Study looks at sleep deprived nurses and driving

  1. Hospital staff nurses who work extended hours, work at night, struggle to remain awake at work, or obtain less sleep are more likely to experience a drowsy driving episode, according to a study published in the December 1 issue of the journal SLEEP.

    The study, authored by Linda D. Scott, PhD, of Grand Valley State University in Grand Rapids, Mich., focused on data that were collected from 895 full-time hospital staff nurses, who completed logbooks on a daily basis for four weeks providing information concerning work hours, sleep duration, drowsy and sleep episodes at work, and drowsy driving occurrences.

    According to the results, almost 67 percent of the nurses reported at least one episode of drowsy driving, and three percent reported experiencing drowsy driving following every shift worked. On average, nurses reported experiencing an episode of drowsy driving one out of every four shifts they worked.

    Two-hundred eighty-one episodes of motor vehicle crashes/near-motor vehicle crashes were reported during the study period. The majority of these incidents occurred following shifts that exceeded 12.5 hours in duration. The likelihood of a motor vehicle crash/near-motor vehicle crash significantly increased with longer shift durations. The risk for a motor vehicle crash/near-motor vehicle crash almost doubled when driving following shifts that exceeded 12.5 hours.

    The risk for a drowsy driving episode doubled when nurses worked 12.5 or more consecutive hours. Working at night also significantly increased the risk for drowsy driving incident. In fact, 79.5 percent of the nurses who worked only night shifts reported at least one episode of drowsy driving.

    Almost two-thirds of the nurses reported struggling to stay awake at work at least once during the study period, and 16.9 percent of the nurses actually fell asleep at least one during their work shift. Nurses who struggled to stay awake at work were significantly more likely to report struggling to stay awake driving home after work. In particular, the likelihood of a drowsy driving incident was tripled when nurses experienced episodes of drowsiness at work. The risk for a drowsy driving episode was also increased when nurses reported falling asleep on duty.

    Although research on the effects of chronic sleep restriction has revealed that most adults require at least seven to eight hours of sleep each night to avoid developing chronic sleep debt with its accompanying performance deficits, the hospital staff nurses in this study frequently obtained less sleep than this critical threshold. Only 20.8 percent of the participants reported obtaining at least six hours of sleep prior to every shift they worked. The risk for a drowsy driving episode increased by nine percent for each hour of sleep lost.

    "Given the large number of nurses who reported struggling to stay awake when driving home from work and the frequency with which nurses reported drowsy driving, greater attention should be paid to increasing nurse awareness of the risks and to implementing strategies to prevent drowsy driving episodes to ensure public safety," said Dr. Scott. "Without mitigation, fatigued nurses will continue to put the public and themselves at risk."

    Drowsy driving, the dangerous combination of sleepiness and driving, or driving while fatigued, while operating a motor vehicle, is becoming a growing problem in the United States.

    In a sense, drowsy driving can be comparable to driving under the influence, as sleepiness results in a slower reaction time, decreased awareness, impaired judgment and an increased risk of getting involved in an accident, resulting in unnecessary deaths or injuries to innocent people. Nearly nine out of every ten police officers responding to an AAA Foundation for Traffic Safety Internet survey reported they had stopped a driver who they believed was drunk, but turned out to be drowsy. The survey was coordinated with the National Highway Traffic Safety Administration (NHTSA).

    Drowsy driving can be prevented by becoming educated on the importance of sleep and the risks involved with taking the wheel while feeling fatigued.

    There are two main causes of drowsy driving:
    • Sleep restriction
      Persons getting less than the recommended seven-to-eight hours of sleep each night are more likely to feel tired the following day, which can ultimately affect their cognizance behind the wheel. Not getting enough sleep on a consistent basis can create "sleep debt" and lead to chronic sleepiness over time. While some factors, including working at a job that requires long hours and familial responsibilities, are beyond a person's control, other reasons for sleep restriction represent a lifestyle choice. This includes sleeping less to have more time to work, study, socialize or participate in other activities.
    • Sleep fragmentation
      Sleep fragmentation causes an inadequate amount of sleep and can negatively affect a person's functioning during the daytime. Sleep fragmentation can have internal and external causes. The primary internal cause is sickness, including untreated sleep disorders. External factors that can prevent a person's ability to have a full, refreshing night of sleep include noise, children, bright lights and a restless bed partner.
    Drowsy driving is the direct cause of approximately 100,000 police-reported crashes annually, resulting in an estimated 1,550 deaths, 71,000 injuries and $12.5 billion in monetary losses, according to the NHTSA.

