As any nurse knows, health crises don’t just conveniently fall into the nine-to-five parameters of a normal workday. They’re round the clock. So when it comes to nursing, the intense shift work and long, crazy hours aren’t optional; they’re part of the job description.
According to a 2006 study published by the National Library of Medicine:
- More than 25% of nurses surveyed worked 12 or more hours a day.
- About 33% worked more than 40 hours a week.
- More than 33% had worked six or more days in a row at least once within the previous six months.
- Almost 25% rotated shifts.
- 17% of all nurses worked mandatory overtime.
- Nearly 40% worked jobs with on-call requirements.
The statistics were even more alarming when factors like being a single parent or working multiple jobs were taken into consideration.
If you’re a nurse, these stats probably aren’t telling you anything you don’t already know. Less acknowledged, however, is that such intense working schedules have some serious ramifications—physically, mentally, and emotionally.
It probably goes without saying that the most serious effect that shift work has on nurses is sleep deprivation. National data from 2010 showed that over half of night-shift or rotating-shift healthcare workers got six or fewer hours of sleep each day. The National Sleep Foundation recommends a minimum of seven. You might feel as though you can power through, but studies have shown that, contrary to common misconceptions, your mind and body actually do not adjust to sleep deprivation, and sleep loss can manifest in countless ways that you might not be taking into consideration.
- Sleep deprivation can lower your cognitive functioning, slowing your response time, impairing your work performance, and causing you to make errors you might not have otherwise made. Your ability to judge your own performance also greatly diminishes.
- Because of your slower reaction time and cognitive function, your risk of injury from workplace mishaps increases with your fatigue level.
- Studies have shown that being awake for 17 hours straight is comparable to having a blood-alcohol level of 0.05%, and being awake for 24 hours straight is like having a blood alcohol level of 0.10%. That’s 0.02% higher than the legal driving limit. Driving while sleep-deprived causes 1 million accidents, 500,000 injuries, and 8,000 deaths annually in the United States. A 2010 survey conducted by the American Nurses Association showed that 10% of participants (1 out of 10!) had gotten into an accident as a result of shift work fatigue.
While sleep deprivation is a danger in its own right, the effects of long-term shift work and the subsequent loss of sleep can manifest in other significant health issues.
- Obesity: Not only has sleep deprivation been linked to changes in the hormones that control your hunger levels, but there are simply fewer options at 3 a.m. for healthy, balanced meals. And by the time you’ve worked 12 hours, you’re probably not thinking about whipping up a meal from scratch or hopping on the treadmill once you finally make it home.
- Unhealthy habits: Studies have also shown that there is a higher percentage of smokers among shift workers than non-shift workers, which can lead to numerous health conditions.
- Diseases: Multiple studies have shown that shift workers may be at a higher risk for various diseases and chronic physical conditions. These include:
- Cardiovascular disease
- Gastrointestinal problems
- Breast cancer
- Fertility and pregnancy issues
Certain conditions, according to Medical News Today, could be a result of disturbed circadian rhythms and the body’s inability to adjust to a constantly shifting environment (in this case, the hours of the day you work and sleep). Such disruptions to these natural rhythms have been linked to a decrease in melatonin production, which has subsequently been linked to a higher cancer risk. Interruptions to your circadian rhythms have also been shown to affect your blood pressure and cholesterol levels.
Your body isn’t the only thing that can be damaged by long work hours, changing schedules, and the effects of poor sleep—your relationships with your family and friends can also suffer.
Your exhaustion, as well as the demands of your schedule, can lead to a range of relationship-straining behaviors—from forgetting important dates to having a shortened temper. Research shows higher divorce rates and lower rates of marital satisfaction among night-shift workers.
The National Library of Medicine also published a study that showed a notable increase in depression, psychological issues, burnout, and dysphoria among shift work employees in comparison to daytime employees.
Steps to take
So, you may be wondering, what can we do about it? It’s unlikely that the need for long, strenuous working hours is going to lessen anytime soon. Nurses will always be needed 24/7/365.
Happily, there are steps you can take to improve both your sleeping and working hours and your overall quality of life.
Improving sleep quality
The most important thing to do to improve your sleep is simple: Create environmental conditions that promote sleep.
- A dark, quiet bedroom seems obvious, but for those of you who work nights and have to catch some shut-eye when the sun is at its peak (or if you live in an area with high levels of light and/or noise pollution) this can be challenging. Try some light-blocking shades for your windows or an eye mask. If you need a nightlight, try one with red tones and avoid white or blue light—that includes cell phones, tablets, televisions, and backlit clocks. To block out sound, your best friend may be noise-blocking earplugs or a white noise machine. Also, make sure to turn your phone to “do not disturb.” If you’re driving home during daylight hours, consider dark sunglasses. Bright light affects your circadian rhythms because your body is naturally inclined to stay awake when it detects daylight.
