Expert provides tips to help nurses cope with night shifts and fatigue

Finding creative ways to recruit and retain nurses at a Reno, Nevada, hospital led Barbara Hobbs, assistant dean of the SDSU College of Nursing Rapid City Site, to pursue research on the impact of shift work.

In 1979, Hobbs was department head of the cardiac intensive care unit at Washoe Medical Center and found that the staffing level was not adequate for the growing cardiology program. "I looked at scheduling patterns, cost justification and got support to use a more creative schedule to recruit nurses," she explained. While doing this, Hobbs said, "I found the human resources people in the gaming industry did more to educate their employees about night work and strategies to get sleep than the nursing system."

This and more recent experiences as a director of nursing at Bakersfield Memorial Hospital in California sparked her interest in issues that affect workforce retention. "Shift work is one of the biggest factors that can drive nurses away from hospitals," Hobbs said. With an older workforce, shift work, particularly 12-hour shifts, are also often the reason these experienced nurses choose to retire, thus contributing to a loss of knowledge and experience and the shortage of hospital nurses.

The challenge of retaining employees who work at night impacts not only health-care facilities, but also service sectors, such as police and fire departments, and manufacturing companies, such as at 3M and Bel Brands. Hobbs pointed out alterations in sleep patterns also affect those who work underground, including coal miners-;and even scientists working at the Sanford Underground Research Facility in Lead.

For this and other scholarly work, Hobbs was named the Outstanding Scholar for the College of Nursing at the university's Celebration of Faculty Excellence in February.

Altering sleep habits

Hobbs, who started teaching at SDSU in 1994, began doing research on the impact of shift work as part of her doctoral work at the University of Nebraska Medical Center.

"When people stay up at night, they are working against their normal biological clock. As a result, their normal sleep-wake patterns get disrupted," Hobbs explained. Understanding the physiological effects of shift work and long working hours can lead shift workers to seek out and learn about evidence-based coping strategies to improve their sleep quality and quantity by also considering their internal clocks.

In an article analyzing how shift work impacts nurses and patients, Hobbs and Ann Berger, now associate dean for research at UNMC, gave nurses tips on how to establish both a routine, including an anchor sleep time, and a bedroom environment conducive to daytime sleeping. They also emphasized how timing of food and beverage intake, as well as exercise, can reduce health risks of shift work.

Helping nurses cope with fatigue

Because of her work in this area, Hobbs served on the American Nurses Association steering committee that drafted the organization's position statement to address nurse fatigue, which delineates the responsibilities of registered nurse and their employers. "The guidelines are based on research," Hobbs noted. The final position paper, published in November 2014, is posted on the ANA website.

Recently, Hobbs collaborated with Lori Wightman, chief nursing officer at Regional Health and vice president of nursing at Rapid City Regional Hospital, to examine fatigue among critical care nurses.

Experts recommend that nurses work no more than three 12-hour shifts in a row with two days off, the nurse-researchers reported in the Jan. 2018 article in Nursing Critical Care. Research shows that the risk of fatigue-related accident increases by 36 percent during the fourth 12-hour night shift compared to the first night worked.

"As professionals, nurses feel if they are not present, they are abandoning their patients. Nurses need to take breaks," Hobbs said. Their day should include scheduled breaks both to eat and to rest, especially working 12-hour shifts. "It's the manager's responsibility to facilitate that."

As professional nursing and health-care organizations develop workplace practices that help nurses cope with fatigue due to shift work, those strategies and recommendations can also help night-shift workers and their employers in other business sectors.

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