Night Shift Survival

Birthmama · Nov 4, 2004

Dear new graduate and labor and delivery nurse

I remember being in your position many years ago, and it wasn't all easy. First of all, I congraulate you on arriving in L&D, it's the most rewarding job I've ever been in, especially as a new grad. To the question. Life is a roller coaster on nights. Make sure you take your brakes, read up on power naps, it can work wonders. Coffee or caffeine, although not popular in this day and age can be beneficial. Red bull (equivilant) can also be effective. If you work at 11p go to bed with the kids for a couple of hours before work. Sleep in the morning as much as possible, when you get home, and most important. Don't plan activities when you should be sleeping, you don't do anyone any good if you don't get your rest. Some of the nurses I know even take their kids to daycare for awhile during the sleep time; it can socialize your children and give you a break. Husbands are a different subject they either understand or don't. Talk to him about what it's like to stay awake at night, it helps. Even better is when he gets a night job too; makes all the difference in the world. Good luck, Birthmama.

Shed13911 · Nov 4, 2004

I have been in your position and it can be really hard when the family life suffers as that has to be your #1 reason why you went into nursiing in the first place. You have to find a happy median. If you can not do nights, it is not your fault that your body can not adjust. You may want to speak with your nurse manager(depending on your perception of her) if you feel she should know that you may not be able to cont on that shift. Maybe she can work with you and find a day position somewhere else. I loved L&D too and had to do my share of nights. It was horrible to try and balance those hours with trying to sleep too. You are either exhausted or :uhoh21: feeling guilty when you need to sleep verses spending time with the little ones. If it is not quality time, wouldn't it be better to sleep and feel more rested so that you are not so upset? Your husband needs to help you find a balance as to what will work for your family! Good luck in whatever you choose to do!! Get some rest though. It is hard to think clearly when you are exhausted.

SmilingBluEyes · Nov 4, 2004

can you possibly cut back to part time or perdiem? That is what it took for ME to survive those 12 hour nightshifts. We cannot do it all! Remember, time will come and a daytime opportunity WILL come up. You have your foot in the door now! Hang in there.

pushinrn · Nov 5, 2004

I was in the same postion about 2 years ago. The thing that saved my fanny was changing to 8-hour shifts; that little 2 hour nap after I tuck the kiddo in makes a huge difference, especially when I am charge. Hang in there- the balance is there, you just have to find it.

Good luck!

breastfeedingRN · Nov 5, 2004

I am a new grad as well, in Couplet Care and working part time. I do 2 nights in a row on weekends. You said you work part time. Is that 2 12s a week? Maybe you could split them up and work say Monday night, then Thursday or something. Then you wouldn't lose so much sleep.

Here is what I do, right now. Saturday, wake up around 8am or so, sometimes later. Take a nap at noon or 1pm for an hour or 2 if I am very lucky. :) Leave for work at 6:30p home by 8am Sunday. Sleep from 9 or 10 am-3pm, leave for work again, home by 8am Monday. Sleep from 9 to noon. Go to bed at 9pm that night.

Nights are hard. Hope that you can figure something out. Good luck to you !!

JaneyW · Nov 15, 2004

You need to make your sleep a priority and your family needs to understand this. Invest in some good earplugs and nap whenever possible. As moms and nurses, we tend to put ourselves last. It is important to your safety and the safety of your patients that you are rested and ready to work. It is also imortant to your sanity and the sanity of your family that you are rested and ready to be with them as well.

I do 1 12s a week and I like to do them back to back with childcare lined up to get a full days' sleep in between. Good luck. You will get used to it!

Audreyfay · Nov 15, 2004

This was a pretty good article about surviving night shift.

Night Shift Physiology

By Terri Kerner-Gore, BSN, RN, CNII

It is 4 a.m. and your patients are settled for the moment. Time to sit and do some charting. The medical chart is open before you, waiting to be completed, but your eyelids are falling to half-mast despite the interesting story a co-worker is telling. Fighting off that irresistible urge to sleep is becoming harder by the second. You've ingested enough caffeinated beverages to keep an elephant awake for a week, but each time you sit down for more than 5 minutes your eyes want to close.

You feel chilled and recall with a small chuckle the time it was quiet on the floor and, just for fun, the night shift staff kept an hourly recording of each other's temperatures to prove body temperatures drop around 4 a.m. Deep in this thought, you nod off momentarily and then, with a small jerk, awaken to the muffled giggles of your co-workers. Although they understand, they still find it amusing that someone could fall asleep in the middle of writing a sentence.

But why is this happening? Yesterday, you had a good day's sleep of about 6 hours and yet it seems impossible that you'll ever make it to 7 a.m. when the next shift arrives to relieve you.

Rhythm of the Night

What is occurring has been referred to as "microsleep." It's a spontaneous episode of uncontrollable sleep that may last from 2 to 30 seconds. It can occur regardless of what activity the nurse is doing and become more frequent as the shift progresses. Inactivity, such as sitting, increases the susceptibility of falling prey to microsleep.1

Being more rested is the key to safety and increased productivity for night shift nurses. Mental functioning and alertness are affected by lack of sleep and the stress caused by fatigue. These are serious concerns for nurses who are responsible for drug administration and critical care of patients in hospital settings.

