Working night shifts can be a bit difficult when you are not used to it. Even though the duties are the same as those during the day, the working environment for nurses changes after dark. There is less noise and people around. There are fewer distractions, and our internal clock is meant to shut down after dark, making it difficult to stay awake.
As the ‘Certified Nurses Assistants Academy’ points out, on their published work ‘How to Survive the Night Shift’: “Over 15 million Americans work night shifts, or have jobs that require them to rotate to nights.
Night shifts are a necessary part of healthcare.In any hospital or inpatient facility, activity slows at night, but nursing care continues around the clock. Frequently new employees will begin and remain on the night shift until a position on the day shift opens.” 1
According to the U.S. Department of Health and Human Services: “Almost one-fifth of the nurses working permanent night shifts reported struggling to stay awake while taking care of a patient at least once”. And “the occurrence of falling asleep during the night shift happened at least once a week among 35.3 percent of the nurses who rotated shifts, 32.4 percent of the nurses who worked nights, and 20.7 percent of the day/evening shift nurses who worked occasional nights.” 2
As the Oncology Nursing Society points out: “Night-shift work disrupts the synchronous relationship between the body’s internal clock and the environment.” 3
The lack of sunlight makes our body naturally release melatonin, telling our brain that it is time to sleep.
Clinical Sleep Medicine Journal studies show that: “the Individuals working nights and rotating shifts rarely obtain optimal amounts of sleep. In fact, an early objective study showed that night shift workers obtain 1 to 4 hours less sleep than normal when they were working nights.” 4
The American Academy of Sleep Medicine clearly indicates that: “The primary role of the nurse is to maintain a vigilant presence and detect subtle changes in patients’ conditions in order to head off complications. Impaired vigilance can reduce their effectiveness.” 5
A Nurse as stated by The American Nurse Association (ANA): “is responsible for practicing healthy behaviors that reduce the risk for working while fatigued or sleepy, for arriving at work alert and well rested, and for promoting a safe commute to and from work. During work shifts, nurses are responsible for taking meal and rest breaks and for implementing fatigue countermeasures to maintain alertness”. 6
As the ‘Top Nursing Organization’ specialized on Nursing programs, information, and education, says on their published information ‘27 Survival and Work Balance Tips for Night Shift Nurses’: “It is not easy to work when everyone sleeps, in fact, it is quite challenging when someone needs to undertake critical tasks and responsibilities. Due to this, nurses are diagnosed with several life-threatening diseases and health issues. In various researches, high levels of adverse health effects such as heart problem, gastrointestinal issues, cancer,and musculoskeletalinjuries are found in the night shift nurses. All this not only affects their overall health but also shows negative results in their performance. As a result, they are not able to deliver their best to the patients.’ 7
The following survey data results from ‘Night Shift Fatigue amongst Nurses’ study published by ‘Stat Crush Survey Data’: “Shows that the majority of nurses on the night shift describe the shift being manageable with a report of 65.79%. Amongst being manageable, for 27.19% of nurses say their shift is stressful.”
Result: Level of Stress
Result: Correlating Fatigue with Level of Stress
As recommended in the work ‘How Nurses Can Cope with Stress, Burnout, and Depression from the Job’ published by ‘Nurse Grid’: “Every workplace is different, and some nurses will respond to their environment in different ways. If you feel overwhelmed on the job, a few events or interactions might be responsible. Try to stay on top of your stress levels on the job and see if you notice when a situation goes from bad to worse. Maybe a patient was extra ornery or one of your colleagues isn’t doing their job. Whatever sets you off, make a mental note and try to avoid these situations going forward. If a problem continues, you can try talking to your nursing manager to see if you can remedy the situation.
Being a nurse can leave your head spinning. You have to deal with a thousand details at any given moment, and sometimes you just need a break. But instead of staring at your phone or social media on your lunch hour, try to clear your mind by avoiding new information. Looking at the news isn’t going to calm your nerves. Step outside and let your mind wander for a few minutes. Sometimes a mental reprieve is all you need to get back on your feet.” 10
That is why you should follow these essential tips to stay awake.
Getting Enough Sleep Is Your Number One Priority
A good, comforting and relaxed daytime sleep is vital to make it through the night and keeping your mind sharp. At least seven straight hours of sleep during the day is recommended.
