Should Night-Shift Nurses Nap at Work?

Laura A. Stokowski, RN, MS

Disclosures

August 05, 2016

Editor's note: Please consider taking our poll, Nurses: Do You Nap on the Night Shift?

Just a year ago, on August 2, 2015, at 8:00 in the morning, a nurse from Johns Hopkins University, driving home after working the night shift, was killed when her car left the road and crashed into a utility pole. Joanna Kaskasian left behind a husband and three children, ages 5, 3, and 11 months.[1]

"Drowsy driving," as it's called, is frighteningly common, as nurses who work the night shift are aware. Going to work "well rested" is no guarantee that, at the end of a long, 12-hour shift, the nurse will make it home safely. What makes Joanna Kaskasian's death even more tragic is that it was preventable.

My Kingdom for a Bed

Any nurse who has ever worked the night shift on a regular basis knows what it means to crave sleep. No matter how much attention and care the night shift–working nurse gives to personal sleep hygiene, a time comes in the early hours of the new day when circulating cortisol levels have hit rock bottom and the nurse would give almost anything for a nap—especially on the first night of a stretch, when the nurse has most likely been awake since morning, trying to live a normal life with the rest of the world. Many nurses could get over this predictable "hump" with a brief, 20- to 30-minute nap.

Nurses are somehow expected to ... just keep going and going, without sleep, without breaks, and without complaint.

Employee napping has been used successfully in many 24-7 industries, including hospitals, as a strategy to improve safety both on the job and during the drive home.[2] Yet in nursing, the practice of intentional napping has never taken off in a significant way. There is a persistent stigma attached to nurses taking naps, and moreover, most hospitals have written, enforceable policies against sleeping at work. Nurses are somehow expected to be immune to fatigue—they are the "Energizer bunnies" of healthcare who just keep going and going, without sleep, without breaks, and without complaint.

A Napping Pilot Project

A team of nurse researchers, dismissing the notion that napping is unprofessional, set out to determine whether napping on the night shift was feasible, safe, and effective.[3] They invited six different nursing units from two hospitals to participate in a pilot project in which the units would develop and implement a viable napping protocol, taking into consideration each unit's unique architecture, staffing levels, patient care needs, and nursing culture around breaks.

Three of the units never got to the planning stage because the nurse managers vetoed the idea upon hearing it, without presenting it to their staff nurses. Their reasons for declining to participate included insufficient staffing, concerns about nurses not waking up for rapid-response duty, a lack of suitable napping space, and general biases against nurses sleeping at work.

One unit didn't take formal breaks at all on the night shift, so napping would be superfluous on that unit. Two other units considered participating but ultimately were unable to overcome barriers to napping. In the end, only one of the six units invited to participate was able to implement the napping pilot project.

So, what happened on this single napping unit? The nursing staff collaborated on a plan for napping, devised a suitable napping space, planned for patient care coverage, and worked out other details. For 3 months, the nursing staff implemented their napping protocol.

To gauge its safety and effectiveness, nurses who napped completed a "sleepiness scale" before napping and a short survey afterwards. A total of 153 nap surveys were available for analysis. Pre-nap sleepiness averaged a "6" (on a scale of 1-10, in which 10 represents the highest level of sleepiness). Nurses fell asleep for more than half of the naps (43% slept "lightly" and 14% "deeply") and average nap duration was 31 minutes. Only 1.3% of napping nurses felt "very groggy" upon waking, although 20.3% admitted to feeling "a little groggy." After 52.6% of the naps, nurses felt "alert and refreshed" and overall gave a score of 7.3 out of 10 points on the "helpfulness of napping" scale (in which 10 represents "most helpful").

Many nurses commented that napping reduced drowsy driving on the way home. Incidentally, this unit voluntarily continued (and improved upon) the napping protocol after the formal study period ended; it's been in use the past 3 years. And it has also been implemented hospital-wide after the human resources department was convinced to revise the policy against employee sleeping.

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