For centuries, many hospitals have always had the traditional concept of eight-hour shift. The trend later changed, and nurses began taking the 12-hour shift. With such an arrangement, the program made sure that nurses had a three-day change on a weekly basis to balance their flexibility and work life. However, as the growth and demand of hospitals increased, the lengths of working per shift also changed and became unpredictable because of the increasing needs of the patients and the unanticipated changes of the staff. As a result, nurses were forced to work beyond their shifts. When long hours of work were combined, and the shifts rotate between night and day through continues shifts, the nurses then fall into the risk of burning out or getting fatigued which when not observed may compromise the care of patients. This essay will discuss the impact of night shift nursing on patient outcomes, satisfaction and nurses fatigue.
While there are rules on cumulative working hours and shift lengths for the resident physicians, there are no policies for public work hours for the registered nurses. For instance, a state like California and Maryland ruled out the overtime system, but gave nurses the options if the nurses want to continue working for more extended hours they were permitted. Moreover, the distinction between mandatory and voluntary overtime for the registered nurses was often blurred (Birmingham 31). The shortage of nurses due to a weak economy was one of the reasons why the nurses were influenced to work past their regular working hours. When a person has sleep deprivation of fatigue, several consequences usually affect the body and the mind.
Impact of Fatigue on patients and nurses
According to Hobbs " Wightman (p. 9), when a person has an insufficient sleep, they usually develop mood alterations, psychological changes, and cognitive impairments. The study done by the authors revealed that fatigue is also associated with reduced judgment, vigilance, lack of concentration, decreased coordination, awareness and motor skills. The individual may also have slower reactions (Hobbs " Wightman 12). Sleep deprivation, according to the study also leads to reduced communication skills and lack of the ability to deal with emotional demands. When nurses are fatigued, they usually get affected both mentally and physically. For instance, physical fatigue may lead to hypertension, metabolic syndrome, stroke, elevated sugar levels and obesity. Inwardly, fatigue decreases the concentration and alertness of the individual.
Sleep error and deprivation in nurses
When decreased mental processing is combined with fatigue, the body of the individual usually is never safe. Based on research done by Johnson et al., (p.25) fatigue and mental disturbances typically have a harmful error, mainly if the wrong type of medication is used to the patient. For instance, one study done in Australia on an 8-12 hour shift discovered that several errors made by different nurses regarding charting, transcription, and medical procedures. Most errors, in this case, were noticed with other nurses and other at night with the nights if medical practitioners (Johnson et al., p.25). The majority of them were exhausted, struggled to wake up, and the majority of them during their shifts had other challenges including causing accidents while driving to work. The amount of sleep that was decreased due to the length of the change because of the 24 working hours brought exhaustion and nurses were found to be struggling to be awake at work.
Nurses Shift length, Quality, and Care
Several cases of the number of working hours have been reported to be the leading factors of fatigue on nurses. The more time they spent at work the, the more the level of fatigue and the less they take care of the patients. Stimpfel and Aiken (p.122) also researched patient’s safety and discovered that it was jeopardized because nurses had high levels of fatigue due to the increased working hours. Most of them had developed pressure ulcers and also acquired the nosocomial infections. The study also revealed that employed nurses that worked more hat twelve hours were more prone to the needle stick. Moreover, work-related fatigue can compromise the patient's health because most nurses are usually hands-off due to lack of sleep. During this time, most patients are generally treated by several nurses because most of them don’t follow up.
During the hand-off period, critical data about the patient is also lost because of lack of concentration. In a standard daytime shift set-up (6 am- 6 pm), nurses were reported to be very active but the nightshifts which included waking up in the middle of the night altered with their patterns of alertness, performance, and sleep. The human body according to researchers designed to stay away during the day and sleep at night (Stimpfel et al., 2502). When shifts are created, they usually interfere with the natural trend of sleep, adding to disrupting the circadian rhythm which causes sleep fatigue and deprivation. Misalignment of sleep under the circadian rhythm is also known to lead to challenges with falling sleep, early awakenings, and several arousals during sleep leading to shorter sleep duration due to poor sleep quality.
During the night shifts, the nurses are usually denied about four hours of sleep every day as compared to those that work during the day. A statistic study conducted by Minus " Water House (p.30) discovered that due to the circadian rhythm, the human body becomes less effective between 10 pm and 6 am. This is known to have a significant impact on the nurses mainly if they are to provide high quality and safe services during the night shift hours. According to the numbers, it was evident that 26-50 percent of nurses that work at night have reduced alertness, excessive fatigue, long-term insomnia and decreased sleep (Minus " Waterhouse 37). Moreover, the results of the study revealed that more than 30 percent of nurses that worked during the day were reported to sleep at work at least once a week. Besides the adverse effects of fatigue, the idea of being awake during the night can compromise work safety (Minus " Waterhouse 40). Several studies have also discovered that lack of sleep impairs the efficiency of a person to carry out their duties thus putting them and the patient at risk. The authors also stated that “sleep loss and the desire to work while on the circadian cycle increases the risk workers not being alert thus impairing with the nurse's duties,” (Minus " Waterhouse, 2010).
