Most nurses are chronically sleep deprived

Sleep has become a hot button topic in health care, at least when it comes to physicians. The fact that doctors-in-training don't get enough of it has resulted in regulations governing duty hours in resident training programs across the nation. In 2002, the Accreditation Council of Graduate Medical Education (ACGME) reduced the number of hours that resident physicians can work to 80 hours per week. Until now, however, the relationship between sleep and errors, injuries, and worker's health has been little studied in nursing. Researchers including Jeanne Geiger-Brown, PhD,RN, an associate professor at the School of Nursing, are changing that.

Until the late 1960s, most hospital-based nurses worked eight hour shifts.That began to change in the early 1970s, and today, as researcher Alison Trinkoff, ScD, RN, FAAN, a professor at the School, has helped to document, the majority work 12 hours or more. Geiger-Brown is now researching the impact of extended work on RNs' ability to get enough sleep—seven to eight hours on a routine basis.

To find out how nurses are faring with 12-hour shifts, Geiger-Brown recruited 80 hospital nurses from a Southern U.S. hospital and outfitted them with an actigraph, a wristwatch-like device that measures their sleep. What she found is alarming. Two-thirds of the RNs in her study got fewer than six hours of sleep between 12-hour shifts. One-third got fewer than five hours of sleep, and some only had two hours of sleep.

Most of the nurses in her study were chronically sleep deprived, she says, because working a 12-hour shift often doesn't give nurses enough time to rest."First of all," she says," many don't leave their workplaces when their shift is over, but remain at work for 30 to 60 minutes or more to finish their activities and charting. Then there's commute time plus chores to do at home."

Many of Geiger-Brown's subjects know they are exhausted. "One nurse told me she has her husband call her on the cell phone while she's driving home to keep her awake. Some nurses don't go to the bathroom, hoping a full bladder will prevent them from falling asleep during their drive."

Because sleep effects brain function, nurses who are sleep deprived cannot process information effectively and may be irritable with colleagues and even patients, notes Geiger-Brown. She points to studies showing they are also at higher risk for cardio-vascular disease, hypertension, metabolic syndrome, diabetes, obesity, and suppressed immune function. They are also at higher risk for making errors or sustaining an accident or injury on the job.

Unfortunately, says Geiger-Brown, exhausted nurses often have "false beliefs" about the risks of chronic sleep deprivation. Because they have not yet made an error or had an accident, they think they won't in the future .Or they believe that if they are careful, they won't harm a patient or themselves. The reality, says Geiger-Brown: "No individual can control the consequences of chronic sleep deprivation. It's a biologic phenomenon that is beyond our control."

"When hospitals and nurses agreed that the 12-hour shift was a good thing, they risked a generation of nurses having ill health as a consequence of chronic sleep deprivation," says Geiger-Brown.

So what does she recommend? First of all, rethink the wisdom of the 12-hour plus shift as standard operating practice for all nurses. To do this, she says, nurses and hospital administrators need to better understand "the mechanics" of sleep. She also believes hospitals need to help nurses cope better with shift work—by allowing nurses to take naps in the workplace.

"I can't change the system, but if I can get nurses to get an extra hour of sleep, that's a victory," says Geiger-Brown.