I wanted to express thanks to the staff at Advance for your series of articles in this weeks publication that focused on night shift nurses. I have been a night shift nurse for the past 20 years and I find myself increasingly disturbed by the lack of acknowledgment, intentional or not, that the night shift receives. Recently, at my institution, there has been a lot of debate regarding the night shift. I was hoping maybe your magazine might be of assistance in helping solve our dilemma.
I would like to know what the general population of night shift nurses does on their break when and if they get one. I would like to know why there is such a large debate over the night shift using their break to take a nap. Other professions, such as doctors, police officers, and firefighters who work at night, are given break rooms where they are encouraged to take a nap on their break. Is this the case because they are predominantly a male saturated profession? Are nurses forbidden to take a nap on their break because we are predominantly a female saturated profession?
In recent months, there has been much research about the effects of night shift on health. The increase of breast cancer, prostate cancer and heart disease has been published in highly respected medical journals. I would like to know why we work in a health care system, yet we do not focus on ways to improve our own health. The national sleep foundation recently sponsored a month dedicated to the prevention of driving drowsy. I know many health care workers who have been involved in serious motor vehicle accidents because they worked all night long without a break.
I was wondering if you could poll the areas nurses to see which hospitals encourage their staff to nap on their break and which forbid it? I was wondering if you could poll the night shift to see how many nurses fell asleep while driving or made a med error because they were exhausted. I would like to point out that it is not normal to stay awake at night and if every night shift nurse who experienced difficulty staying awake at night left to go to days-there would be no night shift left. I would also like to know if you could find out the routine of other hospital as far as night shift breaks go. Federal labor laws require a 15minute break every 4 hours. Most hospitals allow for a 30 minute meal break in the course of your shift. This totals 1 hour and 15 minutes for those nurse who work a 12 hour shift. Is it acceptable, by labor board rules, to combine your time and take 1 hour and 15 minutes as a lump sum? What are other peoples thought on this subject?
It occurs to me, that the day shift has the ability to leave the hospital for lunch or go outside walking when they have break time. This does not afford the other staff members the option of calling the breaking nurse off her break for an emergency. This practice is probably ok for the day shift when there is physically more staff available. It is also normal to eat and exercise during the day, so it is enjoyable and relaxing for the day shift to engage in these activities on their break. They can come back to their unit feeling refreshed and ready to be a productive member of the health care team. However, nights are a whole other ball game. People don't normally eat or exercise at night. They normally sleep. Therefore encouraging the night staff to utilize a desolate cafeteria or walk laps around the first floor of a practically abandoned building is not going provide the level of refreshment a nurse needs to properly and productively care for his/her patients. The other issue involves the accessibility of the staff. If a night shift nurse is given a place to lay down on her break which is close to the unit, they are easily accessible in case of an emergency. If a nurse is forced to leave the building and take a break in his or her car, it is unsafe, for both the nurse and the unit. The nurse would never hear a code blue being called out in a parking lot, and with a skeleton crew on at night, every member of the staff is needed.
I have encountered the opinion of nursing administration that the night staff (on a 12 hour shift) should be taking half of their break around 10pm and the other half of their break around 5am. This practice seems appropriate by day staff standards because that is what the day staff finds suitable for their shift. When working a night shift, we need to focus on the activities of the unit. Most patients are awake between the hours of 10pm and 1am. They are looking for their nurse to reassure them that they are safe and take care of the evening routine. Then they wake up at 5am and want a nurse readily available to assist with a bath or get them ready for the activities of the day. Most patients will sleep from 1am to 5am. It appears logical that this would be an appropriate time for a nurse to take a break. If there are 4 nurses working on your unit, each could utilize their 1 hour and 15 minute break without causing disruption to the unit routine. We do not work in a 24 hour factory where schedules should be set in stone. We care for human beings whose needs are always our number one priority. I don’t know of any nurse who would tell her patient “I’m sorry, I will change your dressing 2am because I need to go to dinner right now” What would that do for a Press Gainy survey? Night shift nurses need to be resourceful. It only makes sense to me, that the practice of encouraging the night shift to take a nap on their break makes the best use of the occasional down time that occurs at night without taking away from patient care and allowing the staff to more productive with their patients. Please keep in mind, patients need their rest and if a nurse has to juggle break time at 10pm the patients will need to be woken up at 3am for care. That makes for a patient who will be very cranky the next day
This seems to be a topic of embarrassment, because nurses do not want people to think of them as lazy. They do not want their patients to think they were asleep on the job. Wouldn’t it be more beneficial to provide a comfortable place for a nurse to take a private rest time, behind a closed door, where they could meditate and rest, come back refreshed to finish their shift? Or, would you rather have a nurse sit wearily at the desk at 3am, drooling on a chart, and not able to formulate a cognitive sentence when they pass meds at 6am? Nurses should not be embarrassed by the natural instinct to follow circadian rhythm and proven measures to combat the fatigue and detrimental outcome that has plagued night shift workers for years.
Nurses, like any other profession, should be encouraged to take their allotted break time. There is a reason the labor board instituted the labor laws that mandated breaks in the first place. As members of the 21st century, we should be knowledgeable in the areas of employee satisfaction and strategies that have been proven to boost productivity and a safe work environment. To ban a practice that has been proven through scientific research to benefit people both physically and mentally seems to be bordering on ignorance. Nurses have long been famous for the” martyr effect”. They forgo caring for themselves because other people need their help. That is the personality trait of most nurses. I think our profession can only blossom if we act like professionals and practice what we preach. Would you really feel comfortable accepting a medication from a haggard looking exhausted nurse? Wouldn’t the public be happier in knowing that our health care system is investigated ways to raise the safety standards of our hospitals?
Thank you for your nurse focused articles, and I would appreciate if you could let me know where you stand on this topic. Our hospital is investigating this topic this month with a decision being made at the end of the month. If you have any suggestions that might help us come to middle ground, I would truly appreciate it.
A Night Shift Nurse from Long Island