem. How do you help your clients overcome this?

We look at what they are currently doing, the barriers they are facing, and how it is making them feel. We assess their schedule, their budget and overall wellness goals. We dive into the basics of meal planning, and food preparation. We schedule their meal and snack time for ease.

From there, we look at meals that they can incorporate multiple times during the week that are versatile and nutrient dense. We consider the time it takes to meal prep because if there is a lot of preparation, people typically don’t want to do it. I encourage slow cooker meals and Instant Pot meals and promote leftovers.

We even dive into their grocery shopping process, and consider the shelf life of various whole foods. Breaking the process down, while keeping an open mind is key. Providing my clients with accountability and support throughout the process gives them confidence to move forward and make the best choices for themselves. 

What is one mistake that you see clients making with their food choices? How can it be fixed?

People don’t make time to eat. People schedule their lives around everything else, but you should schedule your life around when you should eat because ultimately that food that you’re going to be sitting down and chewing is going to nourish and fuel your body. A lot of people don’t take that as a priority and everything else that goes with it, like grocery shopping. 

The biggest thing is consistency – find a system that works for you, especially with meal planning.

Any final advice for shift workers?

Staying active is so important. It improves mood, and helps with stress management. Shift workers sometimes say, ‘I don’t have enough time to be active.’ But if you schedule it and do your movement prior to going into work, you’ll increase your energy and keep it stable throughout the night because you’ve done your cardio prior to going into your night shift. 

The biggest thing is consistency – find a system that works for you, especially with meal planning. And for your days off, don’t overextend yourself with tons of things to do. Don’t burn yourself out, stay consistent with your ritual so that it allows for success.

Lastly, stay hydrated, nourish your cells and if you have to schedule time to drink water, that is okay. Set a timer and drink on!

Thank you, Erin, for sharing your wise and loving approach to nutrition, cooking and all things food-related. Check out more of Erin’s approach to health on her FB page @Nourished Root

Photos: Mitch Jackson

Meg Harrell: Blogging and Tiny Living on Night Shift

Meg Harrell, 32, is a CDICU nurse and the lifestyle blogger behind MegForIt. She lives in a tiny house with her family of four in North Carolina. Here, she shares her preferred work schedule, her tricks to fall asleep after a busy shift, and why screen time can be the enemy of daytime sleep.

–– As told to Lauren McGill. Edited for clarity and conciseness.

What do you do for work?

I am a RN and I’ve worked from 7 p.m. to 7 a.m. in CDICU (Cardiovascular ICU) for the past three years. I also tutor nursing students online and write e-books and resources to help new nurses and nursing students.

Tell me about your schedule.

I try not to do night shifts in a row, so I divided my schedule so it would be one weekend shift, one Tuesday shift, and one Thursday or Friday shift. Depending on my husband’s schedule, if I don’t get to sleep too much, it’s just not healthy to drive to work with no sleep for nights in a row.

Was your management accommodating about your preferred schedule?

Management was great and super nice about it. We had a big influx of new nurses and so we were well-staffed with a lot of the new people trying to pick up shifts. Also, I told my manager that if I got nights in a row, I might not sleep at all, so I needed my schedule broken up or I would not be a safe nurse.

I think that if night shift works for you, you should stick with it. 

Why did you make the switch to night shifts?

The main reason was my kids (ages 4 & 6). Childcare was difficult. It was nice when we were living with family and I could just drop them off at my mom’s or drop them off at my in-laws. But then once you don’t have that, it’s hard with younger kids. I would trust a sitter if my kids were a little bit older, but when my kids were little babies and they couldn’t go to school yet, it’s hard and it was also expensive. 

How do you coordinate childcare with your husband?

Usually, I will go pick up my husband when he’s done work and then we’ll do the switch-off with the kids. He’ll take the kids, drop me off at work and then I’ll work all night. He’ll put the kids to bed, sleep all night, and then he’ll come and get me in the morning and we’ll switch off the kids again.

Sometimes I will drop him off at work in the morning and I’ll have the kids. Other times he can come home and watch the kids for a couple of hours while I sleep, or he comes home early and I sleep a couple of hours before the shift. While I’m sleeping, my husband will take my kids to the library, the pool, or the playground. 

Besides working as an RN, what else do you have going on? 

I run the lifestyle blog Meg For It. I am also a travel writer, so I get hired by brands, resorts, and companies that want me to travel to places and write about what is happening there. Next weekend, I am flying to Disney! They have something coming out over there and I get to bring my kids, which is great.

Tell me about your living arrangements. 

I live in a tiny house that is 360 sq ft. with my two kids and husband in a tiny house community in the Smoky Mountains. Our bed raises up to the ceiling, so when it’s on the ceiling I have a living area, and when we bring it down we have a bedroom.

How do you sleep during the day in a shared tiny house?

I close all the blackout curtains and do a bit of meditation and some special deep breathing techniques to come down a little bit. I feel like when I’m at work, my adrenaline is running and I can’t just switch it off. I have to bring myself down a couple of levels to finally be able to relax and fall asleep.

Any advice for shift workers transitioning over to tiny house living?

Be vocal about your needs to your partner – if you need them to be quiet, or you just don’t want to be touched. Blackout curtains are also a must because sunlight messes with your sleep. And depending on noise levels, use ear plugs. Good quality ones are worth investing in because they’ll help you go into those deeper levels of sleep.

Be vocal about your needs to your partner – if you need them to be quiet, or you just don’t want to be touched.