Fatigue during working hours compromises decision making, reaction, and productivity, possibly jeopardizing the health and safety of patients.
Important studies published by the U.S. Department of Health and Human Services indicate that: “Sleep loss is cumulative and by the end of the workweek, the sleep debt (sleep loss) may be significant enough to impair decision-making, initiative, integration of information, planning and plan execution, and vigilance. The effects of sleep loss are insidious and until severe, are not usually recognized by the sleep-deprived individual.” 11
Take Short Naps During Your Night Shift
Wear a sleep mask and make the room as dark as possible. Wear earplugs to keep any noise out. Turn off your cell phone, just keep your alarm set to make sure you’ll take no longer than 10 to 20-minute naps. Longer naps can make you feel groggy.
Adjust your body and mind to new sleeping schedules. Stay in a fresh and bright area during reduced activity time to help you stay awake.
As published by The American Academy of Sleep Medicine: “Napping has been suggested as a strategy to improve performance, reduce fatigue and increase vigilance.” 12
Results from Nurse Performance and Patient Safety studies published by the U.SAgency for Healthcare Research and Quality “Have shown that short breaks not only improve performance and reduce supjective fatigue, but they are also effective in controlling the accumulation of risk associated with prolonged task performance and sleepiness.”13
Keep Your Mind Occupied
Keeping busy and active is key to staying alert. If you happen to have some downtime, take advantage and keep your body active by walking, stretching, and checking on your patients. By moving about, you keep your blood circulating and your mind sharp. You can even catch up with some reading.
Staying fresh will allow you to provide patients with better bedside care. Being able to spend more time with patients will improve your connection and communication with them as well as making them feel comfortable, safe and secure.
At night, you can do all the checkups, monitoring and assisting all you need to. It’s also a good time to update any pending paperwork because you won’t experience many interruptions, unlike during the day.
As the Night Shift Nursing Survival Guide from the ‘Advanced Medical Certification Course’ recommends:
During the day shift, nurses are constantly busy with doctors, supervisors, kitchen staff and patients which can make the day shift feel quicker. To feel just as busy, try and get extra work was done that could help out the busy day shift nurses, get organized, or spend more time with your patients who are actually awake. 14
Bond with Fellow Nurses and Coworkers
You can bond with your co-workers and get to know each other better since there is reduced staff and workload. This helps lower any pressure you might be going through. Collaboration among colleagues is crucial for professional growth. A good way to break the ice with coworkers is to bring along a few quiet board games, which you can also use for patients who are early risers or have trouble sleeping.
The Evidence-Based Handbook for Nurses published by the National Center for Biotechnology Information advances science and health regarding Nurses night shift work reveal that: “Teamwork and interdisciplinary collaboration have the potential to mitigate error and increase system resilience to error. Clinicians working in teams will make fewer errors when they work well together, use well-planned and standardized processes, know team members’ and their own responsibilities, and constantly monitor team members’ performance to prevent errors before they could cause harm. Teams can be effective when members monitor each other’s performance, provide assistance and feedback when needed, and when they distribute workloads and shift responsibilities to others when necessary”. 15
Eat Healthy and Stay Hydrated
Keep healthy snacks (oatmeal, protein, vegetables or healthy crackers and bars) with you and avoid large meals one hour before your shift starts. Snacking every two hours will keep your body fueled, sharp and active. Hydrate often and control your coffee intake, too much coffee can work against you.
Here are some useful recommendations from the Advanced Medical Certification ‘Night Shift Nursing Survival Guide’:
Be active the day before your shift
While this might seem counterintuitive, staying active and exercising the day before your shift is important for proper, feel-good mentally sane hormone release to get you through the night.
Resist the caffeine fix late in the shift
Don’t drink more than a cup or two of coffee in 24 hours, in the long run, caffeine is addictive and will disrupt your circadian rhythm more so than your temporary night shift state. Also, try and avoid drinking caffeinated beverages during the second half of your shift, as that will surely keep you up long after your night shift is over.
Wear a digital watch
A night shift is a time when you are most likely to lose track of time, so wear a good digital watch and consider setting alarms. You’ll never miss a medication again!