But does it have to be this way? It is important to understand why it is so difficult to stay awake at night so that adaptations made by night shift workers can be effective.

The difficulties of night shift workers primarily stem from sleep loss/deprivation that is tied to our circadian rhythm, which regulates our body's cycles. It is a 24-hour cycle that is dependent on light, and is involved with hormone release, body temperature, and sleep/awake cycles. Humans are diurnal, meaning that we are at our best during the daylight hours with a natural dip in alertness in the mid-afternoon. The strongest urge to sleep occurs between the hours of 2 a.m. to 5 a.m.2,3,5

Our genetically obtained circadian rhythm dictates how well we function at a certain time of the day. No one has the exact same rhythm, which explains why some people are "night owls" while others are not. Even night owls are subject to the sleep disturbances associated with night shift work.

The circadian rhythm is associated with hormone production such as melatonin, cortisol, growth hormone, prolactin and seratonin, among others.6 Melatonin levels naturally increase at night and sleep is normally initiated during this rising phase. Temperature levels of the body are in decline during this time.3

Night shift workers go against this natural phasing by trying to sleep during the daytime hours when melatonin levels are lower and body temperatures are higher, which inhibits the ability to sleep for long periods of time. The average sleep time for night shift workers is 2-4 hours less than normal nighttime sleep. All this leads to work related sleep deprivation that increases stress on the body, both mentally and physically.6

Better Sleep

Nurses should be aware that while there may be no way to reset the internal clock, there are ways to combat these natural rhythms to get a more restful sleep.

A "power nap" is one way to combat the sleepiness encountered during work. During scheduled breaks, a nap as short as 15-20 minutes can be helpful. Many people say this makes them feel worse and believe that a nap isn't helpful. This is not necessarily true. This feeling is referred to as "sleep inertia" and if you understand that it follows a power nap then goes away within 1-15 minutes, then the benefits of the power nap can be appreciated and will rejuvenate a tired worker. Although some research has reported up to 4 hours to recover from a power nap, the shorter recovery time seems to be more accepted. It is important to realize that the benefits of the nap may last for many hours, providing a more alert state and better work productivity.3,4

Eating, drinking and even exercising properly while working the night shift will also improve the ability to sleep during the day. While beverages containing caffeine can be helpful at the beginning of the shift, intake should cease by 3 a.m., as caffeine can linger for 15 hours or more in the body. Also, avoid junk foods while at work. Instead, eat foods low in fat and high in fiber. Light, frequent meals are healthier than large meals and keep blood sugar levels from fluctuating. Going to sleep on an empty or over-full stomach adversely affects sleep. If you exercise at work, do so at least 3 hours before attempting to sleep so that your body has time to cool off.

If you are sleepy after your shift, try to take a nap before going home. If you are sleepy while driving, one option is to take a few minutes to stop for a nap with the car locked. Because our sleep patterns are affected by light, wearing sunglasses may help your body ease into sleep once at home. Another tip is to drink fluids while driving. Taking small sips helps keep you wake. Think about it, how many of us above the age of three can fall asleep while eating or drinking?

Night Shift Physiology

Day Sleeper

To help them sleep during daylight hours, some night shift workers use over-the-counter drugs like Benadryl, among others, and the hormone melatonin (which is not approved by the FDA). Some also resort to prescription sleeping pills. More studies need to be done in order to determine whether these drugs are helpful or if they are actually a detriment to night shift workers.

Meanwhile, family members need to understand how important sleep is for the night shift worker and that daytime sleep is not the same quality as nighttime sleep. Mood and emotions are adversely affected by fatigue and a feeling of being chronically tired is commonplace.

Without consideration from your family about the need to sleep, attempts at restful sleep may be futile.

Make sleep a priority. Socialization with family members often needs to take a back seat to sleep. Of course, most families don't understand this, especially with extended families or families with small children. If a plan can be worked out with family members to respect the time you need for sleep, you will be better for it.

Family needs and commitments however, often take precedence over sleep. In social situations, sleep or the lack thereof, is often the primary topic of discussion by a night shift worker. It can become almost an obsession, which is not always conducive to great conversations or social life.

Setting aside time isn't always the problem however. Often, the night shift worker lies in bed unable to sleep, suffering from insomnia. This can be most frustrating. Here are some helpful hints for better sleep:

- Develop a bedtime routine to prepare your body for sleep

- Sleep in a darkened room and use eyeshades if necessary

- Utilize 'white noise' or earplugs to keep noises from disturbing sleep

- If possible, maintain the same sleep schedule when not working to keep your body on a consistent cycle

- Avoid alcohol prior to sleep, although you may feel relaxed at first, it actually disturbs sleep

Arm Yourself

When it comes to trying to stay healthy, both mentally and physically, the challenges faced by night shift nurses are unique.

