Running head: SLEEP DEPRIVATION AND SHIFT WORK

Sleep Deprivation and Shift Work Kathryn Bertke and Jennifer Edson Ferris State University

SLEEP DEPRIVATION AND SHIFT WORK Abstract There is a strong correlation between working long hours shift work and sleep deprivation. Sleep deprivation enhances nurse burnout and patient dissatisfaction and creates a concern of

safety. Learning ways and implementing promotion of adequate sleep is important and can have many beneficial outcomes.

SLEEP DEPRIVATION AND SHIFT WORK Sleep Deprivation and Shift Work Nursing is an occupation with many shift options. In the hospital, it is found that nurses generally work eight or twelve hour shifts. The majority of hospital shifts have been converted into two twelve-hour shifts; one of the reasons for this change has been for only needing two nurses for 24-hour coverage. Twelve hour shifts are appealing to the nurses as well because it gives them four days off a week. However, many questions in regards to nurse and patient satisfaction and nurse and patient safety exist. Do long shifts create sleep deprivation and is

sleep deprivation related to nurse and patient safety? Is nurse burnout more likely in twelve hour or eight hour shifts? It is important to promote adequate sleep and positive health behaviors for nurses because proper rest and sleep are extremely important for the safety of the nurses and for the patients and their care. Health Effects of Sleep Deprivation A lack of sleep regardless of working eight or twelve hour shifts have an effect on nursing capabilities, and a nurses personal health. Hospitals are now typically requiring twelve hour shifts from nurses to cover twenty-four hours of patient care. Patients have a continuity of care by only having two nurses every twenty-four hours and with continuity of care, patients have several benefits. First, nurses have a better understanding of each patient and their needs. The longer they know them, the more the nurses know in regards to each patient need and are able to recognize what is normal for each patient and in turn, able to identify new problems or the onset of new symptoms. With longer shifts, however, fatigue follows. One of our basic human needs is sleep and because of this, sleep deprivation causes fatigue and has many negative effects. Fatigue is defined as, the desire or disinclination to continue performing the task at hand. It is a weariness that can be caused by either mental or

SLEEP DEPRIVATION AND SHIFT WORK physical exertion. A person can be fatigued without being sleepy (Stokowski, 2004).

Symptoms of fatigue and sleep deprivation include the following: Increased irritability and bad mood, inability to concentrate, lack of energy, short-term memory loss, apathy, poor communication and preservation on ineffective solutions (Stokowski, 2004). Twelve-hour and Midnight Shifts With twelve hour shifts it has been noted that fatigue and sleep deprivation play an important role in patient safety. When nurses work consecutive twelve hours shifts, a study found that the average total sleep time between 12-hours shifts was only 5.5 hours. Night-shift nurses averaged only about 5.2 hours of sleep, and the quality of their sleep was extremely fragmented ("Sleep-Deprived Nurses," 2010). From experience, this is very accurate. After

working a twelve hour day, arriving home at 7:30 p.m., making dinner, doing homework, helping children with homework it can easily be 11 p.m. or later until one sits down and relax from a days work. If one has to get up at 530 a.m. the next day for work the following day, there is very little time for a full nights rest. Unfortunately, with as many blessings of only having to work three days a week, comes the negative side to working twelve hour or midnight shifts. There is clear evidence that nurses are at risk for making more errors with longer work shifts. They also have more needle stick and musculoskeletal injuries, drowsy driving, sleep deprivation and fatigue (Geiger-Brown & Trinkoff, 2010). Often times sleep deprivation has been compared to drunk driving because of how sleep deprivation has an effect on cognitive abilities. Nurses working 12.5 hours or more had twice the odds of drowsy driving and an MVC or near miss when compared with those working 8.5 hour shifts (Geiger-Brown & Trinkoff, 2010). Burnout and Patient Satisfaction

SLEEP DEPRIVATION AND SHIFT WORK Although most nurses think and believe that working three shifts a week is appealing, studies suggest that the truth behind it, is actually a higher percentage of nurse burnout. Increases in

shift length were associated with significant increases in the odds of burnout, job dissatisfaction, and intention to leave the job. The odds of burnout and job dissatisfaction were up to two and a half times higher for nurses who worked longer shifts than for nurses who worked shifts of 8-9 hours (Witkoski Stimpfel, Sloane, & Aiken, 2012, p. 2506). Although patients receive more continuity of care when nurses work twelve hour shifts, studies show that patients are less satisfied with the care of nurses that work longer shifts. In one study, larger percentages of the patients in the hospitals with the more nurses working the longest shifts reported that nurses sometimes or never communicated well; pain was sometimes or never well controlled; and they sometimes or never received help as soon as they wanted. For many patient outcomes, dissatisfaction decreased as the proportion of nurses working shifts of 89 hours or 10-11 hours increased (Witkoski Stimpfel, Sloane, & Aiken, 2012, p. 2506). For this reason, it is important that nurses can engage in healthy sleep behaviors and promote these behaviors to their colleagues. Promoting Adequate Sleep A little over two-thirds of the nurses participating in the Staff Nurse Fatigue and Patient Safety Study reported struggling to stay awake on duty, and 20 percent reported actually falling asleep on duty(Rogers, 2008). As nurses, we are very aware of what our patients need to do to accomplish healing; when it comes to our own health, we are not always as quick to admit when we need some rest. Nurses have the ability to put their own needs aside and focus on their patients, however, when nurses are working multiple twelve hour shifts, they are more likely to make mistakes and put their own health at risk. Getting enough rest is not only an important part

SLEEP DEPRIVATION AND SHIFT WORK to a professional nurses day, it is imperative to their health. By promoting healthy sleep practices in conjunction with healthy behaviors, nurses are able to care for themselves and their patients more efficiently and safely.

