You know I love to come for shift work, and just how detrimental it can be to our health and eating behaviours. However, being “on-call” is a little different, and offers its own unique challenges to our dietary patterns.

What is “On-Call”?

If this is a genuine question you don’t know the answer to, I am immediately jealous of your life outside healthcare.

“On-call” has several different meanings in different professions, but ever the narcissist – I’m going to make it all about me. In my workplace, out of hours care is either in house or on-call. In house, as the name suggests, requires the individual to stay in the hospital for the duration of the shift. On-call is done on a phone call basis – the worker stays at home until the hospital calls you in as required. These shifts are typically (but not always!) longer, as the thought process is that you will actually be on-site working less. These are typically 24 hour shifts during the week, and at the weekend one poor unfortunate soul covers from Friday to Monday morning.

Once “called” in, an individual typically has 30-60 minutes to make it into the hospital and their place of work. This obviously depends on the situation, and place on work, so it’s a rough timeline. After their work is done, the individual is then free to leave until they are called back in.

So, with a rough idea of what an “on-call” shift consists of, let’s talk about how it ruins your life and eating behaviours.

Stress

This is pretty much common sense, but the physical impact of stress when working on-call is well-demonstrated in literature. Consider this study by Maleczek et al.⁽¹⁾ that literally demonstrated T-wave inversions and other cardiac changes on ECGs of emergency medicine doctors when they received a “bleep” (alarm) when on-call. This is suggestive of high stress levels. And if you have ever been wrenched from a deep sleep with the news that someone is dying and your assistance is needed, you’d be fairly bloody stressed too.

Healthcare workers experience high levels of stress in their workplace at baseline⁽²⁾, and on-call is no different. Again, this can be heightened in the on-call setting – stressing about making it to work on time, stressing about what is waiting in work etc. Out-of-hour on-call cases tend to be more stressful owing to the nature of traumatic cases themselves and less staff on-site. Some of the darkest shit I have seen has been on call.

Out-of-hours/emergency work is associated with the highest level of stress amongst healthcare workers⁽³⁾.

Stress has a profound impact on our eating behaviours. Stress can lead to an increase or decrease in appetite amongst individuals⁽⁴⁾. When stressed, individuals typically preferentially consume energy-dense, high sugar or fat foods⁽⁵⁾, which may lead to obesity over time.

So, the associated stressors with on-call work may lead to a reduction in dietary quality, alterations in energy intake and altered appetite.

Sleep Disturbances

Call yourself a nihilist? Try healthcare!

Nothing will ruin your sleeping pattern like on-call work, where every damn time you close your eyes you get woken up by some horrific trauma waiting for you in the hospital. Love that.

The research says that healthcare workers need sleep to maintain health and performance at work⁽⁶⁾. If you work on-call, this will be equal parts hilarious and unrealistic. Long-hours, increased workloads and sleep deprivation are associated with the healthcare workers’ constant companion, fatigue⁽⁷⁾.  

When we are sleep deprived or fatigued, we tend to eat more overall, consume less protein and higher fat ⁽⁸⁾. Chronic sleep-deprivation is also associated with elevated drive to consume energy-dense foods⁽⁹⁾.

Food Accessibility

This is a little more anecdotal. There are a number of considerations to how on-call impacts your access to food. First and foremost, if you get called in to a long emergency theatre case, you sure as hell aren’t eating for hours. You can’t just whip out some Tupperware in the middle of theatre, no matter how much you maintain it’s sterility. Absolutely not happening.

I’ve discussed the lack of facilities for meal preparation and availability of more nutrient-dense food options in hospitals during out-of-hours care here , so I won’t dwell too much on it, but again it can be another major influence on your diet when on call.

If you’ve been in a case for hours, and haven’t eaten, you want food. And you want it yesterday. So, your natural inclination is to eat whatever you can get your hands on quickest. Which is typically something chocolate from the vending machine, and hardly the ideal nutrient profile.

Meal prepping itself offers some constraints. If you are on call, you cannot really start any intensive meal-prep beyond grilling things or burning things in the air fryer (both culinary talents of mine). Getting called in mid-cooking and having all of your expensive ingredients go to waste just adds insult to injury. Now you not only have no food, you have a burning hole in your pocket (or your house if you forgot to turn off the oven before you got called in).

So, What Can We Do About It?

Quit your job. It’s always the answer.

In the interim, preparation for on-call work is key. You could try:

• Doing a food shop the night before your call shift/weekend, to ensure you have nutrient-dense food to hand.
• Have some pre-prepared meals to have just in case you get called in.
• Have snacks. I cannot stress this one enough. Having a selection of portable snacks you can easily carry and have access to that don’t require heating can be lifesavers. Think protein bars, nuts etc.
• Be self-compassionate. Shit happens. Eating a chocolate bar because you haven’t eaten in 6 hours because of work doesn’t make you a failure, it makes you a human being. It’s literally how you are wired. Don’t dwell on it.
• Slow down when eating, and try and be mindful. This is easier said than done of course, especially when you are starving and stressed out of your tree. Trying to be intentional with your eating can help stop the drive to emotional eat or overeat.
• Eat when you can. This is particularly pertinent for weekend shifts. If you can, try and eat meals as regularly as possible. You don’t know when you’ll be called in, so eating a big meal upon waking (assuming it’s not being woken up by Switch ringing to tell you there’s a patient on the table) could be a shout.

Conclusion

I cannot stress this enough – quit.

Working on-call can be challenging to our physical health as well as our will to live. This can have a knock-on effect on your dietary intake. Whilst waiting for your P45, you can get through your remaining shifts armed with some nutritional strategies to help you get through life on-call.

References

1. Maleczek M, Shebesta K, Hamp T et al. (2022) ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial. Scand. J Trauma Res Emerg Med 30(47).
2. Cheng CT, Chua JH, Cheng LJ et al. (2022) Global prevalence of resilience in health care professionals: A systematic review, meta-analysis and meta-regression.  J Nurs Man 30(3), 795-816.
3. García-Tudela A, Simonelli-Muñoz AJ, Rivera-Caravaca JM et al. (2022) Stress in Emergency Healthcare Professionals: The Stress Factors and Manifestation Scale. Int J Environ Res Pub Health 19(7), 4342.
4. Torres SJ, Nowson CA (2007) Relationship between stress, eating behaviours and obesity. Nutrition 23(12), 887-894.
5. Yau YH, Potenza MN (2013) Stress and eating behaviors. Minerva Endocrinol 38(3), 255-267.
6. Parry DA, Oeppen RS, Amin MS et al. (2018) Sleep: its importance and the effects of deprivation on surgeons and other healthcare professionals. Brit J Oral Max Surg 56(8), 663-666.
7. Paice E, Hamilton-Fairley D (2013) Avoiding burnout in new doctors: sleep, supervision and teams.  Postgrad Med J 89, 493-4.
8. Al Khatib HK, Harding SV, Darzi J et al. (2016) The effects of partial sleep deprivation on energy intake: A systematic review and meta-analysis. Eur J Clin Nutr 71, 614-624.
9. Greer SM, Goldstein, AN, Walker, MP (2013) The impact of sleep deprivation on food desire in the human brain. Nat Commun 4.