Nursing Overnight — How Do You Adjust?

June 10th, 2011


By , BSN, RN

As a new nurse, I was surprised to find overnight shifts were the hardest to get. I thought I would be relegated to the middle-of-the-night as the newbie, but instead, there were wait lists to work overnight. It turned out that co-workers with families and other jobs vied for the overnights, leaving reasonable day and evening hours for the rest of the nursing staff.

Hospitals are the single largest employers of nurses in the United States. In order to provide care around the clock, staff nurses traditionally worked one of three 8-hour shifts (day, evening, night). A nursing shortage in the late 1970s and early 1980s prompted changes in shifts to 10- and 12- hour stretches. A recent American Nurse Association (ANA) poll of more than 16,000 nurses indicated that 58% of the nurses worked 12-hour shifts, with 20.8% working straight 12-hour nights.

I still don't understand how people adjust to that lifestyle, and it seems that science thinks many don't do it very well. A recent study, published in the scientific journal Public Library of Science One, found as many as 25% of hospital nurses go without sleep for up to 24 hours in order to adjust to working on the night shift. The study finds that this is the least effective strategy for adapting the internal, circadian clock to a night schedule.

The sleep strategy study published in Science One was based on questionnaires from 388 nurses who work at the Vanderbilt University Medical Center. Night nurses there are typically scheduled three nights on followed by two to five days off, when most switch back to a normal sleep cycle. That means most of them are shifting sleep cycles as frequently as twice a week.

In the past, similar studies have shown that repeated incidence of sleep/wake cycles being out of sync with the biological clock is not healthy. There are increased risks for developing cardiovascular, metabolic and gastrointestinal disorders, some types of cancer, and mental disorders when the sleep cycle is so deeply disrupted. Besides the physical risks to nurses' health when sleep cycles are so in flux, there are also safety issues for patients.

Fatigue, whether related to sleep deprivation, inadequate recovery or long work hours, is strongly tied to cognitive, psychomotor and behavioral impairment. For nurses on the overnight shift, that translates to slowed reaction times, lapses of attention to critical details, errors of omission and compromised critical thinking skills. In a national study of more than 2,000 nurses, working 12 or more hours per shift on any other shift than days, there was a 68% increase in the likelihood of a needle stick.

The most common sleep strategy used by about half the study's participants was to sleep in late on the morning before their first night shift. The practice of skipping sleep altogether was the second most common means of adjustment. Very few participants reported maintaining a nighttime schedule on their days off.

This phenomenon of disrupted sleep even has an official name, shift work disorder (SWD), and it is a recognized medical condition that can be diagnosed and treated by a doctor. There are ways to combat it and try to find a healthier lifestyle before the symptoms get so severe you need medical treatment.

  • Create darkness. Even a very small crack of sunlight between the curtains can cause you to wake up when you are sleeping. If affordable, invest in room darkening or blackout shades. Less costly alternatives are to drape a heavy blanket over the windows or use masking tape and aluminum foil to cover the window panes.
  • The rest of the world may be awake, but make every effort to limit noise intrusions. If possible, turn of the phone. Create white noise with a fan, light, low music or a white noise machine.
  • Set a sleep schedule and try to keep to it. Try to go to bed at the same time every day so that your body has a rhythm.
  • Eat healthy. Drink water. Get some exercise. Get some sun, in small amounts.
  • Try to keep your schedule over the weekends. The less change the better.

Overnight shifts aren't for everyone, but they do offer some benefits. Generally, there is incentive or shift adjustment pay for working the overnight shift, which means more money in the pocket for you. Other pluses include greater autonomy, fewer staff meetings, and usually, no traffic jams. The night shift tends to be a looser, friendlier, less formal environment and there is a real sense of camaraderie among those folks who are up all night.

2 Responses to “Nursing Overnight — How Do You Adjust?”

  1. Jisuzhman Says:

    I worked 5 years of night shift. Always tired. Up over 24 hours at least once a week. Developed racing heart & gerd from all the coffee I drank to stay awake! Gained 20 lbs eating to stay awake. The only thing good about nightshift was the other RNs I worked with. Now I’m day/evenings 12 & 8 hour shifts and I love it! Would never work nights again no matter what the shift diff was!

  2. admin Says:

    Thanks for your comments, I do agree. The best part of overnights was the people, real team players. And the worst, the eating to stay awake.

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