Night Shift Nurses
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Night Shift Nurses
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Fewer roles in healthcare are as misunderstood as that of night shift nurses, whose invaluable contributions to the well-being of patients and the success of nursing teams are consistently under-appreciated. Itâs understandable that the work of night shift nurses goes unrecognized, because they are caring for patients while the rest of the world sleeps. Yet few nurses face more challenges and make more sacrifices for their profession than those assigned to the night shift.
For example, patients are likely to feel vulnerable at night: they are in unfamiliar surroundings, they are trying to sleep in a strange bed, they are usually in discomfort if not outright pain. And as any nurse who has worked the night shift will tell you, patients are as likely to be awake through most of the shift as they are to sleep through it.
Counterbalancing the challenges faced by night shift nurses are the many benefits that come with working through the night, such as spending days pursuing outside interests or advancing nursing careers. The resources and tips in this guide are intended to keep night shift nurses healthy, rested, and ready to provide their patients with high-quality care. As a great number of happy night shift nurses can attest, it is possible to enjoy time with family and personal pursuits while working the night shift.
The most common misconception about night shift nurses, according to Grace Eire on the Little Things blog, is that all is calm at night. In fact, night shifts are just as busy as day shifts. As Eire writes, âPeople donât stop being sick just because itâs nighttime.â Of course, nurses working the day shift have tremendous workloads, so they sometimes leave what Eire refers to as âless desirableâ tasks for the night shift.
Having to deal with tired patients trying to sleep in an unfamiliar bed is only one of the ways the shift is tougher than day and afternoon (swing) shifts. For example, another disadvantage for night shift nurses is they may lack access to resources, such as a full-service cafeteria and other support operations. Here is a look at some of the unique challenges that night shift nurses must overcome, as well as ways to retain nurses who work the night shift.
In many hospital departments, such as intensive care units and emergency rooms, the activity level doesnât change from shift to shift. In other departments, activity may appear to decline at night because there are fewer staff and visitors around, but night shift nurses are kept as busy as their counterparts on other shifts. Night shift nurses often spend much of their work time responding to calls from patients, keeping them clean, monitoring and changing IV lines, and performing similar nursing duties.
Night shifts generally have fewer nurses and other staff working than other shifts, so nurses working at night depend on their nursing team for support. This means during their quiet times, night shift nurses are often kept busy helping other nurses. Throughout their shifts, night nurses try to ensure their patients get as much sleep as possible, because rest is important for their recovery. However, many report their patients are often tired, uncomfortable, and anxious in strange surroundings, all of which make patients grumpier than they are at other times of the day.
The physical and emotional effects of working through the night and sleeping during the day are exacerbated by the feeling many night nurses experience of being excluded from work and social activities. This is just one of the challenges faced by night shift nurses that their counterparts on other shifts are unlikely to experience.
The greatest threat to the health of night shift nurses relates to the effects of chronic sleep deprivation. A study reported by Scrubs Magazine found that nurses slept one to four hours fewer per week when they worked the night shift. Among the risks resulting from sleep deprivation are a doubling of the chances of being in an auto accident after getting less than six hours of sleep in the previous 24 hours and a quadrupling of the risk after getting fewer than five hours of sleep.
These are among the elevated health risks faced by nurses working the night shift:
In addition to coping with a chronically tired nursing staff, nurse leaders face unique hurdles in keeping the night shift appropriately staffed, ensuring safe practices, and making decisions about when to notify a doctor in the middle of the night about a patientâs status. Managing the night shift nurses presents challenges for nurse leaders charged with ensuring their departments run well and their employees are motivated and growing in their careers.
Health Leaders cites studies that found errors and on-the-job injuries increase dramatically on night shifts, due primarily to the human tendency to lose focus and alertness at night, even with plenty of rest. Still, nurse managers can help night shift nurses perform at 100% effectiveness by devising work schedules that ensure sufficient rest between shifts. Managers should also watch for signs of fatigue in nurses on the night shift and encourage them to take regular breaks. In the past, few hospitals allowed night shift nurses to sleep on the job, but many now see the benefit in allowing nurses to take short nap breaks.
No matter the shift, workers must report for duty fully prepared to perform at their best. This means being thoroughly rested and feeling healthy and strong. It is imperative for nurses working the night shift to get sufficient sleep, eat nutritious meals, and engage in regular physical activity. These resources can help night shift nurses ensure they are able to maintain peak performance all through the night.
Finding time to sleep is only one part of the overarching challenge of adopting a flexible schedule for meals, socializing, exercise, and favorite activities. Yet without sufficient sleep, all areas of a personâs life suffer. The National Sleep Foundation describes shift work disorder as a condition that arises from long-term night shift work and increases the risk of some chronic illnesses. Among these illnesses are heart disease, ulcers, obesity, and gastrointestinal and metabolic diseases.
