Most hospitals have adopted the 12-hour nursing shift schedule, despite a 2012 Center for Health Outcome and Policy Research study that showed its impact on patient safety and quality of care.
Another study from the University of Maryland’s School of Nursing determined that a cumulative effect exists. Nurses who worked three consecutive 12-hour shifts suffered from sleep deprivation and exhibited slower reaction times. The pattern was the same for day and night shift workers.
So why are hospitals still sticking to these shifts? Let’s take a look at its origin.
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Origin and Effects of 12-Hour Shift
The 12-hour nursing shift began in the 1970s as a means to retain nurses amid a growing nursing shortage. Hospitals benefitted from less overtime and less use of agency nurses. Meanwhile, it became popular among nurses as it allowed more personal off time. Hospitals benefitted as the increased time off improved morale and reduced absenteeism. And there may be better continuity of care and communication as nurses report only twice in 12 hours.
But since then, this flexibility may contribute to fatigue. Whether immersed in family activities or a working second job, nurses may not get enough sleep. There may also be more room for error as nurses grow tired and pay less attention to details.
The flexible schedule may also make a regular sleep pattern harder to achieve. There are also studies which suggest 12-hour shifts have long-term effects on a nurse’s own health, placing them at a greater risk for obesity, heart disease, stroke, hypertension, glucose regulation, GI disorder and reproductive problems.
While shift length and cumulative working hours for resident physicians are regulated, there are no national work-hour policies for nurses. Nevertheless, love ‘em or leave ‘em, 12-hour shifts are here to stay. Hence, here are ways to stay alert and some tips for getting home safely after a long shift.
Tips to Stay Alert
Regardless of the length of your nursing shift, the following tips will help you stay alert:
– Get plenty of sleep before you work.
– Maintain a healthy diet.
– Eat healthy snacks such as yogurt or a protein snack. Avoid caffeine and foods high in fat and sugar, which may interfere with sleep.
– Make sure you take your breaks. During breaks, take a walk.
– Leave the unit if workload permits.
– Perform deep breathing.
– Consider a nap. Yes, I said nap.
Traditionally, nurses asleep on duty were fired for dereliction of duty. However, some hospitals are actually allowing nurses to nap when on break. Nurses should just not sleep at the nurses’ station or in patient care areas.
Why Nap at Work?
According to the National Sleep Foundation, a 15- to 20-minute nap can restore alertness, enhance performance, and reduce mistakes and accidents. A 40-minute nap can improve performance by 34 percent and alertness 100 percent.
In a study, the Salk Institute for Biological Studies put 30 well-rested people through a set of tasks four times in the course of a 10-hour shift. Some subjects were allowed 20-minute naps, while others stayed awake the entire time. Performance dropped by more than 50 percent for participants who stayed awake the entire time.
Napping benefitted the diet as well. Psychology Today reported employees decreased consumption of caffeinated beverages by 30 percent after a California firm implemented a napping policy.
As a nursing educator, I am also intrigued that short naps after lunch may enhance information processing and learning.
The Need for Nap Rooms
With nurses restricted from napping at the nurses’ station or in patient care areas, nap rooms are fast becoming essential. To help you create a nap room, follow these guidelines:
– Staff must be available in case of an emergency.
– Rooms are only to be used during breaks.
– Nap rooms should be clean, quiet, dark, and equipped with reclining loungers. Employees should consider using earplugs or an eyeshade. Darkness stimulates melatonin production, the sleep- inducing hormone.
– Body temperature drops when asleep, so adjust the room temperature or use a blanket.
– Be sure to set an alarm so you can relax.
Ideal napping times are morning or just after lunch. Avoid late afternoon naps as you are more likely to fall into deep sleep which make you feel groggy. Meanwhile, consuming foods high in calcium and protein an hour or two before a nap may promote sleep.
Tips for Getting Home Safely
As I would leave work, a co-worker used to say, “Drive carefully. If you have an accident they will just bring you back here.” There are probably a million tricks to staying awake and alert on the drive home and I have probably tried them all. But such tricks are not cures and may provide a false sense of security.
CNN reports after being awake for 20 hours straight the average driver performs as poorly as someone with a blood alcohol level of 0.08 percent, the legal limit in all states. The bottom line is, if you are tired, you must sleep. If you display the following symptoms—frequent yawning, heavy eyes, and blurred vision, slow reactions, or over steering—pull over at the first safe opportunity and rest.
Several years ago, Howard Frady, a dear colleague, fell asleep while driving home and died. I offer the following tips in his memory.
– If you feel sleepy, take a short nap.
– Consider using public transport or taxis rather than driving.
– Take a brisk walk before driving.
– Carpool with a co-worker when possible.
– Adjust the temperature inside the car as needed so it does not make you sleepy.
– Keep the music at a non-distracting level.
– Avoid medications that may make you drowsy such as cold and allergy medications.
– Seek treatment for any known sleep disorders such as insomnia, obstructive sleep apnea, restless legs syndrome, or narcolepsy.
I hope this information helps you remain awake, aware, and alert, regardless of the length of your nursing shift. Remember, before we can take care of others, we have to take care of ourselves first.