- Make comfort a priority. Set the thermostat so you’ll be comfortable without needing to get up and adjust it, and invest in quality bedding. Consider a warm bath before bed to fully relax your body and mind.
- Avoid spicy meals and too much liquid, which might contribute to your waking up in the middle of the night. Also, limit your alcohol intake. Although it might feel like alcohol makes you sleepier, it can actually harm your REM sleep and cause wakefulness. And let’s face it: no one wants to work 12 hours with a hangover.
- Try to set your body clock to wake up at the same time every day. If you need to catch up on sleep, going to bed early is better than sleeping in late.
- Exercise. A poll conducted by the National Sleep Foundation showed that those who exercise regularly sleep better. Even a 10-minute walk during your break will help. But be careful—exercising can also be energizing, so be sure not to exercise too close to bedtime. Three hours beforehand is ideal.
Staying awake on the clock
Getting to sleep is one thing. The flip side of the coin is staying awake as you round the halfway mark of that 12-hour shift.
- Seek out light. If you’re working a long shift and start to feel yourself wilting, try to go somewhere with bright lights. Bright lighting instigates a chain reaction so your circadian rhythm will wake you up by fooling your body into thinking it’s daytime.
- A cup of coffee at the beginning of your shift might be your lifeblood, especially if you didn’t sleep well or you’ve had a particularly busy week. And it’s perfectly acceptable to have your morning (or afternoon) cup of joe to wake you up. But be cautious about how late in the day you have it, as the caffeine that helps keep you on your feet can also make it difficult to fall asleep later. Also, be cautious of ingesting too much caffeine, as it can cause heart and nervous system problems. The Mayo Clinic writes that up to 400 milligrams a day seems to be a safe amount for most healthy adults, but not everyone has the same tolerance, so be aware of your body’s reactions. (Bear in mind, though, that a caffeinated beverage is no substitute for good sleep.)
- Take a nap. It may sound a little unconventional, but if your employer allows naps during breaks, research suggests it might actually be an ideal solution. The National Sleep Foundation says that a 20- to 30-minute nap can help improve alertness and performance. But make sure that after waking up, you let any grogginess pass before performing the important tasks. Longer naps (anything past an hour) can actually decrease alertness, so it’s best to keep break-room naps to a shorter duration.
Reducing overall risks
- Ask for help. If you’re feeling fatigued and are tasked with a challenging physical demand, like heavy lifting, ask for help from a colleague to reduce the chances of an on-the-job injury.
- Eat balanced meals (and save some of that well-deserved overtime pay) by packing lunch from home. Staying out of the cafeteria and away from fast food will reduce your chances of obesity. Try to eat three regular meals spaced throughout the day, and be consistent with your mealtimes. These serve as important cues for your body’s internal clock. Also, exercise when you can, even if it’s just a quick jaunt on your break. But prioritize when necessary, such as around bedtime—sleep first, exercise later.
- Post a shift schedule for your family so that they can keep track of when you’re available, when you’re working, and when you need to be sleeping. If you can, factor in some quality time with your family members, but make sure you communicate when you need rest, and rely on your nearest and dearest to be considerate of your needs during those times.
- Talk to your employer about your schedule. If you’re on a rotating schedule, it’s best for your body if you work clockwise—meaning your next shift doesn’t start earlier in the day than your last one. Your shift should be no more than 12 hours within a 24-hour period, and no more than 60 hours in a seven-day period. If possible, the best-case scenario would be to work a regular shift, but sometimes this isn’t feasible. However, it is in your employer’s best interest to work with you—studies show that workplace efficiency decreased by up to 15% when employees worked 60-hour workweeks. Working a shift schedule also makes you more likely to commit errors, require worker’s compensation for on-the-job accidents, or ultimately quit your job.
- Consult with your MD. If you’re having trouble sleeping, make an appointment with your doctor. Sleep is imperative to your wellbeing, and chronic sleep deprivation needs to be addressed to make sure you stay in good health. Also, be sure to keep up with your regular health screenings and touch base with your doctor about any symptoms of illness you may experience.
A word about sleep aids and stimulants
Stimulants or sleep aids can seem like a quick solution to weariness at work or insomnia at home, but an array of serious physical and psychological side effects can present themselves with pharmaceutical aids. These can range from cardiovascular complications to suicidal thoughts. Taking any such medicines or supplements should be considered only on advice from your personal physician. This includes over-the-counter options like the popular melatonin. The FDA does not regulate over-the-counter melatonin, and some researchers warn that more research is required on the supplement and that the long-term effects are not fully known.
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