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