Shift-Work Disorder: How Nurses Can Cope

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Nurses enter the profession knowing they are likely to be confronted with night work and 12-hour shifts that will disturb their sleep patterns, eating habits and social lives. These are drawbacks to physical and mental health, but they are not going away as long as hospitals, clinics and other health care institutions need staffing 24 hours a day.

Nurses need to learn how to cope with shift-work disorder and the problems it causes, not only for the sake of personal well-being but to reduce the likelihood that they will make mistakes on the job. Shift-work disorder can lead to declining job performance; impaired concentration, coordination and memory; poor decision-making; and increased irritability and mood swings.

Individuals suffering from shift-work disorder are more likely to come down with immune-system damage and common heath conditions such as a cold or flu. In addition, affected individuals may be at a greater risk of obesity, high cholesterol, gastrointestinal disease, heart attack, breast cancer, prostate cancer or mental health problems.

Pros and cons of 12-hour shifts

Some of these problems may be made worse by the prevalence of 12-hour shifts, which are, by far, the most common nursing work schedule in inpatient facilities such as nursing homes, acute care hospitals and rehabilitation centers. The 12-hour shifts tend to reduce the overall number of nurses an institution needs and enhance continuity of care by reducing patient handoffs from three times a day to two.

They also seem to be popular with nurses, according to numerous studies, including recent University of Oklahoma School of Nursing research and a New York study that involved 805 nurses from 13 New York hospitals. These studies have found nurses to be happier with reduced commutes, increased days off, greater potential for overtime pay and generally greater lifestyle flexibility.

However, the documented effect of 12-hour shifts on nurses and nursing performance is not nearly as positive as nurses’ opinions of the work schedule. Multiple studies have demonstrated that the increased fatigue that accompanies a shift at least 50 percent longer than a usual work schedule results in a higher number of accidents and nursing mistakes.

Still, it is possible to reduce the severity of shift-work disorder.

What is shift-work disorder?

Shift-work disorder is part of the circadian rhythm category of sleep disorders — which includes jet lag — with variable light a primary cause. Forcing the body to sleep when it is normally awake, or forcing it to be awake when the body normally sleeps comes with health consequences. Most people stay awake during the daytime, so working solely or partially at night disrupts sleep.

Here are factors that may increase the likelihood of shift-work disorder and how to fix them.

Improving sleep patterns

Working from afternoon to evening or overnight can make it difficult for nurses to go to sleep on a regular schedule. Exposure to bright light or sunlight before bedtime can contribute to shift-work sleep disorder.

Establishing a routine like drinking warm milk or herbal tea, taking a hot bath or shower and ensuring the bedroom is completely dark to resemble nighttime will work for some. Avoiding caffeine, alcohol, sugar and nicotine near bedtime, since these substances may interfere with sleep, also might be effective, as might melatonin supplements or sleeping pills or opportunities, if allowed, to use naps or rest periods during a shift to recharge.

Improving dietary patterns

Mealtime is directly affected by shift work. While nurses might have scheduled lunch or dinner breaks, there’s always the possibility that they will not be able to take them. Quick, easy fast food or even vending machine snacks often replace healthful meals.

Discovery Health recommends that people eat their biggest meal at the start of their day, whenever that day begins, and the lightest meal at the end. Portable healthful snacks — string cheese, nuts, high-protein energy bars, dried fruit — can help nurses stay energized during shifts in addition to preventing hunger, so keeping a supply at work is helpful. On days off, nurses can celebrate having full control over their food choices by including fresh vegetables, fruit and whole grains in their meals.

Coping with social issues

Long, unconventional work hours can limit the amount of time nurses spend with friends and family. Working night shifts, weekends and holidays can easily disrupt nurses’ relationships, since those times are when the majority of social gatherings occur. Even when a nurse is at home, he or she might want to do nothing but sleep after working a 12-hour shift.

Having family meetings — or couples time — once or twice a week can guarantee “face time” with loved ones and help nurses maintain good communication. Scheduling a phone check-in with a partner or child at the same time every night during a work shift will make them feel supported and cared for. Likewise, a bulletin board in the home where schedules, school assignments, messages and artwork are posted means everyone has access to family activities. Nurses should also cultivate friendships and plan social outings with other shift workers — people who can provide camaraderie and emotional support on the same schedule.

Seeking help

The physical and mental health of nurses is just as important as the health of the patients they attend to every day. With planning and care taken to avoid or cope with shift-work disorder, it is possible for nurses to achieve work/life balance.

A doctor may be able to offer a variety of solutions to treat shift-work disorder. Perhaps medications will improve poor sleep patterns. But for some, a drastic change may be advisable, such as cutting back on work hours or finding a new role.

edited by Colin Seymour

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