Practice Matters

Surviving the night shift

night shift nurse survive sleep tired cancer awake

Early in my nursing career, I rotated shifts—from days to evenings and then to a 2-week schedule of nights. One of my most eye-opening experiences (literally) came one night when I awoke to find myself standing with my forehead planted squarely on the medication closet door. I’d been asleep for only a few minutes, but it scared me witless.

Catching those ZZZs
Dozing on the job is one of the major downsides of working the night shift. Studies examining the effects of night-shift work have concluded that many nurses and other night-shift workers suffer sleep deprivation or sleep disturbances. As we all know, sleep deprivation can impair psychomotor performance and skills—and that can be a prescription for errors.
Sleep patterns are influenced by the body’s circadian rhythm, which also affects temperature regulation, appetite, and hormonal secretion. When the circadian rhythm follows its natural course, the sleep cycle settles into a pattern, and you find yourself either that cheery morning person or a night owl with a nocturnal bent.

But interruptions in the circadian rhythm may disturb the delicate ebb and flow between health and illness. Consequently, working the night shift may increase the risk of:
•    heartburn and indigestion
•    fatigue
•    menstrual irregularities
•    colds and flu
•    heart disease and hypertension
•    weight gain
•    workplace and motor vehicle accidents
•    emotional disturbances, such as moodiness or depression.

Can the night shift cause cancer?
A recent study commissioned by the World Health Organization’s International Agency for Research on Cancer found a link between night-shift work and cancer development. Evidence also shows a higher breast-cancer incidence in female night-shift nurses. From this data, some experts conclude that shift work disrupting the circadian rhythm probably is carcinogenic—partly from suppressed production of melatonin. A hormone produced in the pineal gland, melatonin is thought to regulate circadian rhythm and promote sleep.

“I love the night life”
Given the drawbacks of working the night shift, why on earth do so many nurses prefer it? For many, it allows more quality time with their children. They get home from work in time to put their kids on the school bus; after grabbing some sleep, they wake up in time to greet their kids when they return from school in the afternoon.
Money is a major incentive, too. Many facilities offer shift differential pay that can make night-shift work more lucrative.
For some nurses, another plus is being removed from the politics of the day shift. Other benefits include easier commuting and having free time during the day to engage in activities not available during evening hours.

It’s been a long day’s night
Let’s say you work nights. After a busy shift, you finally get home and slip under the bed covers. The house is quiet, and at long last you’re free to give up the battle with your weary eyelids.


But the rest of the world—most importantly, your neighbors and their barking dogs—care little about your need for sleep. And when you’re trying to sleep, background noise can be deafening.

Add to this your clueless friends and relatives who can’t seem to understand that you need to sleep during the day because you work at night. My first inclination is to suggest you call them up in the middle of the night and ask, “What’s new?” On second thought, ignore that advice. Instead, read up on how to enhance your ability to sleep. (See Sleeping more soundly below.)

Sleeping more soundly

A quiet, cool, dark environment is optimal for sleep. Here are some ways to help achieve it:

•    Invest in a “white noise” machine. This device combines all sound frequencies, absorbing other sounds and replacing what your brain hears with a more soothing sound.
•    Buy a natural sound machine or a sound conditioner, such as the type used for babies that mimics the maternal heartbeat. For adults, popular models mimic the sound of a soothing waterfall, the ocean’s roar, or chirping birds. These devices don’t absorb surrounding sounds as much as provide another auditory focal point.
•    Wear ear plugs. Convenient and inexpensive, they quiet the environment around you.
•    Turn off the telephone ringer.
•    Use room-darkening window shades, or wear a sleep mask that eliminates light.
•    Turn your thermostat down. A cool room is more conducive to sleep than a warm room.
Less stress means more sleep
It’s hard to sleep when you’re tense. To help relax, try these strategies:
•    Avoid caffeine at least 3 hours before bedtime.
•    Create a relaxing bedtime ritual that helps your brain rest. Before bed, avoid watching TV, which stimulates your brain and can delay sleep onset.
•    Eat sleep-inducing foods about 1 hour before you go to bed. Foods that contain tryptophan, such as milk or a banana, help the body make serotonin, which can slow down the brain.
•    Avoid scheduling more than three night shifts in a row, to minimize hormonal disruption.
•    Try aromatherapy. Essential oils, such as lavender, chamomile, bergamot, or sandalwood, may help calm the nervous system.
•    Talk to your doctor about taking melatonin supplements, which some studies suggest promote sleep.
•    Finally, grab a nap whenever you can to catch up on much-needed sleep.

If you still have trouble sleeping after trying various techniques and you find yourself less than fully alert at work, try to rev up your body by walking briskly. Step out into the fresh night air or do a few jumping jacks. Also, stay hydrated with water or decaffeinated tea; avoid caffeine and sugary snacks.

Bypassing bias against night owls
Unfortunately, night-shift nurses may become invisible to hospital and nursing administrators, which ultimately may affect their job promotions and other professional opportunities. In some facilities, night nurses face discrimination from nurse colleagues and other healthcare workers who assume they’re less skilled than day-shift nurses. So if you’re seeking a lateral job change or a promotion, be aware that you might be up against an “out-of-sight, out-of-mind” mindset on the part of administrators.
To get around this disadvantage, find a way to make yourself more visible. Volunteer for a committee that meets during the day shift, write a clinical article, provide or assist with an educational in-service, or conduct a nursing research study on your unit. Here’s the point: Working the night shift isn’t a free pass or an excuse for letting your nursing career coast.

Overhauling your personal life
Maintaining relationships with family members and friends can be another serious challenge for night-shift nurses. If it’s been ages since you got together with friends, or if your kids barely recognize you, it’s time to overhaul your personal life. Consider ways to schedule these relationships into your day on a regular basis. For instance, volunteer at your child’s school. Meet a friend for lunch. Exercise your body and improve relationships at the same time by taking a walk with a friend. On your days off, try to maintain as normal a schedule as possible—one more that’s in tune with your family’s.

Eyes wide open
If you work the night shift, regularly examine the quality of your health, career, and personal life with your eyes wide open. I know that’s no easy task for a weary nurse whose eyelids feel like lead. Whether you work the night shift because you have to or because you want to, make the most of the advantages and diminish the drawbacks, so you can snooze during the day and breeze through the night.

Joan C. Borgatti is the owner of Borgatti Communications in Wellesley, Massachusetts, which provides writing, editing, and coaching services. Her website is www.joanborgatti.com.

Selected references
American Academy of Sleep Medicine. Night shift nurses more likely to have poor sleep habits. ScienceDaily. June 12, 2007. www.sciencedaily.com/releases/2007/06/070611074125.htm. Accessed August 6, 2008.

Hitti M. Night shift work may cause cancer. Studies suggest link between circadian rhythm disruption and cancer. WebMD. November 30, 2007. www.webmd.com/cancer/news/20071130/night_shift-work-may-cause-cancer. Accessed August 6, 2008.

Staif K, Baan R, Grosse Y, et al; WHO International Agency for Research on Cancer Monograph Working Group. Carcinogenicity of shift-work, painting, and fire-fighting. Lancet Oncol. 2007;8(12):1065-1066. www.thelancet.com/journals/lanonc/issue?issue_key=S1470-2045(07)X7082-7. Accessed August 6, 2008.
Visit www.AmericanNurseToday.com/journal for a complete list of selected references.

 

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