Routines for the Unroutined: Shift Work and the Art of Consistency
For my last thoughts in this “routines” series, I want to focus on all of you lovely shift workers out there. I am you. As a pediatric intensivist, I alternate between days and nights (and that transition is becoming increasingly difficult with age). When making appointments, I’m the person who says, “My schedule is completely random, just tell me when you have openings.”
So how do we create routines when our working life feels unreliable?
The important moves are to:
Accept the reality of the situation.
Understand that “unreliable” is the routine.
Step 1: Accepting Reality
This sounds obvious, right? “Of course, I’m accepting my reality,” you may say, “I’m living the darn thing.” Sure, you show up for shifts, care for patients, teach, and attend meetings as your sleep schedule (and boundaries, more on that in a second) allows.
But pause for a moment: are you quietly waiting for an exit ramp? Do you tell yourself, “This will get easier when…”?
When more staff are hired.
When the kids are older.
When I’m better at my job.
That kind of future-focused bargaining drains brain energy and prevents you from living the life you want now. The sooner we stop arguing with reality, the sooner we reclaim that energy for routines that actually serve us. (If you want to dive deeper into this, check out my earlier blog The Art of Acceptance: Letting Go of Arguments with Reality.)
Step 2: Make “Unreliable” Reliable
When your schedule won’t play by the rules, the way forward is to create anchors—points of steadiness you can return to no matter when your shift falls. Here are some practical ways:
1. Choose a Singular Priority
Notice I didn’t say “priorities.” You get one. A priority, by definition, is the most important thing. Mine right now is physical health. That clarity makes decisions easier: if I must choose between inbox zero and eight hours of sleep, sleep wins.
Try setting one priority for two weeks. See how much simpler your routines become when they orbit around what matters most to you right now.
2. Protect It with Boundaries
Boundaries are your personal guardrails. For me, that means winding down at 8:30 p.m. so I can get the most sleep. Do I sometimes break it? Sure, if a patient needs me. But I don’t break it for email or “just one more” Netflix episode.
Another example: I don’t book challenging gym classes post-call. Instead, I plan something gentler (a walk or yoga video). That way I don’t waste energy beating myself up for canceling last minute.
Boundaries are how you carve routine out of chaos. You decide them. You decide when to break them.
3. Craft Schedules in Smaller Blocks
Yes, your clinical calendar may be mapped months ahead. But routines can feel more manageable if you plan in smaller chunks, such as weekly or biweekly.
Every Sunday night (or whenever your “week” begins), sit down with your shifts and your priority in mind. Cancel what conflicts. Block what matters. Build in recovery time.
This simple act shifts you from being jerked around by your schedule to actively shaping it.
4. Anchor Habits to Non-Time-Based Cues
For shift workers, clock time is slippery. Instead of saying, “I’ll meditate at 7 a.m.,” try cues like:
After I brush my teeth, I’ll stretch for five minutes.
When I brew coffee, I’ll review my to-do list.
Before walking into the unit, I’ll take three grounding breaths.
These “if–then” anchors work regardless of whether your “morning” is 7 a.m. or 7 p.m.
5. Prioritize Recovery as Much as Activity
Shift work is physiologically hard. Studies link it with higher risks of heart disease, diabetes, obesity, and even cancer. That’s not a scare tactic; it’s a reminder that routines aren’t just about productivity. They’re about repair.
Build rituals that help you come down from a shift as deliberately as you wind yourself up for one: blackout curtains, white noise, or a consistent “off-duty” signal like a shower or journaling. Protect your rest as if it were your most important meeting (because it is).
Final Thoughts
Shift workers are a quirky bunch: dark humor, odd superstitions, and stories you can only tell to people who’ve been there. Routines won’t make the work easy, but they make it sustainable.
Keep an eye out for the routines you’ve fallen into that no longer serve you. Get creative with new ones that do. And remember: the unreliable can become reliable when you decide what anchors matter most.
As Noah Wyle said at the 2025 Emmys: “To anybody who is going on shift tonight, or coming off shift tonight, thank you for being in that job. This is for you.”