    On average, most adults need seven to eight hours of sleep each night to feel alert and well-rested.

    According to the American Academy of Sleep Medicine (AASM), people can avoid becoming drowsy while driving by following these tips:
    • Get enough sleep
      AASM recommends that adults get seven-to-eight hours of sleep each night in order to maintain good health and optimum performance.
    • Take breaks while driving
      If you become drowsy while driving, pull off to a rest area and take a short nap, preferably 15-20 minutes in length.
    • Consume caffeine
      Caffeine improves alertness in people who are fatigued.
    • Do not drink alcohol
      Alcohol can further impair a person's ability to stay awake and make good decisions. Taking the wheel after having just one glass of alcohol can affect your level of fatigue while driving.
    • Do not drive late at night
      Avoid driving after midnight, which is a natural period of sleepiness.
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  3. by   Diary/Dairy
    Thanks - great article.
  4. by   TheCommuter
    I work 16 hour shifts every Saturday and Sunday. After completing these long shifts, I must make the six (6) mile drive home. To be honest, I feel like a drunk driver when making my way home on Sunday nights after completing my second double shift in a row. The fatigue and lack of sleep between shifts causes me to be a rather impaired driver on Sunday nights.
  5. by   HM2VikingRN
    It is just not worth taking the risk. There was a nurse convicted of vehicular manslaughter as a result of sleep impaired driving in MN. If you are tired don't drive. Take a short nap before driving home. I personally would hate to responsible for causing a death as a result of being impaired d/t fatigue.
  6. by   CaLLaCoDe
    I gave up driving after working an all night 12 when I was leaving a business in our town pulled out of the driveway. Realized there was oncoming traffic heading my way and immediately made a right into another driveway. I note the street was not clearly labeled ONE WAY. I am so lucky that I can walk home from my work and only risk a fall or frozen limbs.
  7. by   deleern
    After a couple of 12 hour shifts I have been known for making dumb driving mistakes.. Once I ran a red light... Just got a warning and and escourt home.... Thank goodness for small towns...
  8. by   UM Review RN
    I moved off night shift and this problem was one reason why I'm glad I did.
  9. by   oramar
    I never worked a 16 hour except when mandated, usually a 3pm to 7am. I remember driving home at 7:30 am and slapping myself in the face trying to stay awake. That was back when they used to threaten to turn you into the BON if you didn't stay. I don't think they can do that anymore.
    Last edit by oramar on Dec 4, '07
  10. by   Diary/Dairy
    I have only once worked a 16 and just would not do it again. I am tired enough after 12 hours.

    BTW, there have been some mornings that I was lucky to make it home.....totally do NOT remember how I got there.......
  11. by   ElvishDNP
    This study comes as no surprise to this nightshift nurse.
    I always pray that God will help me stay awake on the commute home, as 46 of the 48 miles are highway, and lonely highway at that. So far He hasn't let me down. But when I blink, I sure don't keep my eyes closed for long!
  12. by   Alois Wolf
    At my job where I work midnights, I often drive back and forth between different hospitals in NJ (Souther Ocean County, Kennedy, Virtua ect. and sometimes Cooper and even in Philly like Jefferson and Uni. Penn) and I can attest to this article. It is the scariets feeling in the world. No matter what you do, even if you try to dance in your seat you can still feel like your nodding off. It has happened to me so many times that I'd would ever want to count. The only thing that ever works for me is if I can my office and tell them that I have to take a 15 and pull off somewhere for a little power nap. I drive a 12 passenger van and that DEFINATELY not something you want to mess around with when your tired and especially when roads are the way the are during the winter months. If anyone has ever driven in Philly you will understand why this is even more so for an over-sized vehicle.
  13. by   Jokerhill
    I always eat an apple on the way home, I don't know why but it helps keep me awake and stimulated. But I know at a few long red lights I have closed my eyes and gotten scared I was falling asleep. I will shift my truck into park on long red lights now. Jeff
  14. by   Quickbeam
    I worked nights for over a decade and never had a problem. I think the reason was 8 hour night shifts. I was always able to get a full 8 hours of sleep in and still have a life.

    I work in highway safety now and the drowsy driving issue is huge. People from every walk of life are short on sleep and it is showing in the fatal #s.
    Last edit by Quickbeam on Dec 6, '07 : Reason: spelling!