The coronavirus pandemic has tested the health care community, especially nurses working on the frontlines. After two strenuous years, nurses still carry on, even as new variants and surges bring additional challenges.
As nurses continue supporting the health care system and their patients, Rachel Z. Booth Endowed Professor Patricia A. Patrician, PhD, RN, FAAN, in the University of Alabama at BirminghamSchool of Nursing, is launching a new UAB program dedicated to supporting nurses. The Health Resources and Services Administration has awarded Patrician $2.3 million to implement and study programs, in collaboration with UAB Medicine. The programs look to reduce burnout and promote mental health and well-being within the nursing profession.
The three-year grant is a part of HRSA’s Health Workforce Resiliency Award, a program aiming to establish a culture of wellness and resiliency among the health care workforce during the ongoing pandemic.
Patricia A. Patrician, PhD, RN, FAAN.
“I have lived through the nursing shortages in the 1980s, the hospital cutbacks in the ’90s and many other challenging times in the nursing field,” said Patrician, who spent 26 years in the United States Army Nurse Corps. “I have never encountered a situation like the one currently affecting our bedside nurses. Surge after surge, they are there on the frontline, and even stepping up and filling in gaps, to provide the best care for their patients.”
Giving nurses access to”psychological first aid”
Patrician’s grant will create the Workforce Engagement for Compassionate Advocacy, Resiliency and Empowerment, or WE CARE, program at UAB Hospital. The program will hire five nursing development specialists who will receive additional training in resilience and psychological first aid, a program developed by Johns Hopkins University, to assist with selected hospital units. A mental health nurse practitioner will provide counseling support services exclusively to nurses. Additional funds will be allocated to improvements and expansion efforts of oasis areas, or respite rooms, within the hospital.
“The past few years have been extremely challenging for all members of the nursing team,” said Terri Poe, DNP, RN, NE-BC (BSN 1986, DNP 2013), Chief Nursing Officer at UAB. “The team emerged as heroes when the pandemic first started and now are truly exhausted from ongoing workforce shortages, pandemic surges and countless hours of providing high-acuity care. We are very excited to be a part of the grant that will support the well-being and mental health for our nurses. The focus of this work will specifically meet the needs of the nurse and ultimately will have an impact by improving high-quality and safe patient care.”
Patrician, who has dedicated much of her research to studying and developing quality work environments for nurses, hopes the WE CARE program will actively support UAB nurses and establish the groundwork for resources that can be implemented for nurses around the state to access.
“Nurses are some of the most resilient people in the workforce,” Patrician said. “The health care workforce, especially nurses, has dealt with unimaginable and difficult circumstances. Nurses are the backbone of the health care system and need resources that help them during tumultuous times and support their mental well-being.”
Covid pushed a long-standing problem into the spotlight
While the pandemic exacerbated nursing shortages and burnout in Alabama, they are not new concerns in the nursing field. Patrician and her colleagues surveyed nurses across the state in 2019 and determined that burnout and poor staffing were issues prior to COVID-19.
Nursing faculty and staff at the School have pivoted resources throughout the pandemic to assist its clinical partners. Faculty and students dedicated thousands of hours working shifts to alleviate workforce shortages at UAB Hospital, as well as planned and operated community vaccine clinics in partnership with UAB Medicine. The school also collaborated with UAB Hospital to provide a pipeline of students to its student nurse aide position, which allows students to gain experience as patient care technicians ahead of graduation while earning money during school. The ultimate goal is for the students to become familiar with the UAB Health System and return as nurses once they graduate.
“One of our top priorities at the School is not only training and preparing our next generation of nurses but focusing on programs and research that benefit the nursing field as a whole,” said Dean and Fay B. Ireland Endowed Chair in Nursing Doreen C. Harper, PhD, RN, FAAN. “These efforts are critical now more than ever as the pandemic continues challenging our health care system.”
