Whitney L. O’Reilly and Professor Catherine Coverston, Nursing
The current state of health care in America presents some difficult problems with its increased need for nurses along with a significant nursing shortage. There is an approaching aging baby-boomer population along with an aging nurse population resulting in increased nurse workloads and fewer nurses to manage them. Many nurses work longer hours with more patients and pick up extra shifts to make up for the decreased employees. Their sleep is what suffers. As a young nursing student, I began to see and experience for myself the effects of fatigue on nursing care during long 12-hour shifts. I became incredulous whether this was the best schedule for nurses trying to give optimal care, and also whether the existing shifts were aligned with current medical research on the effects of sleep deprivation on mental clarity.
I completed an extensive literature review on the effects of sleep deprivation, particularly regarding cognitive impairment as well as other critical factors related to nursing care. Many studies have been done on the physiological detriments of sleep deprivation, most acutely pertaining to decreased mental clarity and cognitive function. Impairments due to sleep deprivation include slower reaction times, decreased ability to perform fine psychomotor skills, decreased ability to calculate and multitask, mood changes, cognitive changes, and memory problems. Most available studies on sleep deprivation have been done on medical students’ short-term total sleep deprivation. Little direct connection has been made to this point regarding the long-term sleep debt of nurses, and the subsequent errors made due to this chronic deficit. However, the current body of research is very conclusive that the long-term sleep debt of nurses takes a toll on cognitive ability and can therefore be correlated to nursing errors.
I first wanted to correlate the mistake records from hospitals with the research on the negative effects of sleep deprivation. However, I found the information from hospital records very difficult to find, if it was even released. I then decided to search public records of law cases, and found several examples of nursing mistakes made, often in the early hours of the morning. This correlation is not unique to nursing, and I found that in all areas of shift work, the critical errors are often made at this time of day. This furthered my research on shift work in general, and I found extensive studies on circadian rhythms, the sleep/wake rhythms of the body, and their influence on physical and mental fatigue. Through this research I made another connection: most current schedules of hospital nurses are not aligned with their natural body rhythm, which further influences their moderate but chronic sleep deprivation, and can exacerbate any medical problems they may have. Also, with age, the ability to handle shift work decreases, which further compromises the aging nurse population forced to work long, rotating and/or night shifts.
By examining the schedules of nurses, circadian rhythms, and the proven effects of chronic sleep deficit, I was able to conclude that nurses do not receive adequate sleep, and they therefore may be a danger to themselves as well as to their patients.
After finding that there is a conflict of nurse scheduling and medical research, I examined why this occurs. I found that there are many political and economic factors that influence the extensive work hours of nurses, who are already in a mentally and emotionally intensive occupation. This conflict involves such factors as the national nursing shortage, tightening hospital budgets, and the necessity of 24-hour care. After reviewing studies of the effects of shift work and the needs of circadian timing, I was able to recommend ways to alleviate this problem. My proposals for change include shift changes at times more aligned to the body’s circadian rhythm (i.e. 3 am and pm rather than 6 am and pm), 8-hour as opposed to 12-hour shifts, and forward, rather than backward rotating shifts (morning to evening instead of visa versa). I have also been in contact with researchers at Montana State University promoting naps (2 hr breaks) for nurses who work nights and/or excessively long shifts (12-16+ hours).
The mere change in mentality that 1) nurses should not be expected to perform on inadequate sleep, 2) nurses, like physicians, should be allowed a time and place to rest and 3) that sleep should be considered a necessity rather than a firing offense, would be a huge step in the right direction. Although my recommendations perhaps do not completely eliminate the risk of sleep debt for nurses, they may decrease the potential problems that may occur, including the health risks of nurses, and the safety of the patients in their hands.
After completing my research, I have learned a great deal about the complexities of the nursing profession, the reality of the danger involved with current nurse scheduling and the pathways needed to make change in our society. As a nurse I will be more aware of the needs of the body and mind in order to give optimal care, and I will take my research experience to further promote and pursue research in this area. I have already expounded my research in this area by completing qualitative studies of nurses in Argentina on 24-hour shifts, which I also plan to publish.
Much more research could be done regarding the risks of moderate long-term sleep deprivation as well as the ways to remedy and/or mitigate the risks while still caring for a 24-hour patient population. I will also pursue legal change in this area by first publishing this research in associated nursing journals and then by seeking the consideration of policy-making bodies to review this very real problem. I feel this research has been a vital part of my growth in my undergraduate career and I am motivated to further my education and attempts to promote positive changes in our society as I attend law school next year.