In many settings, patients receive nursing care on a 24-hour basis. This means nursing staff must work various shifts. Some nurses tolerate shift work better than others. For most shift workers, symptoms aren’t debilitating. Nevertheless, fatigue caused by long hours, shift rotations, night shifts, or a combination may jeopardize patient safety by contributing to medical errors.
To address this issue, ANA has developed several position statements:
• Assuring Patient Safety: Registered Nurses’ Responsibility in All Roles and Settings to Guard Against Working When Fatigued
• Assuring Patient Safety: The Employers’ Role in Promoting Healthy Work Hours for Registered Nurses in All Roles And Settings
• Opposition to Mandatory Overtime
• Risk and Responsibility in Providing Nursing Care.
ANA is now working on a research project with the National Institute of Occupational Safety and Health (NIOSH) that includes development of a training program to aid nurses adjusting to shift work.
Negative effects
An occupational hazard for nurses, shift work has well-documented detrimental effects on health. It has been associated with cardiovascular disease, GI disorders, breast cancer risk, reproductive dysfunction, oxidative stress, common infections, and psychosocial disruptions. Additionally, it may exacerbate chronic medical conditions, such as heart disease, diabetes mellitus, epilepsy, sleep disorders and psychiatric disorders, and may impede the effects of antihypertensive and asthma drugs. The negative effects of shift work arise primarily from circadian rhythm disruption, sleep deprivation, and impaired melatonin production.
Reports of fatigue-related motor vehicle accidents involving sleep-deprived persons show sleep deprivation resulting from shift work is a public health concern. According to the National Sleep Foundation, sleep-related crashes are most common in young people, adults with children, and shift workers. In ANA’s 2001 Health & Safety Survey, which polled 4,826 nurses, more than 1 in 10 nurses (11.3%) said they had been involved in a motor vehicle accident as a result of fatigue or shift work. In 2006, researchers found similarities between fatigue-related impairments in neurocognitive and physiologic functioning and alcohol intoxication impairments.
Many individual, social, and work-environment factors affect how a person tolerates shift work. Individual factors include age, sleep habits, temperament, medical conditions, and physical fitness. Social factors include socioeconomic status, secondary employment, commuting time and transportation options, hobbies, marital status, and dependents. Work-environment factors include physical and mental stress, workload, job satisfaction, eating facilities, work schedules and shifts, and overtime.
Countermeasures
Shift workers can help adjust to their schedules by avoiding caffeine, nicotine, and alcohol intake for at least 5 hours before bedtime. Also, maintain proper dietary and exercise habits. During the night shift and before bed, avoid hard-to-digest foods.
Routines, such as cleaning up, bathing, and changing clothes, before bedtime may help shift workers relax and prepare for sleep. To create an environment conducive to sleep, use window blinds that block sunlight, block out noise, maintain a cool bedroom temperature, and avoid watching TV. Also, teach family and friends not to disturb you while you’re sleeping.
To prevent falling asleep at the wheel, recognize symptoms that you aren’t alert enough to drive safely—difficulty focusing your vision, frequent blinking or yawning, missing exits or traffic signs, drifting from the lane, and feeling restless and irritable. If these occur, immediately pull off the road and take a nap for 15 to 20 minutes. Better yet, if you feel sleepy, don’t drive; instead, get a ride from a family member or friend, call a cab, or find a place to sleep at work.
Nurses’ shift work and the resulting fatigue can’t be avoided. But you can and must take steps to prevent the negative effects of fatigue secondary to shift work. Avoiding the effects of sleep deprivation protects the health of nurses, patients, and the community.
Visit www.AmericanNurseToday.com/journal for a list of selected references.
Katie Slavin is a Senior Staff Specialist in ANA’s Center for Occupational and Environmental Health.
