Nurses Combating the Health Risks of Working Nights

Working the night shift is ordinary and necessary in various fields, including nursing, medicine, law enforcement, and others. While these positions are crucial to protecting people and saving lives, the workers who take on these jobs are putting their own health at risk. There are significant and numerous health risks to people working at night, and while there is nothing that can be done to eliminate them, there are things that can be done to mitigate these risks.

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Nurses Combating the Health Risks of Working Nights

Industries that are required to be "open" 24 hours a day inevitably need people to work at night. Often, these people have careers that allow them to help those in need. While these workers are necessary, they encounter a number of health risks while working overnight shifts. Some of these risks include weight gain/obesity, circadian misalignment, sleep disorders, digestive problems, and increased depression and anxiety. They are also at risk for committing more errors and having more accidents than daytime workers. Although there is nothing that can completely eliminate the risks, there are some things that night workers can do to help with some of these problems.

When it comes to weight gain and obesity, night shift workers are at a disadvantage. Having a disrupted circadian rhythm, along with eating at night, can impair the ability of the body to process sugar (glucose)2. This impaired processing puts the affected person at higher risk for obesity, diabetes, and cardiovascular disease. One study completed in 2021 showed that eating at night increased blood glucose levels, while eating only during the day prevented the effect2. This presents both a solution and a problem for night workers, as they are typically asleep during the day and working (and presumably hungry) at night. One possible solution to this problem is to eat after work (in the morning) and before work (in the afternoon) and to keep any eating during the night to a minimum. If the worker needs to eat during the night, keeping sugar/carbohydrates as low as possible in the food consumed can help minimize increased blood sugar levels.

Another major risk factor associated with night work is circadian misalignment, which forces people's bodies to work against their natural sleep period. The circadian clock signals the body to release hormones at appropriate times and controls body temperature, alertness, and other daily cycle functions1. Sleeping during the day and working at night does not reverse the functions of the circadian clock; it just leaves a person with a misalignment between the clock and their actions. This misalignment causes sleep disorders, impaired decision-making, and decreased safety while performing activities such as driving.

There are a couple of options to address circadian misalignment, but neither is perfect, and both are difficult to accomplish and/or tolerate long term. The first option is to combat the symptoms of sleepiness and decreased alertness at night by using stimulants (most commonly caffeine) to stay awake and alert at night and then using some type of sedative to sleep better during the day1. This option is not ideal, but it does reduce some of the fatigue and excessive sleepiness that leads to errors and accidents. The second option is to attempt to adjust the circadian clock to better suit the night worker's schedule. This involves steps like exposing workers to bright lights at night, wearing sunglasses on the way home, and sleeping in a very dark room1 in order to simulate night sleeping. The adjustment takes about a week, and while this option does seem to work, it is very difficult to maintain, as the person would have to keep to this schedule both on work days and on days off. Most people would find it difficult to lead a completely nocturnal life. Going to sleep as late as possible on days off and waking up mid-day can help decrease this circadian misalignment while allowing the worker to have some daytime alertness on days off.

Another health risk associated with night shift work is gastrointestinal (GI) dysfunction or digestive disorders3. One study from 2010 showed a higher incidence of IBS (irritable bowel syndrome) in both night shift and rotating shift workers as opposed to day shift workers4. In addition, night shift workers reported more gas, diarrhea, indigestion, heartburn, and other GI symptoms5. While the exact cause of these problems is unknown, the GI system works by the circadian clock, and problems can arise if food is eaten at the times not preferred by the body (night). Also, fatigue can lead to stress, which can cause GI symptoms. By trying to minimize night eating, some of the symptoms may be alleviated. Another solution is to use medications to treat symptoms when necessary.

Depression among night shift workers is another serious concern. The lack of natural daylight and being exposed to bright artificial lights at night can lead to night workers developing a depressive state similar to seasonal affective disorder6. They may also develop depression for other reasons. Working night shift can negatively affect family and friend relationships6 due to the inability of the person to be available at the times when they are needed by loved ones. This can also lead to chronic stress and anxiety. Night shift workers should schedule some time to get sunlight as often as possible6, either in the morning before sleep or in the evening before work. This can help with depression and can also be an avenue to spend time with family or friends, such as taking a walk with the family in the afternoon before work or eating breakfast in the morning with family outdoors on the porch. If depression becomes severe or is having a significant impact, the worker should seek mental health services and possibly antidepressant medication.

