Profiles and Features July 12, 2019

By Ian Samuels

Night Shift Nursing: The Dangers of Sleep Deprivation

Are you getting enough sleep as a nurse? If you work the night shift, chances are the answer is often no.

Night shift nursing can put you at serious risk of sleep deprivation and its attendant problems. 

A lack of sleep can contribute to irritability and errors on the job that place patients at risk, and it can lead to drowsy driving after work, which is nearly as dangerous a phenomenon as drunk driving. 

Addressing this issue is an important key to making night shift nursing work a more positive experience for everyone involved.

Get an overview of the night shift nursing hazards associated with sleep deprivation and some recommended guidelines for preventing it below.

Sleep Deprivation As A Risk Factor In Night Shift Nursing

Medical professionals have been raising the alarm about sleep deprivation as a major risk factor to shift workers, including those engaged in night shift nursing, for more than two decades. 

Experts note that lack of sleep in nurses is dangerous for patients and the RNs themselves.

1. Sleep Deprivation Increases the Risk of Errors

Licensed Mental Health Counselor Gina Marie Guarino says, "A lack of sleep heightens emotions, dulls awareness, and fogs the mind to prevent rational and logical thinking. It also exhausts the body and brain, which affects functioning and productivity. Finally, it is a recipe for making disastrous mistakes, as it causes you to forget things and not pay attention to what is going on around you."

Those problems with the body and brain can result in unnecessary risk to patients, says Eddie Chu, owner of Qualicare Ottawa. 

"This is especially dangerous in healthcare as patient safety, and care can be affected directly. A nurse can be less alert because of exhaustion, preventing them from reacting to a patient’s needs immediately."

[Related: 5 Ways to Fight Off Nurse Fatigue]

2. Night Shift Nursing without Adequate Rest Leads to Danger on the Road

And the risks don't stop once you leave patient bedsides. Chu notes that night shift nursing and associated sleep deprivation can continue to put RNs at risk even after the work is done. 

"Lack of sleep also poses potential harm to [nurses'] own health and safety regarding daily activities such as driving," he says.

The point about driving is worth dwelling on as it pertains to night shift nursing. Being awake for 19 hours creates impairment equivalent to having a blood-alcohol level of 0.05 percent, and at 20 hours, the equivalency rate is 0.1 percent BAC (as shown in Dawson and Reid's study in Nature).

Certified sleep science coach Chris Branter explains:

"Perhaps the biggest danger involved in driving home the morning after a night shift. Believe it or not, drowsy driving can be just as dangerous as drunk driving . . . [and the] worst part is, similar to people driving drunk, drowsy drivers often don't realize they're too impaired to drive. Yet about a third of adults in the US have admitted to dozing off at the wheel."

3. Sleep Deprivation Causes On-the-Job Sleep Episodes

The evidence in favor of what Brantner says is solid and is demonstrated by multiple studies with a wide variety of methodologies and sample sizes. 

Research by Ann Rogers summarized in Chapter 40 of Patient Safety and Quality: An Evidence-Based Handbook for Nurses illustrates this.

And as Alison Trinkoff and her fellow authors note in Chapter 39 of the same handbook, the research support for a specifically heightened rate of danger in night shift nursing is powerful. They note that EEG recordings of night shift nurses indicated brief on-the-job sleep episodes, showing that nurses can fall asleep while they're on duty.

Trinkoff et. al., write that "sleepiness is most apparent during the night shift, and poor daytime sleep appears to be a contributing factor. A meta-analysis combining injury data from several studies indicated that injury risk increased by 18 percent during the afternoon/evening shift and 34 percent during the night shift compared to morning/day shift."

While there isn't space here to summarize all the potential dangers fully, enough of them are touched on above to clarify that sleep deprivation is well worth avoiding in night shift nursing. Of course, this raises the question of how to avoid it.

Healthy Sleep And Night Shift Nursing

As the American Nurses Association notes, the body generally needs "at least seven hours of restorative, comfortable rest daily." 

The ANA offers some simple recommendations for optimizing your sleep routine for nursing in general, including night shift nursing. They include choosing a consistent bedtime and routine, preparing yourself for sleep with a relaxing activity, and avoiding alcohol and caffeine before bedtime (and nicotine in general).

Charles H. Samuels, medical director of the Center for Sleep and Human Performance, amplifies tips like this with advice written specifically for public safety officers equally useful for night shift nursing. 

He recommends specifically determining how much sleep you need per week, comparing this to how much sleep you actually get, and noting this as your "sleep debt." He also proposes some strategies specific to shift work:

  • Using days off to catch up on your sleep debt
  • Creating a day-sleep environment that is quiet, completely dark, comfortable, and free of distractions
  • Getting two-three- to four-hour blocks of sleep during the day when you work the night shift.
  • Catnapping in short 20–30 minute periods with eyes closed, situated in a comfortable and resting position when possible during breaks in your shift

Samuels notes that "You don't have to sleep to get the benefit of a catnap."

 

Follow these recommendations for healthy sleep routines to enjoy a positive night shift nursing experience and keep the dangers of sleep deprivation at bay.

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