Should Night-Shift Nurses Nap at Work?

Laura A. Stokowski, RN, MS

Disclosures

August 05, 2016

Viewpoint

As this study and previous studies have shown, napping can reduce fatigue on the night shift.[2] Although not universally beneficial, some nurses find napping enormously helpful. So then why have so few nursing units and hospitals adopted formal napping protocols for nurses who choose to nap? Minor issues aside, the primary reason is quite simple: Nurse managers and other administrators don't support it and many won't allow it. Many of these administrators, who go home at the end of the day, eat dinner with their families, watch a little TV, tuck themselves into bed, and are deeply asleep when their night-shift nurses are struggling to stay awake on the unit, threaten to fire any nurse who "sleeps on the job."

It was difficult to read this research report without becoming disheartened by the report of negative attitudes of nursing administrators toward napping, as well as the barriers thrown up by these individuals to make it impossible for nurses to take the very reasonable and safe step of planned napping during their night-shift breaks. Physicians have been napping in the hospital at night for eons, and jokes about "bed-head hair" aside, few people complain about sleep inertia when physicians race from deep sleep to a code.

From a patient-safety perspective, how is it possible to consider the few moments of grogginess that nurses might experience upon waking from a nap more dangerous than hours of fatigue and sleepiness experienced by the same nurse struggling to remain alert and provide safe care throughout the shift?

A nurse manager trying to staff a unit may have few qualms about asking nurses to work long stretches of 12-hour night shifts, to rotate from night to day and back to night in the course of a week, or to pull an extra last-minute night shift with no sleep beforehand. These things happen every day. What is increasingly difficult to understand is why hospital administrators and managers who require these kinds of work schedules then turn around and place all of the responsibility for nurses being awake, alert, and error-free (often break-free as well) back on the nurses.

It is a peculiar form of torture unique to the nursing profession.

It is a peculiar form of torture unique to the nursing profession. Nursing culture has for far too long accepted a warped reality that nurses don't need fully relieved breaks away from patient-care duties, even for a mere 30 minutes. Hospitals have long been unwilling to support this financially and have cut staffing margins to the bone, leaving no coverage for breaks. If nurses want breaks at all, they must cover each other's patients, a practice that sounds simple but isn't always feasible or safe.

Working 12 hours without a break, especially at night, is ignored as a safety issue, and it has been going on for so long that nurses simply accept not having real breaks as "just part of the job." Is it enough to just say, "You knew what you were getting into when you became a nurse"? In other words, "If you are tired at work, it's your problem" seems to be the message.

Fatigue might be part of the job, but it doesn't have to be. "From years and years of evidence, we know nurses are sleep-deprived and that it affects both their job performance and their ability to drive home safely," explained lead investigator, Dr Jeanne Geiger-Brown, dean of the School of Health Professions at Stevenson University. "This is not trivial. This is a real problem and—as demonstrated by the death of the Johns Hopkins nurse—a fatal problem in some cases. We need to pay more attention to it."

One strategy is an organized, planned, intentional napping program. "Napping is not that difficult to implement," added Dr Geiger-Brown. "People have to be willing to take a chance on it and make some minor changes. Nurses will still have to come to work well rested because they can't be assured of being able to nap on any given shift. But the fears about nurses napping while patients are being neglected are ungrounded. Nurses would not jeopardize patient care to nap."

What will it take to implement napping in other units and hospitals? "In the pilot hospital, nurses have been the ones who have moved this forward, not the administration," said Dr Geiger-Brown. So it looks like it will be up to nurses to use their shared governance rights to overcome barriers to napping and design napping protocols that will be effective and safe.

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