There are steps that can be taken to improve sleep. An article released from the Division of Sleep Medicine at Harvard Medical School listed twelve ways to improve sleep they included: Avoid Caffeine, Alcohol, Nicotine, and Other Chemicals that Interfere with Sleep Turn Your Bedroom into a Sleep-Inducing Environment Establish a Soothing Pre-Sleep Routine Go to Sleep When Youre Truly Tired Dont Be a Nighttime Clock-Watcher Use Light to Your Advantage Keep Your Internal Clock Set with a Consistent Sleep Schedule Nap EarlyOr Not at All Lighten Up on Evening Meals Balance Fluid Intake - keep hydrated Exercise Early Follow Through-stick with the plan

These tips listed above can help nurses even if they do work odd shifts because it helps establish a routine. In addition to developing a healthy sleep routine, some believe there should be an open dialogue in the workplace regarding this issue. Exchange ideas with your colleagues on ways to cope with the problems of shift work. Set up a support group at work so that you can discuss these issues and learn from each other (National Sleep Foundation, 2013). Learning from each other could prove to be a valuable tool. One tip that serves to be controversial is

SLEEP DEPRIVATION AND SHIFT WORK taking naps. There are some that feel that napping at work should be allowed, For some shift workers, napping is essential. It can be extremely effective at eliminating fatigue-related accidents and injuries and reducing workers compensation costs (National Sleep Foundation, 2013). This is a win-win for all; workers are rested and rejuvenated, patients receive better care, and the employer sees decreases in costs related to employee health. The article goes on to state

efforts to make workplace policies nap-friendly may soon gain popularity as the issue increases in global significance (National Sleep Foundation, 2013). Nurses work long shifts; if they can engage in quality sleep, many mistakes may be avoided and the nursing staff can become healthier. Along with regulating the amount of twelve hour shifts a nurse can work in a row; education seminars implemented on each unit would help to focus on how sleep deprivation and patient care are related. Teaching nurses about the restorative processes that take place when humans sleep and presenting statistics regarding health and safety that relies on that restorative process can leave an impact. For example, On average nurses reported having only 25.7 minutes break during their entire shift. Nurses working the longest hours were least likely to receive appropriate breaks (e.g., 10 minutes every 2 hours and a 30-minute meal period free of patient care responsibilities) (Rogers, 2008). Most nurses would not find this surprising however, the article goes on there is also a growing body of evidence that sleep duration is (1) linked to metabolism and the regulation of appetite, and (2) decreased sleep times may be a contributing factor to the growing epidemic of obesity in this country (Rogers, 2008). This may be surprising to nurses - how many times have you heard a staff member state that they are just not able to lose weight? This among other disease processes are linked to inadequate rest and sleep. Healthy eating habits and staying hydrated are also important for ones body to function properly. Lack of sleep creates a vicious cycle the more

SLEEP DEPRIVATION AND SHIFT WORK tired you are, the more caffeine youll consume to stay awake during the day; but the more caffeine you consume, the harder itll be to fall asleep at night (National Sleep Foundation,

2013). Caffeine seems to be a favorite when it comes to helping people stay awake, short term it is helpful, however, it can hinder good sleep and restorative practices in the long term which can disrupt sleep patterns further. Not only does caffeine effect sleep, but fatigue itself can produce false feelings of hunger, the psychological manifestations of fatigue, sleep and hunger are similar. Thus, when youre feeling sleepy you might feel like you need to head for the fridge instead of bed (National Sleep Foundation, 2013). These are issues that nurses need to be educated on, in order to be an excellent nurse, the nurse must also be a role model to their patients. They need to take care of themselves and put their health first. Conclusion Although the continuity of care by limiting patients to two nurses every twenty-four hours and only working three shifts a week to a nurse seem appealing, study suggest otherwise. Patients tend to be less satisfied and nurses tend to be more burned-out. A way to limit excessive burnout is, to reduce error-producing fatigue, state regulatory bodies should prohibit nursing staff from providing patient care in any combination of scheduled shifts, mandatory overtime or voluntary overtime in excess of 12 hours in any given 24-hour period and in excess of 60 hours in any given 7-day period (Stokowski, 2004). Education and promoting adequate sleep measures are very important. If nurses learn to take care of themselves as well as they do the patients, peaceful nights sleep will be acquired. Promoting adequate breaks and opportunity during the shift for hydration is a great way a hospital could promote nurse health and safety. Learning a night time routine, taking a long hot

SLEEP DEPRIVATION AND SHIFT WORK bath, easing up on caffeine, eating lighter meals in the evening and creating a regular bedtime schedule are events each individual can do to promote better sleep.

SLEEP DEPRIVATION AND SHIFT WORK References

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Geiger-Brown, J., & Trinkoff, A. M. (2010, March). Is it time to pull the plug on 12-hour shifts?: Part 1. The evidence. The Journal of Nursing Administration, 40(3), 100-102. http://dx.doi.org/10.1097/NNA.0b013e3181d0414e Harvard Medical School. (2007, December 18). Twelve Simple Tips to Improve Your Sleep. In http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips. Retrieved October 29, 2013 National Sleep Foundation. (2013). Shift Work and Sleep. In National Sleep Foundation. Retrieved October 30, 2013 Rogers AE. The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 40. Sleep-deprived nurses may struggle to remain viligant during 12-hour shifts. (2010). Retrieved from http://www.sciencedaily.com/releases/2010/06/ 100608091850.htm

Stokowski, L. A. (2004, June 16). A wake-up call for nurses: sleep loss, safety, and health. Medscape Nurses. Retrieved from http://www.medscape.org/viewarticle/481189 Witkoski Stimpfel, A., Sloane, D. M., & Aiken, L. H. (2012, November 5). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2507. http://dx.doi.org/10.1377/hithaff.2011.1377