Did you get a good night’s rest? Nurses, like many other health care providers, frequently work shifts that lead to sleepiness and fatigue. In fact, 55% of nurses work more than 40 hours a week, and one in five nurses works at more than one job. This can have effects that you need to take seriously when you consider your sleeping habits and sleep hygiene.
Going Without Rest: A Risky Business
Research from NASA and the U.S. military has established that there is a significant impairment in cognitive function following 15 to 17 hours of sustained wakefulness. Here are some examples of the impairment you risk due to lack of sleep:
After 24 hours of uninterrupted wakefulness, your impairment is comparable to that of someone who has had 2-3 alcoholic drinks
When you’ve been awake for 17 hours, your cognitive and psychomotor performance becomes roughly equal to that of someone who has consumed 1-2 alcoholic drinks. Staying awake for 24 hours creates a condition comparable to having a blood alcohol level of roughly .10 percent, which is over the legal limit for driving in all 50 states.
Individuals who work night shifts are six times more likely to be involved in a sleep-related auto crash, and can be prone to “drowsy driving,” which is every bit as dangerous as driving while intoxicated.
Nurses who work rotating shifts, according to one study, are nearly two times more likely to make medication errors than nurses who primarily work day shifts.
While there is still limited research into the effects of sleep deprivation on nursing errors, there has been a substantial body of work that studies the effects on rest-deprived people in other occupations, such as police officers, pilots, and air traffic controllers, and the findings are alarming. There certainly are parallels, and as NurseChoice.com remarks, “Experts note that lack of sleep in nurses is dangerous for patients and the RNs themselves.”
Sleep Hygiene
You cannot always change your work schedule to accommodate your rest schedule, so what can you do? For starters, the American Nurses Association wants to dislodge such thinking. The risk to both nurses and patients is serious enough that ANA has an official position on the issue of nurses and proper rest: “both registered nurses and employers have an ethical responsibility to carefully consider the need for adequate rest and sleep when deciding whether to offer or accept work assignments, including on-call, voluntary, or mandatory overtime.”
To ensure that you are getting the most restful sleep possible, the Centers for Disease Control and the National Sleep Foundation offer some basics. Check their recommendations to make sure you are not overlooking the obvious:
Go to bed at the same time each night and rise at the same time each morning.
Make sure your bedroom is a quiet, dark, and relaxing environment, which is neither too hot nor too cold.
Make sure your bed is comfortable and use it only for sleeping and not for other activities, such as reading, watching TV, or listening to music.
Remove all TV’s, computers, and other ‘gadgets’ from the bedroom.
Avoid large meals before bedtime. (CDC, 2015)
Clean Sheets and Lavender: Other Ways to Get a Good Night’s (or Morning’s) Rest
Literal hygiene can also help—for example, make sure you are sleeping on fresh, clean sheets. In a National Sleep Foundation (NSF) Bedroom Poll, some three-quarters of respondents said they get a more comfortable night’s sleep on clean sheets with fresh scent. The NSF suggests that you “wash sheets and pillow-cases at least once weekly, so they always smell fresh,” and regularly wash your pillows. And, while morning showers are more energizing, if you are a night-time shower person, timing is everything. Showering too close to bedtime can make it difficult to fall asleep, but if you shower no sooner than 90 minutes before going to bed, it can help you fall asleep an average of 10 minutes earlier than usual.
The NSF adds that “lavender has been shown to decrease heart rate and blood pressure, potentially putting you in a more relaxed state. In one study, researchers monitored the brain waves of subjects at night and found that those who sniffed lavender before bed had more deep sleep and felt more vigorous in the morning.”
Try to get two three-to four-hour blocks of sleep during the day when you work the night shift.
Learn to catnap. Take a short 20–30 minutes of time with eyes closed, situated in a comfortable and resting position. You do not have to sleep to get the benefit of a catnap.
Remember: The treatment for sleepiness and fatigue is SLEEP!
