Performance and sleepiness in nurses working 12-h day shifts or night shifts in a community hospital

Oct 9, 2017Accident; analysis and prevention

Performance and tiredness in nurses working 12-hour day versus night shifts in a community hospital

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Nurses working night shifts exhibited more performance variability and increased subjective sleepiness compared to those on day shifts.

Average daily sleep duration for both day and night shift nurses was 7.1 hours.
Objective performance on a reaction time test remained stable for day shift workers but declined for night shift workers over the course of shifts.
Night shift workers showed greater variability in performance compared to day shift workers.
Subjective sleepiness levels were higher for night shift workers on a sleepiness scale.
There was poor alignment between objective measures of fatigue and subjective reports.

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Hospitals are around-the-clock operations and nurses are required to care for patients night and day. The nursing shortage and desire for a more balanced work-to-home life has popularized 12-h shifts for nurses. The present study investigated sleep/wake cycles and fatigue levels in 22 nurses working 12-h shifts, comparing day versus night shifts. Nurses (11day shift and 11 night shift) were recruited from a suburban acute-care medical center. Participants wore a wrist activity monitor and kept a diary to track their sleep/wake cycles for 2 weeks. They also completed a fatigue test battery, which included the Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale (KSS), at the beginning, middle and end of 4 duty shifts. Daily sleep duration was 7.1h on average. No overall difference in mean daily sleep duration was found between nurses working day shifts versus night shifts. Objective performance on the PVT remained relatively good and stable at the start, middle, and end of duty shifts in day shift workers, but gradually degraded across duty time in night shift workers. Compared to day shift workers, night shift workers also exhibited more performance variability among measurement days and between participants at each testing time point. The same pattern was observed for subjective sleepiness on the KSS. However, congruence between objective and subjective measures of fatigue was poor. Our findings suggest a need for organizations to evaluate practices and policies to mitigate the inevitable fatigue that occurs during long night shifts, in order to improve patient and healthcare worker safety. Examination of alternative shift lengths or sanctioned workplace napping may be strategies to consider.

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Performance and sleepiness in nurses working 12-h day shifts or night shifts in a community hospital

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