To help night shift nurses get sufficient sleep, the U.S. Centers for Disease Control and Preventionâs National Institute for Occupational Safety and Health has developed an online training module designed to teach night shift nurses and their managers about the health risks associated with shift work and long work hours. The program also presents strategies that nurses and other night shift healthcare workers can use to counteract these health risks by adopting behaviors at work and outside work that reset circadian rhythms and ensure proper sleep patterns.
A review of research related to nurse shift work conducted by the Sigma Theta Tau International Honor Society of Nursing determined that nursesâstudy subjects were almost exclusively femaleâwho work entirely on the night shift have a greater risk of obesity (7.4%) or being overweight (18.6%), while nurses who do shift work for five or more years have elevated risks of breast cancer and death due to cardiovascular disease. In addition, the survey found that the risk of experiencing irregular periods increased 13% for each year that a nurse works rotating shifts.
Conversely, night shift nurses have a lower incidence of some diseases than their counterparts working other shifts: nurses who worked 10 or more years of rotating shifts are 44% less likely to contract melanoma, and those who work more than 15 years on the night shift are 50% less likely to develop Parkinsonâs disease. However, nurses who work rotating shifts have a much higher prevalence of irritable bowel syndrome, and night shift nurses are more likely than their coworkers on other shifts to experience depression and high states of anxiety.
Considering the impact night shift work has on a nurseâs health, family, and social life, it is not a surprise that hospitals often find it difficult to keep the night shift adequately staffed. A study published in the journal Research in Nursing & Health establishes a correlation between nurse-to-patient ratios and successful patient outcomes and lengths of stay (LOS). The study found that while nurses on the night shift spent 64.4% of their work hours providing patient care compared to 60.2% for nurses working the day shift, patient outcomes were worse on the night shift than during the day. For all shifts, the researchers found that patient outcomes and LOS improved as nurse-to-patient ratios fell.
Night shift nurse managers soon learn that nurses on their watch require a different leadership style than their counterparts on other shifts. The policies and procedures set by nurse managers and health administrators are key to ensuring that night shift nurses have opportunities to contribute to the organization in many different ways and to advance toward their career goals.
For example, while all nurses need to develop strategies to cope with the stress that is inherent in their work, night shift nurses have fewer support services at their disposal during their work hours. RN Journal describes how the increased risk of health woes and the disruption of social life inherent in night shift work are made worse by the lack of experience many night shift nurses have because many are recent nursing school graduates.
Nurse managers must adopt strategies that combat the factors that contribute to the negative impact of shift work. First, they have to qualify potential night shift nurses to confirm that they are well suited to working the night shift, particularly whether they will be able to adjust their sleep patterns and circadian rhythms to compensate for night work. They must also make night shift nurses aware of the health risks associated with working at night and encourage them to eat a nutritious diet, exercise regularly, and get sufficient rest, even if doing so requires taking âmicro napsâ as work breaks.
Night shift nurses must make an extra effort to ensure they get sufficient rest, nutrition, and exercise to avoid fatigue, burnout, and illness. The tips for working night shift nurses presented here can help them establish healthy and restful routines that keep them functioning at their best in their work life and home life.
Nurses working the night shift can reduce the chances that they will suffer from chronic fatigue and insomnia by understanding the causes of sleep-related problems and learning techniques to help them establish a healthy sleep routine. American Nurse Today recommends that nurses have a set time when they go to sleep and wake up. The mistake many night shift nurses make is to plan their sleep time around their personal activities rather than the other way around.
Sticking to set sleep and wake times requires that nurses give up some opportunities to socialize with family and friends or take part in other favorite activities. Still, maintaining a regular sleep schedule that guarantees seven to eight hours of sleep is one of the best ways for night shift nurses to stay healthy and alert. To avoid the interruptions that are common to people who sleep during the day, nurses should find a quiet sleep area that is free of distractions. Just as with getting a good night âs sleep, it helps day sleepers to establish a pre-sleep routine, avoid caffeine, and maintain a comfortable temperature in the sleep area.
Some night shift nurses stay awake on their nights off to avoid the âhangoverâ feeling that commonly occurs when alternating between sleeping during the day while working and sleeping at night on their off days. Whether they adjust their sleep times to their activities or follow the advice above and stick with set sleep hours, nurses must maintain healthy eating and exercise routines whether or not they keep vampiresâ hours.
In an interview with the National Sleep Foundation , a night shift nurse identified as Sarah L. says it can be challenging to motivate herself to participate in social activities after stressful work shifts. To avoid the ânight shift hangover,â she groups her night shifts together and tries to exercise before her shift as often as possible so she can âexperience daylight.â On the day after her last shift in a group, she takes a âshort sleepâ of a few hours and then goes to bed early to be rested for the next day. As with many night shift workers, Sarah relies on naps for a quick energy recharge.
Many night shift nurses find that having their days f
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