Harma and Harkola (p 188) also did another research and discovered that due to the decline in vigilance, cognitive function and performance related to fatigue, there is a very high risk of errors and accidents especially on the evening shifts. Many healthcare facilities that were investigated were discovered that productivity loss, healthcare expenses, and the fatigue-related accidents cost about $ 100 billion annually in the U.S (Harma " Harkola 190). The report al; so showed that due to lack of rest, some shifts are left with one nurse who makes a lot of errors in taking care of the patients or prescribing medication. Such condition usually leads to other severe incidences such as needle stick injuries, administration errors, and improper medical equipment (Harma " Harkola 205). While some mistakes appear to be harmless, some of them are known to be life-threatening.
Safety procedures
Due to the concerns of health, many professionals and industries have developed programs that assist in the reduction of the sleep-based error through fatigue management. The program consists of schedule alterations and educational components. Through this system, employees are given information concerning the sleep hygiene measure, circadian rhythms, adverse effect of fatigue, and shift work and how it can be managed through napping during night shifts and by taking coffee (Chalion 126). Managers, in this case, were supposed to make alterations when it came to the ships by making schedules that were compatible with the circadian rhythms. They did this by ensuring that the employees do not more than three days per week in the night shift schedule. Some of the programs were also organized under the service regulations to consider the development and management of fatigue. The program included the nurse to nap, take rest breaks, pharmacological measures, bright lights and exercises to provide temporary relief from fatigue (Chalino 131).
Napping
While napping at work is never permitted in many establishments, the field studies done by Abi Rimmer (p.123) he suggested that taking 15 minutes to 3-hour nap increasing person’s alertness during night shifts. While many companies only allow for long naps, the short naps are said to be more effective. For instance, when a nurse naps for 20 munites during the night shift, they tend to increase their speed of response to enable them to complete their tasks. When an individual sleeps for 26 minutes on a chair, their mental alertness increases as well as the psychomotor performance (Rimmer 138). A good example was also seen in pilots where when they are allowed to take a nap; their performance was observed to increase by 34 percent (Rimmer 132). The study also proved that napping creates individual performances and alertness for up to one hour if the individual was given a chance to lap for only 30 minutes.
Stimulants
The use of coffee usually decreases fatigue. According to a study done concerning the combination of the challenge of exhaustion, It was discovered that when caffeine (200gms) is used positive effects are noticed within the first 15 minutes. Since caffeine was seen to improve the alertness, the study also discovered that when combined with napping people become more efficient and productive during the mighty shifts (Owen 149).
Bright light
Even though many studies have shown that bright lighting in work areas, control rooms and lab place increases alertness in the night shifts, the nurse does not benefit as much as other workers. Usually, bright light involves being exposed to lighting (about 2,500 lux) for more than 2 hours. No study, in this case, has proved the efficiency of bright light and dim lights especially of found in the patient's room (Chalino 134).
Exercise
One advantage of training is that it improves the cognitive performance due to alertness in both non-sleep and sleep deprived subjects. When one exercises for 10 minutes, only 30- 50 minutes of readiness is achieved, but when the individual practices for 50 minutes, there were signs of increased drowsiness based on the electroencephalogram recording. Many researchers, therefore, cautioned that nurses that exercise regularly for alertness end up sleeping more as compared to those that did not work out (Birmingham 35).
Conclusion
The responsibilities of nurses in hospitals are provided patients with 24 hours of effective and safe care with the motive of achieving positive outcomes. However, the nightshift schedule has made most nurses to develop fatigue thus decreasing their rate of performance. Many studies have shown that fatigue, sleep deprivation, and circadian misalignment are connected to lapses in execution, night-shift errors and increased accidents. Even though nurses put a lot of effort to perform they may not achieve this because of the effects of fatigue which decreases their quality of care, safety, and performance. It is also evident that nurses that work more than 12 hours are usually overwhelmed because of consecutive long working hours and the lack of enough sleep. This puts the patient's health at risk as well as nurses themselves mainly if some of them are driving due to the risk of accidents. Nursing administrators, nurses, nurse managers and policymakers to engage each other to divert the culture that allows for more extended working hours to decrease the fatigue level of nurses. Through the safety procedure, it is essential that medical practitioners should ensure that nurses have programs that will allow them to take a nap while being offered coffee to ensure that they are always alert and that the safety of the nurses is assured.
Works Cited
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