I woke up in the middle of the night and I was in labor — my second baby was on the way! As I rushed to the hospital, the first person that I met was a nurse. At 2 a.m. she was about halfway through her 12-hour shift but was ready to help me embark on my birth journey. In hospitals, nursing homes, schools, offices, and workplaces across the country, nurses care for individuals and their families from the beginning to the end of life. They are the glue of the health care industry and counted as the most trusted profession, year after year. And like most Americans, many of them are not getting enough sleep prior to coming to work. My co-authors and I wanted to understand just how much sleep nurses were or were not getting on workdays and non-workdays — and further, if we could determine a link between their sleep and patient outcomes. We surveyed over 1,500 registered nurses to learn about their sleep, their work characteristics, and how they rated the quality of care in their workplace.
We found that most nurses are working 12-hour shifts (or more with overtime hours). On average, they are sleeping under seven hours before work, which is less than the seven to nine hours of daily sleep recommended by the National Sleep Foundation. Averages only tell part of the story, though. While some nurses in our study were getting the recommended rest, when we analyzed our data further we found that 11.4% nurses slept a mere five hours or less before work. Given what we know about our physical and mental functioning after chronic partial sleep deprivation, these results are troubling for the nurses’ health and potentially the patients under their care.
Our next step in the study was to see if there was an association between nurses’ sleep duration and their reports of patient safety and quality of care. Our hypothesis was that when nurses slept less, their on the job performance would decline and lead to lower ratings of safety and quality. Indeed, we found that even after accounting for demographics and work characteristics, that when nurses slept less, their reports of safety and quality were lower. Another interesting point was that nurses slept over an hour longer on days when they were not going to work. This reflects a need to catch up on sleep, which again hints at a chronic sleep debt that needs to be repaid.
In sum, our study shines a light on a critical issue among the nation’s largest group of health care providers and those who are often the last line of defense between a patient and a medical error. In most settings, nursing care is organized and delivered using a shift work model to provide 24/7 patient care. Nurses either self-schedule or are mandated to work specific shifts, oftentimes being scheduled for multiple consecutive shifts and sometimes switching quickly between day shift and night shift. A 12-hour shift coupled with a commute to and from work leaves little time to get the recommended amount of sleep, especially with competing family or social obligations.
Health care is fraught with areas for improvement, from enhanced integration of electronic medical records to reductions in hospital-acquired infections. One simple place to start, however, may be to ensure nurses have adequate time off between shifts, have enough nurses to staff their workplace, and are not forced into working overtime. These organizational changes could result in adequate time away from work, increasing sleep opportunities, and leading to more rested nurses, which ultimately means better patient care for you and me.
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