Nurses Are Talking About

Support for Napping on the Night Shift

Troy Brown, RN

Disclosures

November 22, 2016

Nurses Talk About Napping

A recent Medscape article about whether night-shift nurses should nap at work led to more than 700 nurses adding comments on the article and a related poll.

The Medscape article described a study[1] conducted by nurse researchers who investigated the feasibility, safety, and effectiveness of implementing a napping program for night nurses. They approached six nursing units about participating in the study. Only one unit implemented the program and it was so successful that they kept and improved the program after the study ended.

Nurses who participated in the accompanying poll overwhelmingly supported night nurses being allowed to take naps at work: 68% said they support the practice, 20% said they do not support the practice, and 12% were not sure. Half of the respondents admitted to at least occasionally napping at work.

[Note: Comments appearing below may have been edited for clarity and length.]

Driving While Fatigued

Not only can quality of patient care suffer when nurses are overly fatigued at work, but the nurse's safety is also compromised during the drive home. Among poll respondents, 71% said they had fallen asleep at the wheel or had a close call while driving home.

Driving while fatigued is now considered to be just as serious as driving while intoxicated. The difference is that a drinker knows that he or she has been drinking. The nurse who just got off the night shift might feel awake and alert when pulling out of the parking lot, only to be lulled to sleep during the drive home. "Many times the hustle of work can keep us awake for the shift, but then when the adrenaline is gone and we are driving home, it is impossible to keep our eyes open," one nurse commented.

Nurses spoke about colleagues who had died after falling asleep at the wheel on the drive home from work after the night shift. One lost a colleague who left three young children. "It shook our world, and apparently the hospital's as well: No more working more than two 12-hour shifts in a row," she said.

Many nurses told stories about how difficult it was to get home safely after working the night shift, like waking to the sound of a horn after they fell asleep at a red light. Or the story of a nurse's husband who called all of his wife's friends trying to find her 6 hours after her shift ended. It turned out that she had to pull over and sleep before she could continue driving home. She was so tired that it was after noon when she woke up.

Another reader described her own experience with driving while fatigued. "I was a night nurse for many years and I remember those near misses. I rolled over a vehicle due to lack of sleep. It's not normal, healthy, or safe to try to tell your body that it cannot sleep or rest when it is trying so hard to do so."

"I have fallen asleep twice, to be awakened by the sensation of driving over grass," another nurse commented. "When will administration look at lives and not dollars?"

A nurse who wholly supports the idea of napping tells the story of how she fell asleep while driving home, almost in sight of her house:

"I hit an 80,000-pound tractor towing a steel tank. I ended up with a totaled car, a head laceration, and a fractured femur that kept me out of work for 6 months. I was lucky not to have been killed. It's time that nurses, physicians, and administrators realize the potential dangers of driving while impaired from lack of sleep and take realistic steps to address this issue. I say cheers for the managers who were willing to implement the sleep study."

Another nurse described a particularly scary incident that prompted her to make a big change:

"I remember vividly that after my night shift on a beautiful Easter Sunday morning, I came to an intersection with a red light and thought how wonderful it would be if I could just close my eyes and rest for a little while. The next thing I knew I was awakened by the Ohio State Patrol! I have no idea how many red lights I slept through with my foot on the brake but when I was threatened with arrest and having my car impounded for being 'highly impaired,' I woke up—literally and figuratively—and quit my job! I could no longer take a chance on killing myself or others."

Nurses who drive aren't the only ones who have difficulty getting home after working a night shift. "Many years ago, I changed jobs to a hospital within walking distance of my house because too often I fell asleep on the subway on the way home," one nurse commented.

A Common Practice Around the World

When the hospital doesn't have a napping policy (and most hospitals don't), nurses cobble together enough time for a nap by combining their 30-minute lunch break and their two 15-minute breaks. They often take turns caring for each other's patients, and nurses taking their nap are mindful of returning to their patients on time so the next nurse can nap. Many claim that it is best to take a short (15- to 20-minute) nap rather than a longer one.

A more formal rest and napping policy in place at one hospital was described by a reader:

"One of my first night-shift experiences was improved greatly by an organized and supervised hour-long break arrangement, with multiple locations. The nurse or other staff member could focus completely on resting, knowing that he or she would be awakened promptly by the next staff person in line for a break, with backup from the charge nurse."

Nurses from around the world wrote in to say that napping is more widely accepted in other countries. "Napping has been common practice in Canada for many years," a nurse from Victoria, British Columbia, said. "When I worked in the United States where nurses were not permitted to nap, it was almost fatal to me."

On the differences between countries, other nurses chimed in:

"We have had many Canadian nurses come and work with us. They are shocked at the lack of nap time, which is a given in their hospitals. They are provided with beds and an hour of rest each shift. I believe it is time for a culture change," said one US nurse.

A head nurse from São Paulo, Brazil, described a system created with full administrative support:

"We implemented a 2-hour rest for the nursing staff on the night shift. It was a success, there were no more delays in medications, and complaints of lack of assistance decreased. There was a decrease in absences. On nights when there were many tasks and many more seriously ill patients, the rest time was shorter."

A nurse who worked in intensive care in England in the early 1980s described being able to nap in the nurses' lounge during breaks for 30-45 minutes. "I found it very helpful for getting through the shift. Napping was not only allowed, but encouraged by the administrators and other staff," she explained.

Nurses from Scotland, Asia, Australia, and Peru also said that napping at work is acceptable in their countries.