While there are some options to help mitigate risk for people working the night shift, none of them lead to optimal health for the worker. For many people, the best option for health improvement may be to stop working the night shift as early in life as possible. If that is not an option, then utilizing the strategies presented here can provide some relief and possibly allow for better health outcomes in the long term.

References

1The risks of night work

2Daytime meals may reduce health risks of night shift work

3Effects of Shift Work: The Danger of Not Getting Enough Sleep

4The impact of rotating shift work on the prevalence of irritable bowel syndrome in nurses

5NIOSH Training for Nurses on Shift Work and Long Work Hours

6The Mental Health Effects of Working the Night Shift

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Lindsay Montford

About Lindsay Montford, ASN, RN

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Specializes in Psych (25 years), Medical (15 years).

Ways to deal with the misalignment of the circadian cycle is mentioned in this article without the mention of changing one's own clock to fit one's work schedule.

The probable main reason is putting others' wants and needs before our own. We don't want to miss out on connections with our friends, families, and offspring, so it is we who need to change our lives and not the other way around.

Having worked MNs for 18 of the 36 years that I practiced as Nurse, I came up with an easy, viable solution: Stay on a MN schedule.

I have not gained weight, not had any GI disorders, not been able to deal with depression, or any other health risks as a result of working MNs. Once the body's circadian cycle is changed to a continual schedule, it regulates and working MNs is no different than working Days or Afternoons.

Of course, there are as many advantages to staying on a MN schedule as there are disadvantages, but the vast majority choose to be reinforced with external, rather than internal, gratification.

 

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Specializes in Nurse Writer; RN-BC Ambulatory Care.

 Hi Davey,

I also stayed on a nighttime schedule when I worked nights (for about 10 years). You're right, it does make it far less likely to have physical problems, but for me, it was a disaster for my personal/social and family life. I missed so much! It's an unfortunate choice that many of us have to make. Thanks for taking the time to check out the article, and I appreciate your comment!

Lindsay

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Specializes in Psych (25 years), Medical (15 years).
11 hours ago, Lindsay Montford said:

You're right, it does make it far less likely to have physical problems, but for me, it was a disaster for my personal/social and family life. I missed so much! It's an unfortunate choice that many of us have to make.

It's only unfortunate if we do not plan our lives, then want our cake and eat it too.

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On 8/30/2022 at 11:44 AM, Davey Do said:

Ways to deal with the misalignment of the circadian cycle is mentioned in this article without the mention of changing one's own clock to fit one's work schedule.

The probable main reason is putting others' wants and needs before our own. We don't want to miss out on connections with our friends, families, and offspring, so it is we who need to change our lives and not the other way around.

Having worked MNs for 18 of the 36 years that I practiced as Nurse, I came up with an easy, viable solution: Stay on a MN schedule.

I have not gained weight, not had any GI disorders, not been able to deal with depression, or any other health risks as a result of working MNs. Once the body's circadian cycle is changed to a continual schedule, it regulates and working MNs is no different than working Days or Afternoons.

Of course, there are as many advantages to staying on a MN schedule as there are disadvantages, but the vast majority choose to be reinforced with external, rather than internal, gratification.

 

Absolutely agree!  Been on nights my whole career (though, technically, I was a night owl to begin with) and have never had a problem. 

Everyone I know works around my schedule (and many are happy to know there is at least one person they can still call when they are still awake at midnight ?).  

The one exception is delivery people (who always drop off packages between 11am and 1pm); if it's between shifts, I just sleep on the couch when I know a package is coming (so my dogs jump on on me when the Ring alert goes off), get the package (before porch pirates can), and then fall righ back to sleep ?.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I have been on nights for five years. I do have about 15 "night pounds" I'm carrying around, but I don't think I've had any other negative side effects. But I don't eat at night anyway, I eat from noon until 6pm and then fast overnight whether I'm working or not. I find that I feel better in general on that schedule, and my 15 extra pounds could be more due to my food choices and lack of exercise than nightshift itself.

