AIM: This paper reports a review examining the concept of sleep and its antithesis of fatigue, and considers the evidence on nurses' ability to cope with the demands of continually changing hours of work, their safety, and the impact any manifestations of sleep disruption may have on the care of their patients. While many aspects of this paper may apply to nursing in general, special consideration is given to nurses in the critical care environment.
BACKGROUND: Night duty rotations are common practice in nursing, and particularly in specialist units. It is essential that nurses working in these environments are able to maintain careful and astute observation of their vulnerable patients, and concern arises when they may be unable to do so. Research suggests that fatigue can negatively affect nurses' health, quality of performance, safety and thus patient care, and that the effects of fatigue may be exacerbated for nurses over 40 years of age.
METHOD: The literature was examined for the 10-year period up to December 2003. The databases searched were Ovid, Proquest, Blackwell Science, EBSCO Online, Australian Health Review and WebSPIRS, using the keywords of, shiftwork, rosters, intensive care, fatigue, sleep deprivation and sleep studies.
FINDINGS: There is consensus amongst researchers on the adverse psychological and physiological effects of night rotations on nurses when compared with their permanent night duty peers, particularly for those over 40 years of age. Evidence also suggests that the effects of fatigue on nurse performance may negatively affect the quality of patient care.
CONCLUSIONS: The literature reinforces concerns about the adverse relationship between fatigue and performance in the workplace. Optimal standards for patient care may be difficult to achieve for more mature nurses, who may suffer from sleep deprivation and health problems associated with rotational night work and disrupted physiological rhythms.
