The Week You Can See Coming
Series: Calendar of Your Own · Episode 16 · Pillar 1: Work Life Balance
By Rod Gamble | Week 43, 2026 | Pillar 1: Work Life Balance
The honest version of leaving the rota is that the long days do not stop — they simply stop arriving without warning.
I begin there because almost everything written about moving from clinical work into digital health begins somewhere else. It begins with nine-to-five. No call, work from anywhere, your evenings handed back. That copy is nearly always written by someone with something to sell. So here is the version I would give a friend over coffee — less flattering to me, more useful to you.
The Argument That Is Really About One Thing
There is a thread on one of the large nursing forums that has run for over a decade — thirteen pages of clinicians arguing about twelve-hour shifts. One writes that twelves consume her life; on a work day there is no such thing as “after work”, there is only bedtime. Another says you may pry her twelves from her cold fingers, because she has no wish to be in that building five days a week. A third moved to four eights, took the pay cut, and called it worth every penny.
Read enough of it and something odd surfaces. They want opposite rotas for identical reasons. Every one of them is trying to fit a life around a block of hours they treat as immovable, and the only variable anyone is arguing about is its shape.
From inside, that is invisible. Look at what those same communities offer each other when someone says night shifts have taken their life away: dialysis, clinic, school nursing, hospice, home health. Every suggestion is a different bedside. The set of options we can see is far smaller than the set that exists.
So the question worth asking is not twelves or eights. It is whether anything other than rearrangement is genuinely on offer.
The Most Honest Thing I Have Read About Our Hours
Something else is on offer. But I am not going to sell it to you the way it usually gets sold.
Some years ago an informatics nurse wrote a piece for that same forum about what she wished she had known before moving into the field. It was not a recruitment advert. Many nurses, she wrote, picture a technical team as a stable nine-to-five with no overtime and no weekend hours. Then the correction, flat and unembellished: this is no escape from weekend on-call work. She described go-live days running six in the morning until ten at night, so teams in India or Croatia could sync with hers.
Underneath it, somebody already doing the job gave the most credible account of digital health hours I have read anywhere. She does not work weekends unless she is on call — which comes round every six or seven weeks — and something is live. Some weeks tip slightly over forty. And then a detail that is not a claim at all but a scene: on Fridays at four in the afternoon, she shuts her workstation down.
Put those two accounts side by side and you have the honest offer. Not fewer hours. Not the end of on-call. A week whose shape you can see in advance.
I will happily confirm the unglamorous half. Go-live weeks are brutal. I have run programmes across six countries and several time zones, and there were stretches where my working day was governed by where the sun happened to be over Nairobi or Karachi. Some people make the move and want to go back. Anyone who tells you otherwise is describing a brochure, not a profession.
Building It Again, in a New Country
The stretch that finally taught me the difference came after I left the developing-world programme during the pandemic and rebuilt from scratch in the UK. I held an interim programme directorship for a hospital in Dubai — remotely, from a house in Yorkshire, mid-pandemic, on a high-profile system refresh. Then my own consultancy.
None of that was light. The hours in some of those months were as long as anything I ever worked on a ward. But I knew where they were. I could see Tuesday from Sunday evening. When something at home needed me at eleven on a Wednesday morning, I did not have to trade a shift or make a case to a rota coordinator. I moved the hours, and then I worked them.
That is the whole of it, and it took me an embarrassingly long time to name. The old calendar was not heavier. It was unpredictable — and unpredictability is the thing you cannot build a life inside.
What the Evidence Actually Points At
The research is edging the same way, carefully. A 2026 study in Healthcare asked whether shift-work characteristics, satisfaction with work-life balance and chronic illness were independently associated with burnout in nurses. It is small — a hundred nurses across two hospitals, with little variation in shift pattern between them — so I will not overclaim it. But once other factors were adjusted for, shift duration was not independently associated with burnout, while satisfaction with work-life balance showed the strongest association of anything measured. How long the shift ran mattered less than whether the life around it held together.