What are some of the pitfalls with working nights?

I think you have to be very particular with how you schedule yourself. You have to value sleep. If you have an opportunity to sleep, don’t give it up to watch a movie. Sometimes you have to cancel your plans, because sleep is so important. As life evolves, you have to find a way to value sleep and value time. Don’t waste it!

Also, you cannot waste time on social media. If you want a good sleep pattern, you have to schedule your screentime. You can’t be scrolling through Instagram when you’re about to fall asleep because you won’t be able to just transition.

You have to value sleep. If you have an opportunity to sleep, don’t give it up to watch a movie.

Any final thoughts about working nights?

Night shift is not easier. A lot of people think, ‘Oh, everyone is sleeping.” No! Everyone is not sleeping. Healthcare is an industry that never sleeps so don’t think that night shift is going to be easier if you’re thinking of getting into it. 

And if you’re thinking of leaving night shift, remember that day shift can be challenging with more people coming at you, like management and more doctors, etc. There are always pros and cons. I think that if night shift works for you, you should stick with it. 

Thank you, Meg, for sharing your adventurous approach to life with us! Be sure to follow Meg’s fun-filled IG @meg.for.it and grab a copy of her super helpful Nursing Resource e-book here >>>> https://www.megforit.com/downloads/complete-rn-resource-ebook/.

Ashlee Murray: Spinning Her Way Through Shift Work


Ashlee Murray, 30, is an Emergency Department clerk in a busy Eastern Ontario hospital. Amongst her many side gigs, Murray teaches high-octane spin classes at RIDE Indoor Cycling Studio in Cornwall, ON. In this interview, she gets candid about the toll of rotating shift work and how her own experience has fuelled a passion to help other shift workers stay fit and tackle their stress through spinning.

–– As told to Lauren McGill. Edited for clarity and conciseness.

Can you describe your job? What does a typical shift look like?

I’m a clerk in the Emergency Department. It’s a hectic, crazy, high-stress, high-tension type of job. You have to be on your toes at all times. I see happiness. I see sadness. I see death. I see everything. Some stuff I don’t really want to see but that’s part of the job.

Tell me about your work schedule.

I work full-time, so I work 75 hours bi-weekly. I work on a 14-week rotating schedule and every week is different for those 14 weeks.

Usually, I have a few days off in between my chunk of day or night shifts. There is one week where I work Monday to Friday 7 a.m. to 3 p.m.; another week has a chunk where I work one 12-hour day shift and then three 12-hour night shifts in a row. That is difficult, and definitely not ideal for the everyday person.

What’s life like outside of work? 

I am a fiancée, a mother of three (ages 3, 7 & 8), and a spin instructor. I also do medical transcription on my days off, which is a new position I just took on. I am also an online stylist with Silver Icing, a women’s clothing and accessories website and for I Dress Myself, which is more of a children-based clothing company. I don’t like to be bored so I am constantly looking for more things to do.

What is the most challenging part of your schedule?

The night shifts. Those have always been difficult for me. They throw you off your schedule completely. You don’t feel great. I get that weird, sick feeling around 3 a.m. I completely feel a difference in my body when I’m working night shifts. It’s sluggish, it’s slow. I think that’s normal for most people. 

When you’re working in a rotation that has random night shifts, your body reacts differently than someone who would be doing straight nights because their bodies get accustomed to that. For people like me, every single night shift leads to that sluggish, slow, tired, sick feeling. 

Sleeping during the day is not fun – you want to be outside getting vitamin D and enjoying life but, instead, you have to be up all night while everyone else is sleeping.

Why spinning?

I have been addicted to spinning for the last five years. It is my happy place. Spinning is part of what makes shift work possible for me. I get a big amount of energy out of a spin class and it carries through to the next day.

Spinning is part of what makes shift work possible for me.

What’s your approach to teaching spinning classes?

My classes are geared towards a beginner’s crowd. No intimidation factor there. I try to be very welcoming, supportive and positive and make sure people feel they can be comfortable with me and comfortable in the studio. 

I find it really gratifying to teach classes that many of my colleagues attend. Being a shift worker, especially in the healthcare field, is definitely a challenging job—whether you’re a nurse, whether you’re a clerk, whether you’re a housekeeper. There is stress everywhere in a hospital setting. Being able to accommodate and work out with individuals that work on the same level as you – the same stress level, the same shifts – is rewarding.

As a spin instructor, being able to bring class availability to shift workers was a huge priority for me and I’ve planned my class times around that. 

How do you balance teaching spin classes with shift work? How do you get the time off to teach?

I am very lucky that one of my good friends owns the studio where I work. I submit my schedule to her every month for what I can teach and she lets me teach those classes.

I teach most of my spin classes at 7:30 p.m.. As a spin instructor, being able to bring class availability to shift workers was a huge priority for me and I’ve planned my class times around that. 

What advice do you have for shift workers who are trying to improve their fitness level?

Eat as best as you can. I know it’s not always easy— it’s often a grab-and-go kind of thing unless you have time to meal prep, which is very rare for me, personally. Make sure that you grab that healthier option and try to keep hydrated. Rest is key. You won’t get very much done with a tired brain. Keep healthy, keep fit. Exercise—even walking—is helpful. 

Thank you, Ashlee, for sharing your passion for spinning with us! We love your positive vibe and can-do attitude. If you want to find out more about Ashlee’s approach to spin classes, check out her FB @sitsweatcycle

Photo: Ladouceur PHOTO