Nursing Shift Work: How to Survive and Thrive
With three days on and four off, what’s not to love about 12-hour nursing shifts? “There is one less major shift change to contend with, and patients have fewer names and faces to get acclimated to in a 24-hour period,” writes nursing career guru Donna Cardillo in American Nurse Today. “It all makes sense on the surface.”
But go deeper and the water gets murky, according to research by work schedule and sleep expert Claire C. Caruso, PhD, RN, FAAN. She is a research health scientist at the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention.
“Short sleep duration is reported by 52% of night shift healthcare and social assistance workers,” she says. “Consequences for nurses can be severe, including personal injury or death. A patient error with the same outcomes can have devastating legal ramifications, while falling asleep during a commute home can cause death for you or another person.”
Befriend Your Body
There’s no question that nurses’ demanding hours can lead to sleep difficulties, declines in performance, and increased worker errors, Dr. Caruso says. Studies show fatigue-related accidents and errors are higher for evening and night shifts, and that they increase with successive night shifts.
An October report in the International Journal of Nursing Studies found that as sleep duration becomes shorter, job strain and burnout go up.
“Most of us need seven to nine hours of good, quality sleep daily,” she says.”Shift work and long hours undermine the body’s basic physiology, including needs for sleep, food and exercise. Not getting enough sleep disturbs your circadian rhythms and throws off your body’s defenses to repair wear and tear, fight germs, and get ready for the new day.’”
Body temperature and hormone levels rise during the day and fall during sleep, the digestive tract wants us to eat during the day, plus the body wants to sleep at night and be inactive, Dr. Caruso says. “Irregular schedules upset that balance.”
Know the Risks
In the near term, Dr. Caruso says, shifts between 11 p.m. and 7 a.m. can:
- Result in sleep deprivation and sleepiness
- Cause insomnia
- Negatively impact clear thinking and instigate memory problems
- Affect physical coordination and slow normal reaction time
- Depress your immune system response
- Throw your appetite hormone off-kilter, so you’re hungry—for sweet or fatty foods that increase obesity risk
- Reduce alertness, increasing chances for vehicle crashes and mistakes when delivering patient care
- Strain personal relationships
In the long term, irregular shifts can increase the chances for developing several diseases, for example but not limited to:
- Higher risk for certain cancers; breast cancer has been most studied
- Damage pancreatic cells that make insulin, increasing insulin resistance
- Increase risk for high blood pressure and heart disease
- Cause mood disturbances
Plan to Sleep Deeply
“It sounds simple, but many people don’t really know how to sleep well,” Dr. Caruso says. “Make getting enough sleep a priority, because if you take on shift work, you can’t let it take over your life and health.”
Here’s how to set up an ideal day sleeping environment:
- Blacken the bedroom “so you can’t see your hand in front of your face.”
- Cover windows with opaque material.
- Keep things quiet by using ear plugs, fans, or a white noise machine.
- Turn the phone off.
- Keep room temperature comfortably cool.
- Get a really good mattress and pillow.
Take these steps in your life to ensure requisite zzzz’s, she recommends:
- Ask for understanding and cooperation from family and friends. Eliminate conflicting demands between work life and home life, whether it’s chauffeuring the kids or fulfilling social obligations.
- Evaluate the driving distance to your job, and if it’s far, consider moving closer to reduce driving risk when fatigued.
- For a brief rev-up, use caffeine sparingly. If you’re sensitive, don’t use it or use “strategically.” That means if this stimulant stays in your system longer than you need it, it will affect your sleep once you’re off work, so stop drinking it many hours before you plan to go to bed. Also, don’t drink alcohol before sleeping.
- Take naps if you can. Brief periods of 15 to 20 minutes can increase alertness, while longer than 45 minutes may make you groggy.
- Use light to enhance alertness and help circadian rhythms. Sunlight is best, but bright artificial room light really helps, especially during the beginning of your shift.
- Keep moving. Short periods of moderate exercise can increase alertness.
- Avoiding sleep and alertness medications. Some meds aren’t safe for long-term use, and medical studies are low quality.
Ask for Employer Help
Getting better sleep to be better at work is a partnership, Dr. Caruso says. Ask your employer to:
- Schedule least 10 hours off between shifts and to avoid weekly rotations. “Choose permanent schedules with just one shift, like the evening shift, or rotate shifts slowly by staying on the same shift for two weeks or more,” she says.
- Consider allowing brief 15 to 20 minute naps during work breaks in a sleep-friendly nap room. Use systems to schedule naps and awaken napping workers, and have adequate staff to cover them.
- Schedule your work with others rather than alone.
- Encourage frequent rest breaks every hour or two and longer breaks for meals.
Staff It Up
Inadequate staffing can cause nurses to feel fatigued and frustrated with their day-to-day work, and more likely to make clinical errors, says Karlene Kerfoot, chief clinical integration officer of API Healthcare, a GE Healthcare company. An API Healthcare-commissioned study earlier this year found that 82% of Americans aged 30 or older felt nurses are spread too thin and that diminishes quality patient care.
“Unfortunately, many hospitals today do not have software for staffing and scheduling, and they manage staffing on spreadsheets or paper,” Kerfoot says. “Then they lack important data that can help them evaluate staffing practices.”
Check out openings on Monster to find nursing jobs in your area.