Promote proper sleep among nurses

Nurse Leader Insider, January 25, 2018

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By Jennifer Thew, RN
Originally appeared in HealthLeaders Media

I have worked my fair share of night shifts—8 hours, 12 hours, and 9 p.m. to 6 a.m. In the late-90s, I even worked a rotating schedule that consisted of alternating one month of night shifts with one month of day shifts.

For me, the most difficult schedule to adjust to was working two 12-hour night shifts on Friday and Saturday. You would think that having the rest of the week off would have made it easy, but just as my body recalibrated to a daytime schedule, I would get knocked off course again by those night shifts.

I was tired. I got headaches. More than once, as I was driving home, I realized the last thing I remembered was pulling out of the hospital parking garage. I had driven about 30 miles without being aware of my surroundings.

I'm not the only nurse who has ever felt the ill-effects of shift work. The American Academy of Nursing understands this, too. To support safe nursing practice and patient care, the organization recently released a position statement on nurse fatigue advocating for policies and practices that promote adequate, high-quality sleep among nurses. 
Shift Work Risks

In a 2014 article on the risks of shift work and long hours published in the journal Rehabilitation Nursing, its reported that in 2007, 32% of healthcare workers said they got six hours or less of sleep a day. When compared to day shifts, risks for error are 15% higher for evening shifts and 28% higher for night shifts. By the third consecutive night shift, risk increased by 17%, and 36% by the fourth consecutive night.

Night-shift workers can also experience ill-health effects. Data from the decadeslong Nurses' Health Study found that 11% who worked rotating night shifts for more than six years experienced a shortened lifespan. Those who worked rotating night shifts for six to 14 years had a 19% increase in risk of death from cardiovascular disease. Working rotating night shifts for more than 15 years increased CVD risk by 23%. 

Lastly, in a 2011 American Nurses Association survey, one in 10 nurses reported a motor vehicle crash they believed was related to fatigue or shift work.

Call to Action

The nature of healthcare requires night shifts for the care of patients—so no one is advocating that night shifts be abolished—but there are ways to make shift work healthier and safer for nurses and patients.

In its position statement, the American Nurses Association recommends the following actions:


  • Healthcare organizations and nurses must educate themselves on the health risks linked to shift work and long work hours, including evidence-based strategies to reduce those risks.
  • Healthcare organizations should use evidence-based practices when designing employees' work schedules and establish policies, programs, practices, and systems to promote sleep health and an alert workforce.
  • The workplace culture should promote employees' sleep health to achieve optimum functioning, health, safety, and sense of well-being.
  • Leadership must recognize the role that shift work, long shifts, and nurse fatigue have on turnover, absenteeism, patient safety, and related costs.
  • To relay evidence-based personal practices and workplace interventions to maximize sleep health and alertness among nurses, experts must develop continuing education courses for nurses and nurse managers.

Resources to support these actions include The National Institute for Occupational Safety and Health's Training for Nurses on Shift Work and Long Work Hours, and the American Nurses Association's Healthy Nurse, Healthy Nation information on healthy sleep and fatigue. 

"The academy is pleased to publish this important statement on reducing fatigue in nurses," says Karen Cox, PhD, RN, FACHE, FAAN, the academy's president in a news release. "Many healthcare organizations may not fully understand the health risks for both nurses and their patients from a tired workforce."

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