The issue of night shift and nurses’ health is a very broad one but also very serious. Every week, another study tells us about the negative effects of working the night shift on health—cancer, diabetes, obesity. Recognizing that nursing is a 24-hour business and that we can’t do away with night shifts entirely, what else should we be doing to protect the health of nurses when we are asking them to risk their own health by working the night shift to take care of patients?
Dr Cipriano: We recently put out a position statement on nurse fatigue, and it includes some key points. One is that it’s always been important to make sure that when nurses are scheduled for rotating shifts, that there is an adequate recovery period. Employers are asked to ensure at least 10 consecutive hours per day of protected time off duty for nurses to obtain at least 7-9 hours of sleep. We know from all of the research done on all of the 24/7 occupations that there is a disruption of circadian rhythms when working nights. We have more research on nurses’ health, thanks to the Nurses’ Health Study, so we have been able to track the impact of working nights, to some extent.
My sense is that the same health issues are seen with other types of workers, but we don’t have as much data on those groups. In addition to adequate recovery time after a night shift, we need to make sure that nurses are looking after their overall health and levels of fatigue and getting sufficient rest, making sure that as they plan their schedules, they are able to have adequate sleep periods and, when they are on the job, that they are able to take their breaks and meal breaks.
In the old days, when there used to be permanent night and evening shifts, people could acclimate to working at those times. Current data show that 36% of all nurses work 8-hour shifts, 19% work 10-hour shifts, and 27% work 12-hour shifts. The 2014-2015 ANA health risk appraisal data are consistent with these results. Hospitals tend to use 12-hour shifts as a conventional scheduling pattern, so nurses are typically working only 3 shifts weekly of 12-hour days or nights, but they are still switching back to a daytime schedule on their days off.
Most nurses would prefer to rotate than to work exclusively night shifts, so they are still switching around. If nurses were willing to look at the positive health benefits of more consistency, that could make a difference, but what we continue to see is that most nurses don’t like to work nights. We are in conflict with our inherent nature of wanting to operate in a daytime world, which is the way most people and families exist, but we need to recognize that there is a trade-off. The most important thing is to make sure that we have reasonable, appropriate scheduling and rest periods and that nurses are able to adhere to those.
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