The Well-Rested Nurse: A Frustrating Oxymoron?

The Well-Rested Nurse: A Frustrating Oxymoron?

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:

  1. Go to bed at the same time each night and rise at the same time each morning.
  2. Make sure your bedroom is a quiet, dark, and relaxing environment, which is neither too hot nor too cold.
  3. 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.
  4. Remove all TV’s, computers, and other ‘gadgets’ from the bedroom.
  5. 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.”

Some Final Tips for Becoming a Well-Rested Nurse

Four final recommendations come from Dr. Charles H. Samuels, medical director at the Centre for Sleep and Human Performance in Calgary, Alberta:

  • Catch up on your sleep on your days off.
  • 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!
8 Essential Sleep Tips for Shift Workers

8 Essential Sleep Tips for Shift Workers

Working nights? You’re certainly not alone. According to the Bureau of Labor Statistics, more than 15 million Americans work a permanent night shift or regularly rotate in and out of night shifts.

If you’re working nights, you’ve probably heard warnings about how your alternative schedule could negatively affect your health and well-being.

But your schedule is your schedule and perhaps you can’t change it right now, or perhaps you don’t want to. With that in mind, let’s live in the nocturnal moment and talk about ways you can get better sleep and make the most of the work-life balance you’ve got.

1. Jump-start your night.

As night falls, get some exercise, expose yourself to bright light, and take a hot shower – each of these tricks can help you to feel alert and ready to take on the world.

2. Time your caffeine.

Drinking a cup of coffee at the beginning of your shift will help promote alertness. But don’t consume caffeine for the last 4 to 6 hours of your shift or it may be harder to get to sleep when you get home.

3. Block out and black out.

Just because the sun is coming up when you’re heading home to bed, doesn’t mean you have to take any notice. Wear dark, wrap-around sunglasses to block the morning rays that can wake you up. Keep those glasses on until you’re in the dark sanctity of your blackout-curtained bedroom. Blackout curtains are a must because, even if your eyes are closed, sunlight in your room rouses you. Add earplugs and an eye cover and your sleep is covered.

4. Avoid alcohol.

A glass of wine or beer may help you fall asleep, but you’ll likely pay for it later as alcohol disturbs the second half of your sleep. Go with grandma’s advice and sip warm milk instead.

5. Step away from that device.

Smartphones, tablets, and computers (as well as energy efficient light bulbs) all emit blue light that boosts wakefulness – not great when you’re hoping to catch some z’s. If possible, avoid using devices for one hour before you’d like to fall asleep. Charting until the last moment? Try blue-light-blocking or “sleep” glasses. Yes, you’ll look a little funny during hand-off, but isn’t sleep worth it?

6. Try melatonin (but not so much)!

Whoa, that melatonin in your medicine cabinet is 5mg per dose. Research in the journal Work shows you only need about 0.3mg to fall asleep faster. So grab a pill cutter, trim those tablets, sleep better, and save yourself money to boot. Older shift workers may particularly benefit from taking melatonin as the body’s natural melatonin production lessens with age. Quick review: the pineal gland in your brain produces melatonin in response to darkness – it’s a biological marker of night and makes sleep inviting.

7. Create rituals.

Tell your body it’s time to sleep with calming, soothing habits. Read a book, listen to soft music, or gently stretch. Write down things that are worrying you and tell yourself you are setting them aside while you rest.

8. Use your nose.

There is evidence that certain smells can improve sleep. Lavender, for instance, can decrease heart rate and blood pressure, potentially putting you in a more tranquil state. Vanilla, valerian, and jasmine are other possibly soporific options. If you enjoy scents, try soaps, lotions, or oils to find what works for you.

There you have it: 8 tips for the Holy Grail of sleep – those blissful 8 hours. Hope to see you in dreamland.

Big thank you to the National Sleep Foundation, the American Psychological Association, and the peer-reviewed journals Work and Sleep Medicine Clinics for the useful resources that informed this blog.