Sleepy Sleepy Nurse

MY EMERGENCY DEPARTMENT COLLEAGUES are a youngish group as a whole, compared to me, that is, and most of them have school-aged children. A subset of this group of have traded shifts so they’re substantially working a straight night shift line,* in order to attend to family obligations. Almost all of these, I think, are coming in exhausted. I’m not talking I-missed-an-hour-because-little-Tiffany-woke-me-up, but exhausted. Bagged. Corpses-are-livelier tired. Black circles under the eyes. Uncommunicative to the point of being catatonic. Most work a 12-hour night, go home, get the kids off to school, catch a couple of hours between tending to the ones still at home, cook lunch and dinner, clean house, what-have-you, and still come in for another night.

These nurses scare me a little. We all know about the health effects of working shift, and consistently getting fragmented sleep while on a two or three day run of nights probably isn’t the best for personal wellness. Studies of have linked shift work and poor sleeping patterns to higher levels of cancer and metabolic syndrome. But more importantly, what about the patients? On balance, nurses aren’t doing their patients any favours by coming in sleep-deprived.  One study suggests cognitive and psychomotor impairment correlates with sleep loss. Seventeen hours of wakefulness is the equivalent of having one or two drinks.  After 24 hours, the alcohol equivalent goes up to two or three drinks.To put it bluntly, who would think of going to work having a few drinks? But we do, clutching our Tim Horton’s coffee like a talisman. But then there’s also this: there’s good evidence sleep deprivation contributes to medication errors. For nurses who had poor/ interrupted sleep

the odds of reporting any accident or error were twice as high for rotators [i.e. day/night] as for day/evening nurses. Rotators had 2.5 times the odds of reporting near-miss accidents. After adjustment the effect of rotating on medication errors was reduced from 2.2 to 1.8.

Considering we work in a profession that depends on judgement, clarity of thought, decision-making, organization, information gathering and processing, and critical thinking in general, you might think we would be more concerned with the consequences of sleep deprivation. But we aren’t — we seemed to be trapped in a professional culture which tells us to suck it up, while demanding perfection at the same time — and neither, it seems, are our employers.

One last thought: I have to wonder, where are the spouses in all of this? I get that it is probably far easier for most nurses to arrange their schedules around their spouses as far as child care is concerned. But I think it also speaks volumes about the perceived value of nursing that the professional issues surrounding sleep deprivation — and nursing in general — are ranked rather lower than the spouses’ ability to juggle their schedules. We maybe haven’t come as far as we think.

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*In unionized Ontario hospitals, which is to say, the vast majority of hospitals in the province, nurses must be assigned 50% shift.

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  1. #1 by atyourcervix on Tuesday 06 March 2012 - 1324

    What is the solution though? We work in a place that is open 24/7, all year round. We have to have nurses taking care of the people at night time. Many night nurses I know would rather work straight nights, versus working a day/night rotation. I totally see their point of wanting to stick to just the night shifts — easier on the body, rather than flipping back and forth. But yet, we also have family obligations. I hated working straight nights, because I was always trying to catch up on my sleep during the daylight hours. I missed so many functions for my kids, while sleeping. It was so hard to find a good balance. I now work only evening shifts (8 hrs), and that seems to work best for me. I get enough sleep, plus get to see/do things with the kids.

  2. #2 by Jessica Ellis on Tuesday 06 March 2012 - 1407

    There are people that want to work straight nights, and some who wish to work straight days. Why do they persist in ruining health and endangering lives of nurses by forcing swing shifts?? Utter insanity! I would be exhausted doing that even if I didn’t have kids…

    Yet another indication of ignoring EVIDENCE (as in evidence-based practice) while putting patients and nurses at risk of serious consequences….

  3. #3 by Shahina Lakhani on Friday 09 March 2012 - 1143

    Another wonderful article! While it speaks about the dangers of shift work. There is also another very important issue and I quote,
    ” it also speaks volumes about the perceived value of nursing that the professional issues surrounding sleep deprivation — and nursing in general — are ranked rather lower than the spouses’ ability to juggle their schedules. We maybe haven’t come as far as we think.”

    Yes! women have not come as far as we think and nursing profession which mirrors the problems women are facing (even with more men coming in nursing), is a prime example. As women we have to wake up and understand women’s lib does not mean working ourselves to death. Instead it is about equal value. A woman’s life, her time, her work is as important as a man’s and we must share equal responsibility for the events and necessities in life. Women have always pulled more than their fair share of work, even before women’s lib. Its about time we recognize our own value and advocate for ourselves at home and outside of home.

  4. #4 by Sylvia on Monday 23 April 2012 - 2310

    ” it also speaks volumes about the perceived value of nursing that the professional issues surrounding sleep deprivation — and nursing in general — are ranked rather lower than the spouses’ ability to juggle their schedules. We maybe haven’t come as far as we think.”

    I agree to a point however, I work with many male nurses who juggle there schedule to take care of the kids whils the wife works another job. I tend to think it is generally a personal choice people make. I also know alot of husbands who are stay at home dads while the wife works full time.

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