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Nurses sleep less before a scheduled shift, hindering patient care and safety

Shift work takes a toll on circadian rhythms and can impair the performance of workers, data shows.

Jeff Lagasse, Associate Editor

Nurses sleep nearly an hour and a half less before work days compared to days off, which hurts patient care and safety, finds a new study by researchers at NYU Rory Meyers College of Nursing. The findings are published in Sleep Health, the journal of the National Sleep Foundation.

Nursing, especially in hospitals, is dominated by shift work, with nurses working outside of the traditional 9-to-5 day to be at the bedside around the clock. Shift work takes a toll on circadian rhythms and can impair the performance of workers, data shows.

In addition, 12-hour shifts are common and often result in unexpected overtime to finish patient care tasks or charting. Taken together with commute times and domestic responsibilities, nurses often have limited time to sleep before or between shifts.


Sleep deprivation hurts workers' ability to handle complex and stressful tasks, and work-related sleep loss has led to serious errors in other industries, with the nuclear meltdown at Chernobyl as a particularly devastating example, according to the study. In healthcare, fatigued nurses may be a risk for making critical mistakes in administering medication or making clinical decisions.

To better understand nurses' sleep behaviors and patient outcomes, researchers studied sleep duration and work characteristics among registered nurses to determine whether sleep duration influences quality of care and patient safety. They used data from two surveys of 1,568 nurses collected in 2015 and 2016.

The nurses were asked how much sleep they usually get, including naps, in the 24 hours prior to a scheduled shift, as well as how much sleep they usually get when they are not scheduled to work. They were also asked about the quality of patient care in their workplace. Patient safety was measured using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture.

Nurses reported getting, on average, just under 7 hours of sleep prior to a work day and more than 8 hours prior to a non-work day. The difference in sleep duration between work and non-work days was 83 minutes, or nearly an hour and a half less sleep before a work shift.

Getting less sleep was also associated with lower measures of patient safety and quality of care, a finding that may indicate several underlying issues. At the individual level, nurses who are sleeping less may be more fatigued at work, which may result in performance impairments.

At the organizational level, if nurses are working in an environment that has frequent staffing shortages or high turnover resulting in unexpected overtime and long hours, patient safety may be compromised in part by tired, overworked nurses.

The researchers note that more research on nurses' sleep is needed, but in the interim, healthcare leaders can use evidence-based scheduling strategies, limit the use of overtime, and provide professional development on the importance of sleep for nurses.


Overall, nurses are feeling more burnt out, which can impact patients and significantly influence the retention of nurses in the healthcare setting.

A recent commentary by Connie M. Ulrich, PhD, RN, the Lillian S. Brunner chair in medical and surgical nursing and professor of bioethics and nursing, explores the effects of ethical issues faced by nurses in practice and -- how moral distress may play a larger role in the loss of nurses and clinicians in the workplace.

This so-called "moral distress," she contends, may in some ways be inevitable. Meeting the healthcare needs of a diverse group of patients can be ethically complicated, and it's this tangled ethical picture that can exacerbate stress.

Moral distress results from managing the complex ethical issues in healthcare practice and patient care. Those morally stressful situations can make nurses feel unable to provide the care they think is best based on their professional standards of practice and their values.

Such daily decisions may be emotionally laden, and are often made in challenging circumstances. There may be pressure from patients and families, burden from chronic understaffing, complicated organizational structures and hierarchies, system inefficiencies that shift attention away from patients, insurance or institutional policies that limit options, differences of opinion about appropriate care, and breakdowns in communication with interprofessional colleagues and administrators.

Twitter: @JELagasse

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