I find that nights work well for me for a number of reasons. First, I love my night staff and the environment that really fosters a sense of autonomy and teamwork at the same time. When there's no one there to save your butt, you learn how to do it yourself! It's also worked well for me because I don't keep a straight midnights schedule. I'm fortunate that I don't need a lot of sleep in order to function, so I can spend more time with my family and get things done. This week I just started a dayshift period while I'm on orientation for a new position and I find 7am-7pm to be awful! I'm out of the house at 5:40am, home about 8:30pm and I don't see anyone or have time to do anything. On night shift I'm home by 8:30am and even on the rare days that I sleep as late as 2pm, I've still got over three and a half hours to get stuff done, see my kids and have family dinner together. I can't wait to get through orientation and get back to nights!

I do love my blackout curtains and sound machine. I'm happy when lawn mowing and tree cutting season is over, and as much as I love neighborhood kids, I'm not too sad when they go back to school. I think that night shift can work for anyone, I encourage new night shifters not to focus on the negatives, but embrace the positive aspects of the schedule, it's especially nice to be in the empty grocery stores because everyone else is asleep. ? 

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Specializes in Former NP now Internal medicine PGY-3.

The above is true. if we sit there and think about how bad it is it just causes anxiety. I used to work nights and a nurse and then an NP. it wasn't too bad. Working nights isn't really an excuse to gain weight, I just ate less. 

It is a bit harder now in residency since we only do 1-2 weeks of nights at a time and switch back and forth, which is harder, and we stay later, sometimes until 10 am. 

I usually try to avoid bright lights an hour or two before bed (just like if im on days) drink caffeine up to 6 hours till bed, and take a bit of melatonin. Blinds to block out light are essential. 

The bowels part can be tricky, usually I up my fiber intake on nights and use Metamucil since what is said above is true.

Though I will admit nights are not for everyone. 

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Specializes in Critical Care.

The larger health risk to be aware of is increased risk of cancer if you work night shift that wasn't mentioned.  Be aware, get screenings and do what you can to decrease that risk.  

I've always been a night owl and found working nights was best for me and even allowed a social life, more so than when I worked PM's.  PM's was socially isolating for me as I didn't drink, was too wound up to sleep when I got home and then was up till early hours with nothing to do and then it was time to go to work the next day.  While I didn't love 12-hour shifts, it was nice only being at the hospital 3 days a week and having more time off.  Nights was more laid back and less stressful to me than days or PM's.  

I usually didn't eat at work as when I was on alert I lost my appetite, so would eat breakfast after.  My bad habit was a pepsi addiction since I was a teen so I would drink a pepsi at work and usually that was all.  I finally broke that with the help of topamax and my heartburn has improved. 

After work you can call someone or go shopping and plus having 4 days off, even with needing to sleep before/after your shift some, you still have time to socialize and or do hobbies etc.

Personally, I think rotating shifts between days and nights is worse.  It is good to be aware of the risks of shift work and ways to mitigate it as much as possible.  

Using blue blocking glasses in the morning drive home would also help with sleep and I use blackout curtains.  I even took one of the plastic transfer sheets and taped it up over my window to block even more light.  Plus I use a sleep mask and with the migraine meds I don't have trouble sleeping.

You gave good suggestions for helping to adjust to night shift.  It is not for everyone.  For many it is just a starting point where they quickly pass thru because they prefer days and that is fine.  

Thanks for your suggestions!

 

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Specializes in Med Surg, Tele, Geriatrics, home infusion.

I've worked all the shifts, but for the past 15 years or so it's been 7p-7a 24hrs/ week at my hospital and then home infusions at people's houses the remainder of the week. I love having an acute and a non acute nursing job. It allows me to be a night owl and supplement my income/hours with a side job where I make my own schedule. As long as you allow yourself "you" time to catch up on rest/ tasks, night shift can be amazing for flexibility. 

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