Sleep Quality and Vigilance Differ Among Inpatient Nurses Based on the Unit Setting and Shift Worked

Feb 14, 2014Journal of patient safety

Sleep Quality and Alertness Vary in Hospital Nurses by Unit Type and Work Shift

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Abstract

63% of inpatient nurses reported abnormal sleep quality as measured by the Pittsburgh Sleep Quality Index.

22% of nurses showed abnormal sleepiness according to the Epworth Sleepiness Scale.
33% of nurses reported abnormal fatigue levels based on the Fatigue Severity Scale.
ICU nurses had a higher incidence of abnormal sleep quality compared to floor nurses.
Night shift nurses used more sleep medication than their day shift counterparts.
Day-shift nurses exhibited faster reaction times in psychomotor vigilance tests compared to night-shift nurses.
ICU nurses working day shifts made more than twice as many errors and false starts compared to day shift floor nurses.

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OBJECTIVES: Sleepiness in nurses has been shown to impact patient care and safety. The objectives of this study are to measure sleep quality, sleepiness, fatigue, and vigilance in inpatient nurses and to assess how setting (intensive care unit versus the general floor) and shift worked (day versus night) affect these measures.

METHODS: Nurses from both the ICU and floor were included in the study. Participants completed questionnaires assessing self-reported sleep quality (Pittsburgh Sleep Quality Index, PSQI), sleepiness (Stanford Sleepiness Scale and Epworth Sleepiness Scale, ESS), and fatigue (Fatigue Severity Scale, FSS). Vigilance was measured by means of the psychomotor vigilance test (PVT), before and after a 12-hour duty shift.

RESULTS: The ESS was abnormal in 22% of all nurses, the FSS was abnormal in 33%, and the global PSQI was abnormal in 63%. More ICU nurses than floor nurses reported abnormal sleep quality (component 5) on the PSQI. Sleep medication use (PSQI component 6) was higher in night shift nurses. The FSS was greater in night shift nurses. On preshift PVT testing, day-shift nurses overall provided faster mean reaction time (RT) than night-shift nurses. ICU nurses working the day shift made more than twice as many total errors and false starts than day shift floor nurses. Floor nurses demonstrated a significant decrease from preshift to postshift in the mean of the fastest 10% RT.

CONCLUSIONS: Our data indicate that a significant number of inpatient nurses have impaired sleep quality, excessive sleepiness, and abnormal fatigue, which may place them at a greater risk of making medical errors and harming patients; these problems are especially pronounced in night shift workers. PVT results were inconsistent, but floor and day shift nurses performed better on some tasks than ICU and night shift nurses.

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Sleep Quality and Vigilance Differ Among Inpatient Nurses Based on the Unit Setting and Shift Worked

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