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Clinical Systems Leadership

Effects of the Night Shift on Nurses

Any prospective or current nurse should be aware of the time requirements of the job: And that includes working the night shift. Nursing staff know that at some point they will be asked to work the night shift; even if they are regulars on the day shift, it’s likely nurses will be asked to stay on call overnight on at least a couple occasions; a good number of nurses may even prefer working the night shift. The point is, working nights is an accepted condition of the job at different points in a nurse’s career, and while many understand the demands of this situation, there are real effects on well-being that overnight/early morning work schedules may lead to.

Ask any nurse about their experiences on the night shift and they’ll be sure to have a few bleary-eyed tales of dazed 4 a.m. code blues or difficulty focusing. In this way, nurses are easily able to relate how they’ve personally felt on the night shift, and often find agreement in their colleagues when expressing feelings of anxiousness, haziness and exhaustion. But there are also an increasing number of studies that have examined the science behind the impacts to nurses’ psyches and bodies that the night shift may portend. The results have granted more insight into what the tangible effects of working night shifts are on nurses.

While the night shift may be an unavoidable and constant reality of the job, the strategy in limiting its negative effects is through gaining a better understanding of how the requirements of the night shift can influence nurses’ health and wellness, productivity, patient relations and personal lives.

Nurse tired from work.

Circadian rhythm disruptions lead to complications

Night workers often know the frazzled feeling they may be prone to when on long hours in the dark, and how it can lead to fatigue-induced mistakes and physically feeling sick. Most then think that the answer is simply to get more sleep. It doesn’t matter how much sleep one gets or doesn’t get, what matters is how the individual’s biological clock is synced with their circadian rhythm, and to what degree the two are on disparate tracks.

The circadian clock, according to the American Psychological Association (APA), is an internal timer that tells the body when to release hormones that regulate mood, attentiveness, motor skills and temperature, among many other aspects. Human brains and bodies have been conditioned to, essentially, power down at night, and then fire back into action when day breaks. This poses an obvious problem for nurses on the night shift.

It’s not just the night shift itself, but the irregularity of scheduling that causes unhealthy sleeping shifts in nurses that lead to circadian misalignments. Nurses often work 12-hr shifts on a rotation of days and nights, which means they are constantly changing their sleeping patterns. This behavior can lead to repeated issues with the essential biological functions that the circadian rhythm cues: It can take the body a week to adapt to a new sleeping schedule. A catch-22 then evolves, as not only do nurses get less sleep, but the quality of the sleep also declines.

When circadian rhythms are disrupted, chemical imbalances may lead to fatigue, inability to focus, impatience, mood swings and decreased motor function. A misaligned circadian rhythm may affect a nurse in any number of ways: the APA cited studies that found circadian disruptions led to lapses in judgment and impaired motor skills in medical workers, as well as the fact that health-care professionals were twice as likely to have an auto accident after working 24 hours straight compared to those on a shorter shift.

These ill effects can be felt along the spectrum of performance and personality, in the short term and in the long term. Being overtired can lead to the occurrence of easily preventable mistakes, such as administering incorrect doses of medicine to patients, which could result in significant health complications. It’s incumbent on nurses to understand the ways in which circadian disruptions may affect them.

Increased chances of developing diseases

An overarching risk associated with long-term circadian disruption is the greater incidence of disease. Constant and prolonged disruption of the sleep/wake cycle may make night shift workers more vulnerable to metabolic disorders. An academic article published in Endocrine Reviews stated that “Circadian misalignment increases blood pressure (particularly during sleep) and inflammatory markers, reverses cortisol rhythms, and reduces heart rate variability and insulin sensitivity in healthy adults.”

Cardiovascular disorders can manifest as a result of long-term circadian disruptions. This was shown in a large-scale study of nurses that was published in the Journal of the American Medical Association (JAMA) in early 2016. Researchers used data for some 189,000 initially healthy women available through the Nurses’ Health Study (NHS) and NHS2, and followed up with them over a 24-year period. The study defined exposure as working at least three night shifts a month, with day and evening shifts; and it found “increasing years of baseline rotating night shift work were associated with a significantly higher [congenital heart disease (CHD)] risk in both cohorts.” Of the NHS nurses (mean age 54 years) studied, 7,303 incidents of CHD were seen in the follow-up time, while 3,519 cases occurred in NHS2 nurses (mean age 35 years).

The finding that risks of CHD increase with each night shift logged was most visible in NHS2 nurses with less than five years of rotating night shift work. The study found that night shift nurses had a 12 percent higher risk of CHD than non-night shift nurses; those with five to nine years had a 19 percent higher risk, and those with 10-plus years had a 27 percent higher risk.

Risk of errors rises with fatigue

The most common characteristics of sleep deprivation—fatigue, reduced motor control, poor judgment and slow response times—can be harmless in some settings, like on the couch; but in a fast-paced environment these side effects of an out-of-sync circadian rhythm can constitute serious risks to patient and staff safety, care quality and delivery.

In a study published in 2014 by the Journal of Nursing Administration, 56 percent of the population of night-shift nurses studied were sleep-deprived; nearly half of the cohort had been working night shifts for more than five years. Sleep-deprived nurse were found to get just 3.9 hours of sleep on average, which was shown to affect their work quality: “[I]t was concluded that sleep-deprived nurses had a larger mean number of patient care errors than non-sleep-deprived nurses did.” The Joint Commission on Accreditation of Healthcare Organizations separately cited research showing risk of error increased threefold for working shifts of at least 12.5 hours, 39 percent of all shifts logged in the study.

Sleep deprivation can impact family, social life

Nurses who are no strangers to the night shift know that balancing family and professional life is hard enough. Factor in the adverse effects of sleep deprivation and the task can be overwhelming. The correlation between diminished social life and night shift work was examined in a Journal of Nursing Education and Practice (JNEP) publication from 2015.

In it, researchers sought to better gain insight into how nurses were affected by shift work while at home, and how they tried to cope with it. Responses to questions highlighted trends the study presented as themes of sleep deprivation, which included:

  • Sacrificing sleep for family, children or other responsibilities.
  • Trying to preserve relationships and marriage.
  • Feeling unable to socialize.
  • Juggling basic everyday needs, unable to care for children/parents/family as desired.

Woman with sleeping trouble.

Countering the effects of night shift work

When night shift work is unavoidable, it’s important to plan for it, develop coping mechanisms and to engage with supervisors and health system management on ways all stakeholders can help alleviate the burdens. Some of the strategies recommended in the JNEP study were: decompressing after work, exercising, planning ahead for social events and family time, and communicating sleep needs.

It’s critical for all nurses to understand what effect shift work may have on their bodies and their mentalities. Knowing what dangers are present is the first step to formulating strategies to combat them. Enrolling in the online RN-MSN program at the University of Arizona may help illuminate different ways of doing that.


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