The Four-Count Reset: A Night Shift Lesson in Physiology and Survival

I remember the night with absolute clarity. A routine shift, until it wasn’t.

The room compressed, the air thinned, and my own physiology staged a quiet rebellion. I’m not built for anxiety, if anything, my wiring tends toward the opposite.

I’ve always leaned toward risk, making the kind of decisions that define someone built for implosion, but not retreat.

But on that night, after months of accumulated strain finally converged, my nervous system made its point.

I stepped out of the Level I trauma center into the cold air and tried to breathe.

What came back to me was the same thing we teach patients, students, and each other: simple, structured respiration.

Inhale four. Hold four. Exhale four. Hold four.

A small pattern that shifts the entire autonomic balance.

And this isn’t folklore or wellness-word salad. The evidence is there:

Slow, slow breathing - breathing at your own pace relieves the fight or flight buzz. Taking charge of your breathing can help calm down the heart rate jitters that come with stress and give your vagus nerve a boost - a version of your body's own brake system.

Breathing at set times helps keep your CO2 steady and prevents that tightening, panic - shaking feeling that occurs when you begin gasping. Studies with people who've witnessed a lot of trauma show paced breathing reduces the fizzy reaction of the body when they're under sudden stress.

Box breathing (breathing to the count of four with breaths held for the in, hold, out and hold, then repeat) has been a go-to in the military, flights, and high-stakes medical rooms for snapping back your mental focus when the crap hits. 

The beat is not random, so knowing the pattern makes your body's nervous system switch in an expected way. Actual breathing tells the amygdala and brain stem of the brain what to do, brain scans show. The breath is the warning light and the fix.

I stood under the night sky taking those measured breaths, resetting chemistry, reclaiming ground, and then walked back inside to finish the shift.

It’s one of the rare moments in my life when anxiety had a say, and I can still feel the edges of it today.

Which makes me think about those who live with this sensation not as an exception but as a baseline. Every day. Every Shift.

If a few controlled breaths can bring a veteran trauma nurse back from the edge in the midst of an overnight shift, then that tool is absolutely worth talking about.

Not as a cure-all. Not as a lifestyle hashtag.

As a physiologic intervention with real leverage. And one you can carry in your pocket long after the shift ends.

Why I Wrote - The Shift Worker’s Paradox

This book exists because nurses, and all shift workers, deserve more than advice to “hydrate” or “adjust your sleep.” They deserve research-driven strategies to mitigate risk, preserve health, and understand the exposures they shoulder in service of others.

Author: R.E. Hengsterman, MSN, MA, M.E., RN

Registered nurse, night-shift administrator, and author of The Shift Worker’s Paradox

Nursewhowrites.com

For educational purposes only. Not medical advice.