They cannot rely on "normal" strategies for getting sleep, and have the added burden of health issues, such as an altered circadian rhythm and hormone shifts that are not found in daytime workers.

The social issues of night shift workers are not easy to deal with, and must be worked out by each individual to reach compromises with family and friends that best suit his or her needs.

But armed with some knowledge of the dynamics and physiology of working at night, perhaps third shift workers can achieve a better balance, and of course, get a more restful sleep.

References:

1. Emeril Vernarec, ed. Linda A Perkins. ( 2001). Occupational hazards: Is the night shift worth the risk?. RN, 8: 65.

2. American Sleep Disorders Association. (1997). Coping with shift work. Wellness booklet.

3. National Sleep Foundation. (2001). Sleep strategies for shift workers. Retrieved Feb. 29, 2004 from the World Wide Web: http://www.sleepfoundation.org/publications/shiftworker.cfm.

4. Mercola, J. (2001). Shift work dangerous to your health. The Lancet, 358, 999-1005. Retrieved May 25, 2004 from the World Wide Web: http://www.mercola.com/2001/sep/29/shift_work.htm

5. Fermilab Accelerator Update. (2001) Coping with shift work. Retrieved May 3, 2004 from the World Wide Web: http://www.fnal.gov/pub/news/history_shift.html

6. Labyak, S., Lava, S., Turek, F., Zee, P. (2002). Effects of shift work on sleep and menstrual function in nurses. HealthCare for Women International, 23: 703-714.

Terri Kerner-Gore is an OB/GYN staff nurse at Windham Community Memorial Hospital, Willimantic, CT.

JessicRN · Mar 29, 2006

I guess I am a rare breed because I have worked nights on and off for 20 yrs and love it. I also work with 2 other nurses who also chose to work nights none of us have young family. i LOVE THE SUGGESTION TURN OFF THE PHONE, HAVE DARK SHADES,DON'T DRINK COFFEE...

I have no problems getting to sleep it is the staying asleep that is a problem. The rest of the world does not respect night workers. When I need to get in touch with someone and have to leave a message I leave it and say please call after 2pm ( I sleep from 800 until 2 pm). I get calls before that time all the time. The best is when you get calls from your nurse manager asking you to work or if she has a question do they call after 2pm NO... yet they expect you to stay awake during the night and you can be fired if you fall asleep at work. I used to have family that calls during the morning with the famous words "were you sleeping"

Turning off the phone does not work as people ring the doorbell. Then there are the Jahovah witnesses... I leave a note on the door I work nights and sleep days please respect my sleep time. If you are a jahovah witness I am a good catholic. If you are a friend or family call before you come and call after 2 pm. If you are the mailman leave the package at the door.

BUT STILL PEOPLE RING THE BELL

On the days when my kids or husband are at home they know that Jessica is sleeping you need to be quiet. GOOD LUCK. the music or TV is always a little too loud or they enevitably "forget" and talk too loud drop stuff bang doors. The dog does not know he should not bark. (it amazes me that he knows not to bark at night though). You can't shut off the outside world either. Neighbors have to cut the grass and do their home projects. Kids naturally scream when they are near pools. Dogs bark...UNLESS YOU LIVE IN A SOUND PROOF HOME OR HAVE A SOUNDPROOF ROOM IT IS HOPELESS

How in the world are you still be able to work when you get only 2 hours of sleep. It is amazing no matter how many times you ask people to respect your sleep time yet they inevitably find some reason to call before that time.

It has taken me years to train my family and friends and now I am newly married and now I have to break in my husband and his family and friends.

IT IS NEVER ENDING AND THEY WONDER WHY NIGHT NURSES

ARE GRUMPY :nono:

LoriAlabamaRN · Mar 29, 2006

I use Melatonin to sleep when I get home from work, you can buy it at any pharmacy. I take a 3mg tablet about 45 minutes before I want to fall asleep, and it helps me to sleep naturally during the day. I'm a night shift worker and I love it, but it does take some adjusting (okay, a LOT of adjusting). As for the noise level, try earplugs. Even a couple wads of cotton work wonders, or headphones attached to a white noise machine. Whatever works best for you. Don't give up!

Lori

LizzyL&DRN · Mar 29, 2006

I was in your exact shoes not too long ago. I tried various things(medications, dark windows, etc) to help me sleep during the day. I work part time now and work my two in a row. I usually only get an afternoon nap with my kids before I start my first shift. The kids go to day care on the day where I must sleep between first and second shifts and i take an Ambien to help me sleep that day. I sleep wonderfully all day from about 8:30 am to 4:30 pm and I wake up refreshed and ready to go back to work. Night shift is difficult with young kids. The day between my shifts I only see my kids for 30 minutes. If I were you i'd put my request for days in as soon as a position opens and maybe discuss your sleeping difficulties with your doctor. Another thing I occasionally do is send my kids to daycare the afternoon before my first shift and have the afternoon to myself. Its great for the body and mind to have some alone time.

JessicRN · Apr 1, 2006

Thanks for the suggestion.