The Impact of Shift Work on the Health of Nurses

According to the Bureau of Labor and Statistics, about 15 million Americans are night shift workers or regularly rotate in and out of night shifts and this number will continue to increase. In the hospital environment night shift is necessary to be able to provide continuity of care. Most nurses will have to experience night shift at some point in their nursing career. That means a significant portion of the United States’ work force is exposed to the many hazards of working night shift. This includes fatigue, restlessness, fatigue, decreased attention and disruption of the body’s metabolic process and illnesses. Nurses who work the nocturnal shift are susceptible to changes in their circadian rhythms, which have a major impact on not only their natural sleep cycle but also their physical and psychological health. Understanding the body’s internal clock allows the night shift worker to use different approaches to promote better sleep and self wellness. The overall principle of this paper is to address the pros and cons of working night shift as a nurse, the impact on not only the physical health but as well as the psychological health of night shift nurses, and ways to cope when working night shift.

What is Circadian Rhythms

Wakefulness during the day time is driven by the biological clock in healthy day shift workers (Ferri). Because the circadian rhythms are controlled by internal clock mechanisms, they persist when people are placed in environments free of external cues. Circadian rhythms help determine our sleep patterns. Light is the strongest time cue for the sleep-wake rhythms (Lewis). This means if a nurse is working on the night shift, that individual must be awake when the circadian drive for alertness is low and sleeps when it is high (Ferri). This forces the night shift nurse to not only function but also sleep in the opposite cycle of the natural biologic rhythm. During the night time, the pineal gland in the brain makes more melatonin and its release signals that it is time for sleep. However, light exposure at night can suppress melatonin secretion.

Pros and Cons

Although working nights isn’t the most ideal for everyone, there are some pros. There are many different pros and cons of working the night shift.  One of the benefits of working at night time is the increased wages and shift differential. According to NationalNurseUnited.org, there is about a 20.5 percent shift differential for nurses working the night shift across the nation. Typically it is a bit more chaotic working during the day in the hospital environment versus during the graveyard hours. It tends to be a much slower pace and a bit more relaxed much slower than during the day. For example, there are usually fewer interruptions from family members or doctors making their rounds, medications to administer, or procedures being done. This gives the nurse more time to sit down and have a get to know their patients more one on one. Without the many interruptions that occur during the day time, the nurse really gets to understand the patient and have a better overall look which ultimately allows them to individualize their care better. Another reason a nurse may choose to work the nocturnal shift is because of the greater autonomy. With fewer staff member working than typically in day shift, there tends to be more responsibility put on the night shift nurse. This allows the nurse to use their critical thinking when problems arise and also to show off their leadership skills.

With all the advantages of working on the nocturnal shift, there are also some disadvantages of choosing to work during the graveyard hours. One of the biggest disadvantages of working the night shift is the feeling of being constantly exhausted. According to UCLAhealth.org, night shift nurses get two to four hours less of sleep than the day shift nurses.  Many nurses need about two days to sleep just to recover after working their night shifts. This brings up the next disadvantage of working at night, less family time. It can be a challenge working while the family is sleeping and trying to sleep when the family is awake. There may also be a reduction in social interactions. Some nurses may feel like their social life is nonexistent.

Health issues

Working night shift can lead to sleep deprivation, which ultimately leads to health problems. Sleep influences both behavioral and physiologic functions, including memory, mood, hormone secretion, glucose metabolism, immune function, and body temperature (Lewis). According to NationalSleepFoundation.org, long term night shift work is associated with an increased risk of certain cancers, metabolic problems, heart disease, ulcers, gastrointestinal problems, and obesity.  Night shift nurses who have been working on night shift for more than 15 years have a 38 percent higher risk of dying from heart disease than nurses who only worked during the day (Park). Compared to day shift nurses, long-term night shift nurses also have an increased risk to have diabetes, hyperlipidemia, and hypertension. According to Sleepfoundation.org, working nights or shifts that often rotate puts you at risk for shift work disorder. This is a circadian sleep disorder that is characterized by insomnia, depression, and difficulty concentrating. According to Sleepfoundation.org, having shift work disorder also increases the chance of developing mental health problems such as depression. Night shift workers with shift work disorder are three times more likely to have an accident while working compared to day shift workers.

Maintaining Circadian Rhythms

Although many nurses love working the night shift, it can be detrimental on their health.  There are numerous things that night shift worker can do to try to maintain their circadian cycle which would ultimately promote self-wellness.  One way is to limit caffeine intake while working. Ideally, its best to restrict coffee intake to two cups per shift. Since caffeine is a stimulant, it is best if beverages containing caffeine are consumed during the beginning of the shift rather than toward the end in order to be able to fall asleep faster. If able, its best if the nurse could schedule their night shift days together in order to have longer stretches of off days. This gives the nurse a little bit more time to spend with family and friends and the ability to run errands. Another way to promote a good nights rest after getting off of work would be to install black out curtains where ever the nurse would be sleeping. Keeping the room as dark as possible or wearing a sleep mask may make it easier to fall asleep. Trying to maintain a steady sleep schedule even on off days can help with maintaining the internal clock. Developing a consistent bed time routine is also helpful in promoting sleep. Warm showers or baths and drinking a warm cup of herbal tea are some things that could be incorporated in a bed time regime.

Conclusion

As a nurse, it is important to make you are taking care of yourself that way you can continue to take care of others. Although, not everyone can avoid working the night shift but some of the techniques previously mentioned could be used to help alleviate the strain that working graveyard hours puts on the circadian cycle which ultimately promote better health.

References

• Coping with Shift Work. (n.d.). Retrieved July 22, 2019, from https://www.uclahealth.org/sleepcenter/coping-with-shift-work
• Ferri, P., Guadi, M., Marcheselli, L., Balduzzi, S., Magnani, D., & Di Lorenzo, R. (2016). The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts. Risk management and healthcare policy, 9, 203–211. doi:10.2147/RMHP.S115326
• Coping with Shift Work. (n.d.). Retrieved July 22, 2019, from https://www.uclahealth.org/sleepcenter/coping-with-shift-work
• Park, A. (2015, January 07). Shift Work: Night Shifts Linked to Early Death. Retrieved July 23, 2019, from https://time.com/3657434/night-work-early-death/
• Lewis, S., Dirksen, S., Heitkemper M., Bucher L., & Camera, I. (2017). Medical Surgical  Nursing Assessment and Management of Clinical Problems. (10th ed.). Saint Louis MO: Elseveir.
• Circadian Rhythms. (n.d.). Retrieved July 23, 2019, from https://www.nigms.nih.gov/education/pages/factsheet_circadianrhythms.aspx