Meanwhile the numbers on staying have moved somewhere uncomfortable. Nurse.org’s 2026 retention survey found 43% of nurses want to leave the bedside, up from 38% the year before, and that the most common reason for staying is now financial necessity at 41% — ahead of commitment to patient care. The reason we give for staying has quietly stopped being vocation and started being arithmetic.
The counterweight deserves saying too, because almost nobody says it. In the most recent NHS Staff Survey, 56.61% of staff reported achieving a good work-life balance — the highest since the question was introduced in 2021 — and 71.75% said they could raise flexible working with their manager. It is a record high. It is also barely half.
And flexibility is more available than ward gossip suggests. The BMA is explicit that the only requirement for less-than-full-time training is a well-founded individual reason, wellbeing and personal choice included. Roughly a quarter of physicians already work part-time, on an estimate published in 2021. You would not be the only one — which matters, because for many doctors the barrier was never the rulebook. It is the fear of how the request will be read.
Some of us should stay in the hospital, and some of us should move into digital health. I am not going to tell you which. But I would like us to make that choice against an accurate picture, and the accurate picture is neither “nothing here can change” nor “nine-to-five, no call, work from anywhere.”
Steps You Can Take Now
None of these requires you to hand in your notice. Each one tests the thing this piece is actually about — predictability — rather than the thing we usually argue about.
1. Count the hours you knew about. For one week, do not record how many hours you worked — record how many you knew about seven days in advance. That percentage, not the total, governs whether a life fits around the work.
2. Stop screening roles for “no call”. Screen for boundedness instead. The honest answer sounds like “on call one week in seven, go-lives twice a year, hard stop most Fridays” — not “nine-to-five, never evenings.” A bounded promise is one somebody has measured. An unbounded one is marketing.
3. Ask the three questions out loud. At any interview, or over coffee with someone already inside: how often does the on-call rotation come round? What does a go-live week actually look like? Where is your hard stop, and does it hold?
4. Answer the experience wall with one piece of proof. Every role wants experience in that exact role — a real obstacle, and a beatable one. Pick one project where you already sit between the clinical work and the system: a workflow you redesigned, a build you tested, a rollout you led. Write it up in one page, in the language of the system rather than the language of the shift. That page is the experience.
The move out of clinical practice was never about finding work that asks less of us. The people I coach are not looking to be needed less. It is about work whose demands arrive where you can see them.
Fewer hours would have been welcome. Hours I could see coming changed everything.
When you’re ready to talk, rodgamble.com is where to find me.
References
1. Nurse.org. “43% of Nurses Want to Leave the Bedside. Most Can’t Afford To.” 2026 retention survey. https://nurse.org/articles/nurses-leaving-bedside-retention-2026/
2. NHS Confederation. “NHS Staff Survey results: what you need to know.” https://www.nhsconfed.org/publications/nhs-staff-survey-results-2025-what-you-need-know
3. Personnel Today. “NHS staff survey reveals stability, not improvement.” https://www.personneltoday.com/hr/nhs-staff-survey-reveals-stability-not-improvement/
4. Healthcare (MDPI), 2026. “Factors Associated with Burnout Among Nurses: The Roles of Shift Work Characteristics, Work–Life Balance Satisfaction, and Chronic Disease.” https://www.mdpi.com/2227-9032/14/18/3015
5. British Medical Association. “Flexible training” — less-than-full-time training eligibility. https://www.bma.org.uk/advice-and-support/career-progression/training/flexible-training
6. Medscape, 2026. “Want to Work Less? These Doctors Made Part-Time Pay.” Reports a JAMA Internal Medicine estimate published in 2021 that nearly 25% of physicians work part-time. https://www.medscape.com/viewarticle/want-work-less-these-doctors-made-part-time-pay-2026a1000q54
7. Becker’s Hospital Review. “Nurse job satisfaction drops after 3-year recovery: Survey.” https://www.beckershospitalreview.com/quality/nursing/nurse-job-satisfaction-drops-after-3-year-recovery-survey/
8. allnurses. “5 Things I Wish I Knew Before Starting a Masters in Nursing Informatics” (published 2020, updated 2023) — source of the informatics accounts described above. https://allnurses.com/things-i-wish-i-knew-t720920/