Ease into different shifts steadily
If you work shifts during all times of the days and nights, be most efficient and good to your body by slowly easing into shifts of the opposing times. For instance, if you work a day shift, work an evening shift next before taking on the night shift. 16
As explained by Educational Services for Healthcare Organizations:
“Night shift is a controversial part of nursing. If you’ve never worked it, you have no idea what it’s like. Night duty: it’s the easiest shift, right? No one gets up fifty times to go to the bathroom. No one rings the bell. No doctors come through, and patients never get sick and need care. If you have – and most have – you know it is not as easy as everyone makes it sound. In fact, it is probably the most difficult shift because you are constantly fighting the need for sleep and still making clinical decisions.
Patients need care even when they are sleeping. To be honest, they don’t actually sleep very much during the night. Being in a hospital is anxiety producing for even the healthiest patient. It is scary for those facing life-altering changes. For this reason, night duty is often quite busy. It isn’t fair for the ratios on the night shift to be out of line with day shift ratios because the workload is comparable. Since no one seems to believe this, ratios on night duty are already skewed to the detriment of the nurse.17
Once you train your mind and body to adjust, you will enjoy your night shift and find them very productive. According to studies, people are less tired when they are happy, so make the best of your night shift!
According to information published by the Oncology Nursing Society: “Nurses working various shifts can improve shift-work tolerance when they understand and adopt countermeasures to reduce the feelings of jet lag. By learning how to adjust internal rhythms to the same phase as working time, nurses can improve daytime sleep and family functioning and reduce sleepiness and work-related errors.”19
The American Nurse Association (ANA) states that: “Registered nurses and employers in all care settings must collaborate to reduce the risks of nurse fatigue and sleepiness associated with shift work and long work hours. 20
The Certified Nurses Assistants Academy (CAN) clearly indicates and recommends in their published work ‘Surviving The Night Shift – from Experienced Certified Nursing Assistants’ that: “Lighting is important. To “fool” the brain, you’ll need a source of light during the shift. Most facilities dim the lights at night so patients and residents can sleep. Try and keep lights turned up at the nursing station and break room.”21
As the night shift survival guide published by the ‘Advanced Medical Certification’ states:
“Get a ride home from work if you find yourself too tired to drive. You don’t want to end up back at the hospital being cared for.
As a nurse who works night shifts, we respect and applaud you! It’s so important that you look after yourself and learn to manage your health before, during and after your night shift.” 22
If you’re struggling with the demands of being a nurse, don’t be afraid to reach out for help. Chances are that some of your colleagues or supervisors are dealing with the same issues. When you express yourself, you have a better chance of working through some of these challenges. 23
(1, 21) Certified Nursing Assistants Academy (CNA). CAN Plus Academy. 9 Tips from Experienced Nursing Assistants. Surviving Night Shift
(2, 11, 13) U.S. Department of Health and Human Services.
The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety.
(3, 19) Oncology Nursing Society. Clinical Journal of Oncology.Nursing Impact of Shift Work on the Health and Safety of Nurses and Patients. Berger, Ann M.; Hobbs, Barbara B.
(4) Clinical Sleep Medicine Journal. Kenneth P. Wright, Jr. Sleep Loss and Fatigue in Shift Work and Shift Work Disorder.
(5, 12) AASM. American Academy of Sleep Medicine. June 8, 2010. Sleep-Deprived Nurses May Struggle to Remain Vigilant During 12-Hour Shifts.
(6, 20) The American Nurse Association (ANA). Joint Responsibilities of Registered Nurses and Employers to Reduce Risks
(7) Top Nursing Organization. Nursing Schools. Programs, information, and education. 27 Survival and Work Balance Tips for Night Shift Nurses
(8, 9) Night Shift Fatigue amongst Nurses. 2012. Stat Crush Survey Data.
(10, 23) Nurse Grid. 2018. How Nurses Can Cope with Stress, Burnout, and Depression from the Job. https://nursegrid.com/blog/nurses-can-cope-stress-burnout-depression-job/
(14, 16, 22) Advanced Medical Certification. Online certification and recertification courses. ‘Night Shift Nursing Survival Guide’
(15) Evidence-Based Handbook for Nurses information published by the National Center for Biotechnology Information advances science and health. Nurses at the “Sharp End” of Patient Care
(17, 18) Educational Services for Healthcare Organizations. (AUSMED). 2016. Is Night Duty A Professional Obligation