The battles for night shift nurses

Fatigue could be described as the scourge of the healthcare profession. Caused predominantly by a lack of good quality sleep, it is a physical and mental condition which manifests in the form of energy loss, overwhelming tiredness and impaired cognitive functioning. Understandably, fatigue remains a serious worry for medical staff, particularly those that need to stay alert during night shifts.

The reality of night working

As some nurses undoubtedly will attest, the financial reward for working unsocial hours is attractive and thus the night shift is something that many take on to bolster a pay packet that might have been frozen for several years.

Some may consider they have no choice but to 'do nights', regardless of the upheaval it causes to their personal life.

It is a tough choice, made more so by scientific evidence that suggests regular night working can lead to health problems.

The health impact of 'doing nights'

A recent study cited in NursingTimes.net found that disrupting the body's usual 24-hour biological 'circadian rhythms' by sleeping during the day-time could 'have far-reaching physiological health effects'.

Scientists discovered that delaying sleep by as little as four hours over a few consecutive days had a detrimental impact on some cell regeneration, brain activity, hormone production and other activities that operate in accordance with the circadian cycle; the amount of active genes working to this rhythm reduced from 6.4 per cent to just one per cent.

Nurse fatigue in particular, according to research by the Canadian Nurses Association, is influenced by more than simply an interruption of the circadian rhythm; 'multidimensional', it is compounded by stress, job demands and personal sleeping habits. 

Some people find it easier to adapt than others, over time becoming virtually nocturnal. For others, tricking the biological cycle is out of the question and it is for them that many health bodies have offered advice to help healthcare workers to endure night shifts a little more easily.

Create an environment that promotes sleepAs mentioned above, one of the biggest problems with working a night shift is getting enough good quality sleep.

Akin to jet-lag, many people are at the mercy of their own body clock, which might refuse to let them fall asleep as the day is dawning. Hence it is important to create an environment at home that promotes sleep.

To keep out the daylight, install thick black-out curtains or blinds and perhaps use a sleep mask.

Keep noise to a minimum by putting telephones on voice mail, possibly disconnecting the house land line and using earplugs if necessary.

It might be advisable to explain the situation to family and neighbours to request that they keep the noise down.

For a relaxed environment, keep the room tidy (mess can cause stress) and consider redecorating in calming neutral colours that inspire tranquillity.

Lavender scents are said to aid sleep, so some pot-pourri or fragrance diffusers might help you drift off.

Enjoy a relaxing pre-bedtime routine

Though you'll probably be tired from your shift, it is important to relax and unwind when you get home.

Avoid smartphones, tablets and laptops, the bright lights from which only serve to stimulate the mind and, if you can bear it, don't switch on the television.

Instead, take a short walk, do some gentle yoga, read or have a bath.

The Health and Safety Executive (HSE) says it's best to go to bed at the same time each night, to help you establish a routine.

To determine what time that should be, you may have to experiment with a 'sleep schedule', noting down times and any problems in a sleep diary to help explain tiredness.

These may even fall in two blocks of sleep if it suits you, so says Surrey University Sleep Centre's Professor Derk-Jan Dijk.

Once you have established the right schedule, HSE adds, stick with it.

Eat the right foods

Healthcare workers better than most will know that what you eat can impact your quality of life, but this is also influenced by when and how you eat.

Those on the night shift may suffer a disruption to their digestion, so easily-digestible foods are sensible.

These include fruit, vegetables and carbohydrates. Carbs are especially effective as they release insulin, which promotes the flow of sleep-inducing tryptophan.

To stay hydrated, opt for milk-based or de-caf drinks. Don't drink in vast quantities as you may find yourself waking to empty your bladder. 

Obviously stay away from sugary/energy drinks - which will provide a temporary boost but ultimately a fall in energy further down the line - and avoid alcohol as it impedes sleep quality.

Nicotine too, in high doses, can have the same effects as caffeine, so resist that cigarette until you've woken up or consider cutting down altogether.

Behaviour at workWebMD suggests that keeping the workplace brightly light during the night can help nurses stay alert.

Just as people suffering from seasonal affective disorder might do, those with fatigue may benefit from exposing themselves to special lamps to help 'train their body to adjust'.

A strong cup of coffee at the beginning of the shift can also help improve alertness, but switch to decaf as your shift progresses, so as not to impede your sleep later on.

It's also a good idea to factor your commute into reasons for fatigue - a long journey home is eating into your valuable sleep time. If your commute is too far it might be worth staying nearby when on the night shift or reverting back to days.

Easing from night to day

Of course, not everyone works a permanent night shift, many will work a combination of nights and days, to which it can be particularly difficult to adjust.

Once again, light therapy is suggested as an effective way to reset the circadian rhythms and promote sleep, while the HSE suggests that those 'coming off nights' should have a short nap when they get home, followed by an early night the next day to get back on schedule.

Rotations are hard, says Professor Dijk, as they don't give the body sufficient time to get used to one way or the other. For those that do work on rotation, it's easier to adjust from the day shift to night shift, according to WebMD rather than the other way round.

What your employer should be doing

Night shift workers are not wholly responsible for minimising fatigue, employers have a duty of care to their employees' as well.

ACAS, the employment advice body, says that employers are responsible for planning sensible rotas, should limit shift duration where possible and 'allow for proper recovery time between night shifts'.

Additionally, permanent night shifts should be replaced with rotational patterns, a statement that is based on HSE research which claims two- to three-day shift rotations are best.

Essentially, employers should be promoting education and raising awareness about nurse fatigue, helping managers and staff to identify the symptoms before they escalate.

Ultimately, a healthcare worker's primary concern is that of their patient and if fatigue compromises the quality of the care provided - through errors, slower reactions, lack of attention or reduced energy - then it may be time to consider going back 'on days' permanently.

That said, some of the above techniques may be able to solve sleep deprivation and mitigate fatigue, enabling some to enjoy the 'quiet' of the night shift and it's attractive pay rates.