Napping in the USA

One nurse who spends part of the year in Florida and part of the year in California has found differences from state to state in how breaks are handled:

"In Florida, it is common to be told that you must cover your coworker's four patients (in addition to your own, for a total of eight patients) while your coworker takes a break. Of course, this is unsafe and unethical, so no one takes a break. California has state laws that do not allow this. The employer must staff enough nurses to provide a completely relieved lunch break and two short breaks if the shift is12 hours. It is sad that it takes a law to provide ethical and moral treatment of nursing staff."

Many nurses wrote in to say that their hospitals do not allow napping. "If you are caught sleeping anywhere, even during your unpaid 30 minutes, you are fired. It's OK to take a walk around the property (they have a walking track for employees outside) but it's not OK to nap—go figure!" one nurse wrote.

Another nurse, who tried to get administrative support for napping, said:

"I mentioned napping to our director once and was laughingly told that I wouldn't get support to pay nurses to sleep. I currently get one break for 5-10 minutes during my shift if I am lucky. But ask any magnet hospital or hospital working toward magnet status and they will tout that 'nursing controls nursing.'"

Nurses Who Don't Support Napping

Not all comments from readers were positive, however. Some nurses said they disagree with napping on the job. Some felt that nurses who want to nap at work are not being responsible during their off hours by not getting enough sleep.

"Nurses who work the night shift should take responsibility to sleep before going to work. It should not be up to the hospital to worry about the staff getting their rest," wrote one nurse. "Absolutely not. Ridiculous!" said another nurse about napping at work.

"Nights wasn't my favorite shift, but I never felt that it was right to nap. You're being paid to be awake and observant," explained one nonnapping nurse.

Some said that nurses who have trouble staying awake on the night shift should work a different shift, but others responded that this is not an option for many nurses.

'We Can Do What We Want on Our Unpaid Break Time'

Many nurses pointed out that they aren't paid for their break time and should be able to do what they want. Some said that if day nurses can leave the hospital during their lunch breaks, night nurses should be able to take naps.

One nurse remarked, "If day-shift nurses can use their half-hour breaks—without pay—to run errands, go to the bank, to a coffee shop, or to the cafeteria in another building, they why shouldn't the night staff have the same privilege to use their personal time as they see fit?"

"Technically, it is our time, and as long as our patients are covered, we should be able to rest so we can remain safe and alert caregivers," one nurse wrote.

A Question of Fairness

Many nurses questioned why it is acceptable for physicians to nap but not nurses, and others said that it is not a good comparison because physicians are on duty for much longer periods of time. Most agreed, however, that if physicians can awaken quickly and respond to emergencies, nurses can also. "Why is it that medical residents are given a sleep room and nobody worries about them waking up with sleep inertia and poor judgment?" one nurse asked.

"For as long as anyone can remember, doctors have had access to an 'on-call' room for sleeping. To deny the same to nurses is ridiculous, discriminatory, and dangerous, as we have seen in countless studies," one nurse commented.

Several nurses said that other professions recognize the need for sleep and wondered why nursing does not. A nurse speculated that this was due to a gender disparity:

"We would never let a truck driver or a pilot work [long] hours without a break, because fatigue might lead to a mistake that could kill people. Why do we overlook fatigue in nurses, whose mistakes can likewise lead to injury or death? All of the groups mentioned—doctors, truck drivers, pilots—are male-orientated professions. Nurses [and] midwives are female."

Another nurse was alarmed by the fact that, in the original study, five of the six units invited to participate in the pilot program were "cut off at the knees by the managers."

Making Matters Worse: 12-Hour Shifts, Rotating, Off-Duty Meetings

Several nurses blamed on-the-job fatigue on 12-hour shifts. "With 8-hour shifts you can take a nap after dinner before you go in for your night shift," one said.

Being required to attend staff meetings in the morning after a long night shift is also problematic. Holding staff meetings during the afternoon is no better, as this requires the night nurse to interrupt sleep. One nurse described a tragic consequence of requiring night-shift nurses to attend a daytime meeting. "The manager decided to hold a mandatory unit meeting in the morning, requiring the night staff to stay over. A nurse fell asleep at the wheel driving home and died."

Other nurses echoed these concerns.

"Managers expect night-shift workers to attend meetings after working a 12-hour night. I was asked once to return at 1:00 PM for a 4-hour class after working all night. I did not," wrote one nurse. Another nurse believes that:

"Sleep deprivation is a form of torture. We need to support nurses to feel valued and appreciated when caring for patients at a very difficult time of the day. This piece of research is great; it is very disappointing that so few hospitals felt able to participate."

An Idea That Deserves Further Study

Nurses described the many concessions they have made to improve their own safety when they are fatigued from working the night shift. Some said they moved closer to the hospital so their drive home wasn't as far. One nurse said that her spouse now drives her to and from work.

In some cases, the hospitals are taking steps to ensure that their nurses get home safely after working nights. One nurse described a hospital that requires nurses to nap or go home in hospital transportation or a cab.

Several nurses said that hospitals should have a space for nurses to nap after their shift is over, before they begin their commute home.

One nurse said that if hospitals won't approve napping, they should have designated drivers to get nurses home safely. Another nurse, who used to work nights, said, "I always felt that my drive home, which is longer than 30 minutes, was dangerous. I definitely felt impaired. Finally, after a near-accident, I no longer worked nights for any reason."

Most nurses agreed that allowing nurses to nap on the night shift is an idea that deserves further study.

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