Nursing News

Sleeping Short or Long Can Compromise Nurses’ Health and Performance


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By Megan Murdock Krischke, contributor 

June 13, 2013 - How does your nursing job affect your sleep and your overall health? It may depend on how many physical demands you face on a daily basis.

A new study has found that those working moderately-to-highly physically demanding jobs are more likely to be either long sleepers (9 or more hours per night) or short sleepers (6 or fewer hours per night).  The study, from the Perelman School of Medicine at the University of Pennsylvania, found that those with moderate activity level jobs (those with lots of walking, such as postal workers) were the most likely to be either long or short sleepers and that those working high activity level jobs (manual labor) were more likely to be short sleepers. 

Many nursing positions could be considered high activity, but it depends on the specific job, agreed study authors Holly Barilla, BS, senior clinical research coordinator at Penn Behavioral Sleep Medicine Program, and Michael Grandner, PhD, instructor in the department of psychiatry and member of the Penn Behavioral Sleep Medicine Program.

Holly Barilla: nurses' health and wellness is related to sleep.
Holly Barilla, senior clinical research coordinator, urges nurses who are concerned with their daytime functioning and sleep to speak with a primary care provider or a sleep specialist.

“While nurses might not be always lifting heavy items or running around, they are often nonstop throughout the workday and so I would classify nursing as a high activity job,” Barilla said. “In general, nurses are on their feet for the 8-plus hour workday, transporting patients, and have a constant concern for their patients so there is the stress component with being a nurse.”

The results of the study, entitled “Higher-Activity Jobs Tied to Sleep Extremes,” were presented at the SLEEP 2013 annual meeting of the Associated Professional Sleep Societies in Baltimore in early June.

Sleep hours make a difference 

Barilla and Grandner point out that there are a number of health impacts that can result from being either a long or a short sleeper. Both long and short sleepers show an increased risk for cardiovascular disease and diabetes, as well as having a shorter life span and decreased psychological functioning compared to those who sleep seven to eight hours a night. Short sleepers also have an increased risk for high blood pressure, metabolic disease and weight gain over time, which leads to obesity.  

Grandner sees this as a major, unmet public health problem.

According to sleep medicine expert Ann E. Rogers, PhD, RN, FAAN, Edith F. Honeycutt Chair of Nursing and professor and director of the graduate program for the Nell Hodgson School of Nursing at Emory University, nurses’ work schedules are the major culprits in preventing them from getting a healthful amount of sleep.

“It's very difficult to get a sufficient amount of sleep when working a 12-hour shift or longer, especially when you consider that most people have, on average, a 30-minute commute to work and need time when they get home to take care of household chores and relax with their families,” she noted.  

Nurses who are getting less than the optimal amount of sleep are putting both their patients and themselves at risk.  Because sleep loss can result in decreased short-term memory and decreased ability to focus, sleep-deprived nurses are more likely to make medication errors or fail to notice subtle changes in their patients’ conditions. 

In addition to the health risks, overtired nurses are more likely to be involved in a motor vehicle accident driving to or from work.  That’s because sleep deprivation can affect people in much the same way that alcohol consumption does. 

A 1999 study, “Quantifying the Performance Impairment Associated with Fatigue,” published in the Journal of Sleep Research, found that after just 17 hours of wakefulness, cognitive and psychomotor performance decreases to that of someone with a .05 percent blood alcohol level (like consuming 1-2 drinks). After 24 hours without sleep, impairment equals that of someone with a 0.10 percent blood alcohol level--the level considered legally drunk in the United States.

Despite such findings, the issue of nurses working and driving home fatigued continues to be a problem. Rogers advises that nurses need to be aware of the number of hours they are working and to make sleep a priority.

“Employers should not schedule nurses for more than 12 consecutive hours nor schedule them for more than three consecutive days of 12-hour shifts,” she recommended. “Additionally, if nurses take call, employers should make arrangements to cover their scheduled shift the next day.” 

Michael Grandner: nurses have physically taxing jobs, affecting sleep.
Michael Grandner, PhD, says nurses have some of the most high-energy, high-movement jobs.

“There are people who say they feel ‘fine’ and function well during the day on fewer than six hours or more than nine hours of sleep; however, if people are experiencing daytime impairment it would be advised to speak to a primary care physician or seek out a sleep specialist,” noted Barilla. “I would recommend that nurses find what shift you feel as though you function the best at, speak with your supervisor and maintain that schedule rather than rotating between day and night shifts.”

While, on average, short sleepers are at an increased risk, not everyone who is a short sleeper may be affected.

“We are currently studying how someone can tell whether or not they are impaired,” Grandner explained. “It might be the case that if you ‘feel fine’ then you might be OK, but since people tend to be a poor judge of how sleep-deprived they are, this may not be accurate, either. The main issue, though, is to remember that sleep is critical for health and functioning, and getting adequate sleep should be a health priority.”

“We rely on nurses to keep us healthy, make us better when we are hurt or sick, and keep us safe,” he added. “Unfortunately, we often subject them to working conditions and schedules that put them at risk for poor health and for getting hurt or sick. We need to take better care of our nurses, so that they can take better care of themselves and us.”

“For now, though, nurses should do what they can to keep their own mind and body healthy through adequate diet, physical activity and sleep, and find ways that help them deal with the high levels of stress they will inevitably face,” Grandner concluded.



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