Hospitals are a 24/7 business, but errors and on-the-job injuries both spike after hours, says Ann E. Rogers, PhD, RN, Edith F. Honeycutt chair of nursing and professor and director of graduate studies at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta.
“We know that during night shifts, no matter how well rested you and your colleagues are, everybody will experience some fatigue and may have to fight sleep. You simply are not as alert as you should be,” says Rogers, who researches the effects of sleep deprivation and shift work on nurses.
Even seasoned night shift workers can experience sleepiness while on the clock.
Acknowledging that working at night presents special challenges is an important first step toward supporting nightshift workers, says Rogers. She offers three steps management can take to help them.
1. Look for Signs of Fatigue
“All of us can hide the symptoms [of sleep deprivation] with coffee,” says Rogers. But being under the influence of caffeine only masks the symptoms of fatigue.
Caffeine doesn’t restore attention to detail, grant patience in the face of frustration, or improve coordination, which are all consequences of sleep deprivation.
Other signs of fatigue include slowed reaction time or responses, irritability, poor memory, lack of attention to detail, and excessive consumption of caffeinated beverages.
If a usually calm and collected worker shows signs of fatigue, it wouldn’t be out of line to ask him how he’s adjusting to working the night shift.
2. Tamp Down External Cues
Imagine a clinician wrapping up a 12-hour shift at the hospital to go home and get some rest, only to feel themselves suddenly perking up as they walk outside and are greeted by sunshine and bustling streets.
That wakefulness will likely persist once the worker is at home, lying in bed, desperately trying—and failing—to fall asleep.
Along with circadian rhythms, people rely on external cues to tell them when it’s time to get up, go to sleep, or eat meals. Even if a worker has been awake for a long time, it can be difficult to fall asleep after exposure to bright sunlight and street noise.
Rogers suggests encouraging shift workers to wear dark sunglasses on their way home from the hospital and discouraging caffeine use during the latter part of their shifts. She also advises that workers use earplugs to block out daytime noises and to hang dark curtains in their bedrooms if they need to sleep during daylight hours.
3. Set Rules for Shift Work
Even with environmental checks in place, it’s up to hospital managers and administrators to set rules that can protect workers and patients.
The first is to ensure proper scheduling so workers can get the proper amount of sleep, says Rogers. She has written that the likelihood of a clinician making an error can increase by as much as 36% after working 12-hour shifts on consecutive days.
“We know that workers only use half of their time off to sleep,” says Rogers. “If a nurse has 10 hours off, they will sleep for about five hours, which is not enough rest for anybody,” she says.
It’s also important to ensure shift workers take breaks. Because fewer restaurants and shops are open at night, many shift workers neglect taking lunches and scheduled breaks. Have clinician supervisors and managers encourage their reports to take their scheduled time off, and keep an eye out for workers who skip lunches or work through their breaks.
Additionally, most hospitals don’t allow workers to nap during breaks, says Rogers. She believes this policy is a missed opportunity. “Allowing a nurse to do that will encourage alertness for the rest of the night,” she says.
The night shift may not be the first choice for most healthcare workers, but by acknowledging its unique challenges, hospital administration can help keep workers awake, alert, and present in their jobs.