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From the Spring 2014 issue of Scrubs
There’s a lot of talk these days about how detrimental it is for hospital patients to have their sleep interrupted.
Given all we know about the health ramifications of short-changing sleep, it’s a topic that deserves discussion. But there’s another sleep issue with implications for patient welfare that’s not getting nearly enough attention, says sleep expert Ann E. Rogers, PhD, RN, FAAN. That’s nurse fatigue. Rogers, the Edith F. Honeycutt Chair in Nursing at Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta, says it’s a critically important issue because it affects the health and safety of nurses, their patients and the public.
The long hours (75 percent of nurses work a 12-hour shift), the rotating shifts, the propensity to work through breaks and the stress of the job create the perfect storm for sleep deficiency in nurses, says Rogers.
“Our studies show that nurses devote half their free hours sleeping. In other words, if you have 12 hours free between shifts, you sleep about six hours.” But who has 12 hours free between shifts? On average, nurses put in an extra 50 minutes after their shift officially ends, so the hours on duty are much closer to 13. Tack on the commute time (on average, about 25 minutes each way), do the math and you’ll find there’s not a lot of time left over for shut-eye. In fact, using Rogers’ formula, that leaves about 10½ hours of free time after a 12-hour shift, and that means well under six hours of sleep. Not enough when seven to nine is the recommended amount. On top of that, “Sleep loss is cumulative,” explains Rogers. “So nurses who work 12-hour shifts on consecutive days and are sleep deprived become more and more affected cognitively.”
On the face of it, the sensible solution would seem to be a return to the eight-hour shift, but as Rogers explains, that’s not likely to happen.
“Nurses like the 12-hour shift, and while they don’t like mandatory overtime, they don’t want any restrictions on their ability to work overtime.” One study showed that 80 percent of nurses are happy with current scheduling policies. Results from the same study, however, showed that levels of job dissatisfaction and burnout increase with an increase in the shift hours.
While the evidence clearly points out that the extended hours nurses work pose a threat to patient safety and to their own health, there are ways to mitigate some of those effects.
Most importantly, says Rogers, recognize your own limitations, make sleep a priority and don’t accept an extra shift when you should be catching up on sleep.
Some experts recommend abolishing the 12-hour shift. Where do you stand on extended work hours? Weigh in here!