Sleep Factors and the Night Shift

By: Brooklyn Barney, Sami Dalessio, McKenna

Foxworthy, Molly Hughes, Holly Hunt, Kaitlyn
Jensen, Emily Kingsley, Miguel Nava, &
Lindsey Warne

Lab Group A
Introduction

“Nurses who work the night shift often

experience high levels of sleepiness as a
normal biological consequence of working
during a dip in the circadian rhythm (2am-
6am).” - Jeanne Geiger-Brown, MD
Introduction ● Incidents associated with
decreased sleep:
○ Medication errors
○ Poor judgement
○ Reduced alertness/stimulation
from environment
○ Job related injuries and
accidents
○ Motor vehicle accidents on
ride home
○ Long term health impairments
Clinical Question

In night nurses, how does the

implementation of fatigue
countermeasures (napping and
sleeping schedule), compared to no
countermeasure, affect safe practice?
Summary of Current No national standard/protocol to
aid in safe practice related to
Practice
fatigue in night shift nurses.

Some hospitals have begun

implementing specific schedules to
decrease fatigue.

Some allow napping during breaks,

but none have specifically set nap
breaks.
 Napping:

Synopsis of Current ● Sleep deprivation

Literature Research
● Napping effects
Findings Related to ○ Mental
the Issue ○ Physical
○ Safety

● Hospital environment

● Manager and nurse attitudes

Synopsis of Sleep Schedule:
Current Literature
● Nurses employ different sleep
Research Findings
schedules: switch sleeping,
Related to the same sleeping, shifted
Issue - Sleep sleeping
Strategies
● Nurse preference and most
effective sleep schedule

● Difference in time off

requirements between shifts
 Strengths and Limitations
Strengths:
■ Consistent with previous research
■ Randomized control trial
■ Adequate sample size
■ Valid scales used to measure
sleepiness and effectiveness of
napping
■ Approved by Institutional Review
Board
■ Use of specific inclusion and exclusion
criteria
Limitations:
■ Hawthorne effect
■ Small sample population
■ Studies conducted in different countries
■ Difficult to conduct a “blind” study with this
topic
■ Small response rates
■ Lack of diversity- gender, age, race, culture
■ Low accuracy instruments of measurement
Evidence Based
● Taking two 15 minute naps or
Nursing one 30 minute nap during the
Recommendations night shift.

● Nurses switching from the

night shift to the day shift or
those switching from day to
night need two days between
scheduled shifts.
 ● Average cost of medication
errors each year per hospital is
approximately $600,000
Cost Analysis:
Resource Nurse ● Nationally, medication errors
account for 5.1 billion US
dollars annually
● Implementation of 2 part-time
resource nurses in the ICU
● RN’s on average make
$69,000-$72,000 ($70,852 in
Arizona)
Cost Analysis: Sleep It is imperative that healthcare workers
are educated on the importance of
Educator work fatigue, and the prevention of
medication errors.

Nurse manager compiles educational

materials and videos to present to staff
about circadian rhythms and sleep
hygiene ($10 dollars to print)

Education is PREVENTION!
Nap Pods
● $ 16,000

● Studies show taking 20

minute naps rejuvenates
the nurse

● Arm rest has timer control

 Overall Application

Timeline:

● Week 1: Nursing manager will compile sleep education and resources.

● Week 2: Unit nurses will review the informational materials.

● Week 3: Purchase sleep pod and hire resource nurses

● Week 4: Orient the resource nurses to the unit

● Week 5: Utilize a quiet room on hospital floor for sleep pod (break room)
● Week 6: Inform nursing staff of new sleeping regulations and put sleep plan into
action on upcoming shifts
 Risk vs. Benefit
● Risk:
○ Less staff available in case of
Rapid Response
○ Nurses can wake up less
refreshed and more fatigued than
intended
○ Nurses can abuse the sleep
protocol (i.e. sleeping longer than
the limited 30 minutes)
○ Lack of personal relationship
between the patient and the
“resource nurse”
● Benefit:
○ Nurses experience less fatigue
○ Fewer medication errors
○ Less drowsy when driving home
○ More likely to participate in patient
care
○ Lower burnout rate
○ More likely to float to the floors with
sleeping protocols
 ● Nurse manager in charge
Evaluation of ● Calculate/analyze total # med errors
Medication Errors over one year on night shift
● Implement nap protocol
● Collect med error data for one year
● Compare data with naps against data
without out naps

Expected finding: errors will decrease in a

moderate (15-30%) with nap protocol in
place
 ●
Evaluation of Initial survey
○ Feelings towards work fatigue
Nursing Staff ● Implement nap policy for 1 year
● Retake the same survey
Satisfaction ○ Feelings towards work fatigue
● Compare numerical result to nurses’
feelings of fatigue with and without nap
protocol
● Analyze nurses’ perception of
effectiveness of naps on the night shift

Expected finding: nurses will feel more

confident in their ability to perform
 Summary

● Unsafe practice occurs on night shift at a higher rate than day

shift
● Lack of adequate sleep leads to clinical errors
● Napping prevents fatigue and allows nurses to feel refreshed
● Nurses who adjust sleep schedule to sleep during the day are
most adaptive to the night shift and well rested
● Implementation: Two 15 minute or one 30 minute paid nap
 Summary (cont.)

● Hire a ‘resource nurse’ and sleep educator, install nap pod in staff
lounge
● Cost: $86,000 for the first year and $70,000 thereafter
● Risk: abuse of sleep protocol, resource nurse lack of relationship
with the patients, nurses waking up groggy
● Benefits: less fatigue, fewer patient care errors, higher morale

X
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“I’m so tired”- Philip Moya