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16 tips to spot and help sleepy nurses

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We all know that a sleepy nurse is a potentially dangerous nurse. We’ve helped you identify whether you have shift work disorder, and have given you the tools to trick your body into sleeping when you need it to sleep.

But watching your own rest and enjoying some R & R when you’re a shift nurse may not be enough. It’s about continually monitoring yourself and your fellow nurses. And it’s about being aware of the cues (be vigilant at 4 a.m!) that can set the stage for errors.

Here are 16 tips to help ensure that your work environment is safe and productive:

  1. Get 7.5 to 8.5 hours of sleep prior to coming to work, the average amount of sleep an adult requires. Starting a night shift when you’re sleep-deprived increases fatigue and decreases alertness. If you don’t get this amount from your daytime sleep period, take 10- to 30-minute naps. They will make you feel more alert and enhance performance. Naps longer than 30 minutes can actually make you feel groggier. The best time for a nap is eight hours after you awaken or right before your work shift. Try to make up for lost sleep on days off.
  2. Recognize fatigue and know what signs to look for in others: yawning, blinking, blank stare, head nodding, difficulty concentrating and communicating, poor decision making, confusion, delayed reaction times, poor eye-hand coordination, giddiness, irritability.
  3. Develop a buddy system to help monitor each other for signs of fatigue.
  4. Recognize that the most vulnerable time during the night shift is between 4 a.m. and 6 a.m. Complete challenging tasks before 4 a.m.
    Between 4 a.m. and 6 a.m., double and triple check medications and other important decisions
  5. Eat healthfully and avoid having one large, heavy meal during your shift. Instead, have several quick, healthy snacks. “Brown bag” it. Remember that your body’s normal digestive rhythm can also be disrupted by shift work, resulting in indigestion and heartburn, which can awaken you and keep you up when you’re trying to sleep.
  6. If you’re sleepy, and it’s possible, take a 10- to 30-minute nap during breaks.
  7. If you can’t nap, try to be active/exercise during breaks (climb stairs, walk, do jumping jacks). Exercise can improve your energy and mood.
  8. Use moderate amounts of caffeine to maintain alertness. But remember, if you’re sensitive to its effects, caffeine might make it more difficult to fall asleep after you get home. Ideally, drink caffeinated beverages before and during the early hours of a work shift. If possible, avoid caffeine six to eight hours before your usual bedtime.
  9. Avoid extended working hours, long shifts and overtime. These practices will decrease time available to sleep and participate in family and social activities. Don’t be afraid to communicate with your coworkers about time you need to enjoy your off-duty hours.
  10. Avoid a long commute, if possible, since it will delay and decrease the opportunity to sleep.
  11. The most dangerous part of a shift is the late-night or early morning drive home from work. Do not drive drowsy. If necessary, take a 10- to 30-minute nap before driving home. Consider arranging for someone to pick you up, or take a cab, bus or other form of public transportation.
  12. Discuss issues and exchange ideas with your co-shift workers on ways to cope with the problems of shift work. Organize a support group.
  13. Don’t promote overtime.
  14. Provide vending machines with healthful food choices and put a microwave oven in the break room.
  15. Encourage the use of carpools, public transportation, rested drivers and taxis for the early morning drive home from work.
  16. Educate management and get them involved. If your hospital administration knew that a 26-minute nap doubles productivity and decreases work-related errors, injuries and accidents in shift workers, they might be much more likely to make naps an approved policy. Useful workplace interventions to minimize the adverse effects of shift work include:
  • Installing bright lights to keep the work environment as bright as possible. Bright light is the most powerful natural zeitgeber, which means “time giver.” A zeitgeber is a brain cue for your body’s biologic rhythms, such as sleep. By signaling your body that it should be awake, bright light promotes alertness. It will also help your body adjust to the shift work schedule.
  • Developing a napping policy. Provide a sleep-friendly space and time for scheduled naps. A 10- to 30-minute nap is all that’s needed.

Appropriate shift scheduling:

  • Have a new shift start later than the last one (work clockwise). If a worker is on a 3 p.m. to 11 p.m. shift, he will be more alert and sleep better if his next shift is an 11 p.m. to 7 a.m., rather than a 7 a.m. to 3 p.m. shift.
  • Have less frequent rotations. Have workers rotate shifts every three weeks rather every week. It’s more difficult for the body to adapt to rotating shifts than to work the same shift for longer periods of time.
  • Decrease the number of shifts worked in a row, with at least 48 hours off in between a string of shifts. For an eight-hour night shift, limit the number of shifts in a row to five or less; for a 12-hour night shift, limit work to four shifts in a row. Fewer consecutive night shifts allow more time to recover from the progressive sleep deprivation associated with night-shift work.
  • Plan enough time between shifts to allow employees (and yourself) to get enough sleep as well as attend to their personal life. Rest and relaxation are essential for returning to work feeling rejuvenated and ready to function at peak performance.

To learn more about shift work disorder and get some tips on how to trick your body into sleeping (when the rest of the world is awake), read all three parts of our Shift Work Disorder series!

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Terry Cralle

Terry Cralle is Co-founder and Corporate Vice President of the Keswick Sleep Institute in Charlottesville, Virginia. She holds a B.A. in Sociology from Randolph-Macon College and received her Bachelors of Science in Nursing at the Virginia Commonwealth University and completed a Masters of Science in Healthcare Management with an Emphasis in Healthcare Risk Management from the Finch University of Health Sciences at the Chicago Medical School. Terry is a Certified Professional in Healthcare Quality as well as a Certified Quality Auditor. Terry has had over 20 years experience as a healthcare consultant. She has published on clinical research topics as well as serving as Lecturer at Piedmont Virginia Community College in Charlottesville, Virginia.
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