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Sleep Factors and the Night Shift

By: Brooklyn Barney, Sami Dalessio,


McKenna Foxworthy, Molly Hughes, Holly
Hunt, Kaitlyn Jensen, Emily Kingsley,
Miguel Nava, & Lindsey Warne

Lab Group A
Introduction

“Nurses who work the night shift often


experience high levels of sleepiness as a
normal biological consequence of
working during a dip in the circadian
rhythm (2am-6am).” - Jeanne
Geiger-Brown, MD
Introduction ● Incidents associated with
decreased sleep:
○ Medication errors
○ Poor judgement
○ Reduced
alertness/stimulation from
environment
○ Job related injuries and
accidents
○ Motor vehicle accidents on
ride home
○ Long term health
impairments
Clinical Question

In night nurses, how does the


implementation of fatigue
countermeasures (napping and
sleeping schedule), compared to no
countermeasure, affect safe
practice?
Summary of No national standard/protocol
to aid in safe practice related to
Current Practice
fatigue in night shift nurses.

Some hospitals have begun


implementing specific
schedules to decrease fatigue.

Some allow napping during


breaks, but none have
specifically set nap breaks.
Napping:
Synopsis of Current
● Sleep deprivation
Literature Research
Findings Related to ● Napping effects
○ Mental
the Issue ○ Physical
○ Safety

● Hospital environment

● Manager and nurse


attitudes
Synopsis of Sleep Schedule:
Current Literature
● Nurses employ different
Research Findings sleep schedules: switch
Related to the sleeping, same sleeping,
Issue - Sleep shifted sleeping
Strategies
● Nurse preference and most
effective sleep schedule

● Difference in time off


requirements between shifts
Strengths and Limitations
Strengths: Limitations:

■ Consistent with previous research ■ Hawthorne effect


■ Randomized control trial ■ Small sample population
■ Adequate sample size ■ Studies conducted in different
■ Valid scales used to measure countries
sleepiness and effectiveness of ■ Difficult to conduct a “blind” study
napping with this topic
■ Approved by Institutional Review ■ Small response rates
Board ■ Lack of diversity- gender, age, race,
■ Use of specific inclusion and culture
exclusion criteria ■ Low accuracy instruments of
measurement
Evidence Based ● Taking two 15 minute naps
Nursing or one 30 minute nap
Recommendations during the night shift.

● Nurses switching from the


night shift to the day shift
or those switching from day
to night need two days
between scheduled shifts.
● Average cost of medication
errors each year per
Cost Analysis: hospital is approximately
Resource Nurse $600,000
● Nationally, medication
errors account for 5.1 billion
US dollars annually
● Implementation of 2
part-time resource nurses
in the ICU
● RN’s on average make
$69,000-$72,000 ($70,852
in Arizona)
Cost Analysis: It is imperative that healthcare
workers are educated on the
Sleep Educator importance of work fatigue, and
the prevention of medication
errors.

Nurse manager compiles


educational materials and videos to
present to staff about circadian
rhythms and sleep hygiene ($10
dollars to print)

Education is PREVENTION!
Nap Pods
● $ 16,000

● Studies show taking 20


minute naps
rejuvenates the nurse

● Arm rest has timer


control
Overall Application
Timeline:

● Week 1: Nursing manager will compile sleep education and resources.

● Week 2: Unit nurses will review the informational materials.

● Week 3: Purchase sleep pod and hire resource nurses

● Week 4: Orient the resource nurses to the unit

● Week 5: Utilize a quiet room on hospital floor for sleep pod (break room)

● Week 6: Inform nursing staff of new sleeping regulations and put sleep
plan into action on upcoming shifts
Risk vs. Benefit

● Risk: ● Benefit:
○ Less staff available in case of ○ Nurses experience less fatigue
Rapid Response ○ Fewer medication errors
○ Nurses can wake up less ○ Less drowsy when driving home
refreshed and more fatigued ○ More likely to participate in
than intended patient care
○ Nurses can abuse the sleep ○ Lower burnout rate
protocol (i.e. sleeping longer ○ More likely to float to the floors
than the limited 30 minutes) with sleeping protocols
○ Lack of personal relationship
between the patient and the
“resource nurse”
Evaluation of ●

Nurse manager in charge
Calculate/analyze total # med
Medication Errors errors over one year on night shift
● Implement nap protocol
● Collect med error data for one year
● Compare data with naps against
data without out naps

Expected finding: errors will decrease


in a moderate (15-30%) with nap
protocol in place
Evaluation of ● Initial survey
○ Feelings towards work fatigue
Nursing Staff ● Implement nap policy for 1 year
Retake the same survey
Satisfaction ●
○ Feelings towards work fatigue
● Compare numerical result to
nurses’ feelings of fatigue with and
without nap protocol
● Analyze nurses’ perception of
effectiveness of naps on the night
shift

Expected finding: nurses will feel more


confident in their ability to perform
Summary
● Unsafe practice occurs on night shift at a higher rate than
day shift
● Lack of adequate sleep leads to clinical errors
● Napping prevents fatigue and allows nurses to feel
refreshed
● Nurses who adjust sleep schedule to sleep during the day
are most adaptive to the night shift and well rested
● Implementation: Two 15 minute or one 30 minute paid
nap
Summary (cont.)

● Hire a ‘resource nurse’ and sleep educator, install nap pod


in staff lounge
● Cost: $86,000 for the first year and $70,000 thereafter
● Risk: abuse of sleep protocol, resource nurse lack of
relationship with the patients, nurses waking up groggy
● Benefits: less fatigue, fewer patient care errors, higher
morale

X
References
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Geiger-Brown, J., Sagherian, K., Zhu, S., Wieroniey, M. A., Blair, L., Warren, J., Hinds, P. S. & Szeles, R. Napping on the night shift: A two hospital
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Hammacher Schlemmer. (2017). The productivity boosting nap pod. Retrieved from http://www.hammacher.com/Product/12199

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“I’m so tired”- Philip
Moya

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