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Discussion

Benefits of napping on night shifts

Napping on breaks during a night shift can boost nurses’ health and patient safety

In this article…

  • Dangers of tiredness for nurses and patients
  • Advantages of night napping
  • Strategies to reduce fatigue at work

 

Author

Diana E McMillan is associate professor and Wendy M Fallis is adjunct professor; both at the faculty of nursing, University of Manitoba, Winnipeg, Canada.

Abstract

McMillan D, Fallis W (2011) Benefits of napping on night shifts. Nursing Times; 107: 44, 12-13.
Many nurses deliver care when they are fatigued and sleep deprived, which may place them and patients at risk. A qualitative study found restorative napping on breaks during night shifts helped to improve energy, mood, decision-making and vigilance. This article looks at the benefits night napping can offer nurses doing shift work.

Keywords: Night nursing/Shifts/Sleep/Fatigue

  • This article has been double-blind peer reviewed
  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article

 

5 key points

  1. Most adults appear to need seven to eight hours of sleep per night
  2. Nightshift workers frequently sleep fewer hours than recommended
  3. Shift work, patient care demands, individual sleep characteristics, domestic responsibilities and environmental factors can affect nurses’ sleep health
  4. Nurses and healthcare organisations need to find sleep health solutions to support staff health and reduce nurse and patient safety risk
  5. Restorative napping is effective in reducing fatigue and improving performance


Nurses perform a critical role in patient care. Typically, they are the team members spending the most time with patients and families, are the first to detect and assess changes in health status and the first to react to change and to communicate the need for intervention and team support. They are also the team members who deliver the majority of the ongoing pharmacological, physical and emotional treatment interventions.

Sleep health promotion

Delivering good nursing care demands vigilance, complex cognitive functioning, advanced technical skill and dexterity, and emotional readiness and engagement.
When nurses are rested and alert, patient care is usually a manageable challenge. However, many nurses deliver care when they are fatigued and sleep deprived, which may place both them and the patients in their care at risk. That is why sleep health promotion for nurses should be a priority in both the profession and healthcare organisations.
Most adults appear to need seven to eight hours of sleep per night, with fewer than seven and more than nine or more hours associated with increased morbidity and mortality (Bonnet and Arand, 2011).
For people such as night shift workers, who sleep during the day, the amount of sleep obtained is frequently below recommended levels and its quality is poorer than in those who are able to sleep at night (Gold et al, 1992).
For nurses, shift work, patient care demands, individual sleep characteristics, domestic responsibilities and environmental factors all combine to challenge sleep health.
One US study of medical surgical nurses reported that, before a sleep health intervention, nurses reported obtaining 6.81 hours of sleep on average during work days and, in those specifically working night shifts, that duration averaged 6.32 hours. Subjective sleep quality was clinically impaired in 85% of nurses (Scott et al, 2010).
With reports of sleep disturbance, through insufficient and/or impaired quality of sleep, it is not surprising that nurses are tired. In a study by the Canadian Nurses Association and the Registered Nurses’ Association of Ontario, 55.5% of nurses reported experiencing fatigue during work from almost always to all the time (CNA and RNAO, 2010).
One critical care nurse, in a 2010 study by Fallis et al, said: “It’s a combination of the more nights you do, the more exhausted I feel, the more exhausted I get. And there’s this tiredness that cannot be sorted by sleeping a day or so. No matter how much rest you get, there’s just this exhausting thing about night shifts that you can’t sort.”
The fatigue that can result from sleep disturbance can lead to cognitive, motor and mood impairments, reduced vigilance and increases in errors and injuries (Fallis et al, 2010; Scott et al, 2010). Nurses have also reported significant risk for motor vehicle collisions after working night shifts (Fallis et al, 2010; Scott et al, 2010).
The solution to addressing this health concern is multifactorial. Nurses and healthcare organisations need to work toward effective sleep health solutions to support staff health and reduce nurse and patient safety risks. Box 1 offers highlights of recommendations taken from the CNA and RNAO study report (2010).

BOX 1. STRATEGIES TO REDUCE FATIGUE AT WORK

  • Prioritise sleep health
  • Try to come to work well-rested
  • Recognise your personal energy limits and restrict overtime so you do not work more than 12 hours a day or 60 hours a week
  • Recognise the signs of fatigue in yourself and colleagues - slowed reaction time, cloudy thinking, struggling to stay awake, increased clumsiness, irritability, impaired memory
  • Document and report working conditions that contribute to fatigue or safety risks
  • Use a buddy system to monitor fatigue levels; work as a team to reduce fatigue
  • Promote work schedules that foster regular circadian rhythms, rapid adaptation and adequate rest between shifts
  • Develop and implement sleep health policies promoting sleep health and fatigue reduction
  • Provide sleep health education, optimise shift scheduling and create safe, accessible nap and rest environments

SOURCE: CNA AND RNAO (2010)

 

Restorative napping

Restorative napping, defined as a purposeful, brief sleep period, has long been considered effective in reducing fatigue and improving performance and vigilance in non-heathcare work environments (Mednick et al, 2008).
Napping is also receiving attention as a strategy to combat fatigue within the healthcare field (Arora et al, 2006; Smith-Coggins et al, 2006). In a qualitative study exploring napping on breaks during night shifts, 10 out of 13 critical care nurses who napped regularly during breaks reported several benefits to napping, including improved energy, mood and decision-making, and vigilance (Fallis et al, 2010).
Despite the benefits of napping, it is not universally adopted by nurses working night shifts. Lack of adequate nap facilities, patient care demands, understaffing, interruptions, perceived lack of management support, fear of sleep inertia (Fallis et al, 2011) and feelings of guilt have been reported as barriers (Scott et al, 2010). Box 2 lists organisational strategies to enable staff to take naps.

BOX 2. EFFECTIVE NAPPING STRATEGIES

  • Ensure nurses take uninterrupted breaks and plan to take a rest or nap (20 minutes)
  • Ensure they plan a recovery period before returning to work (15-20 minutes to get over sleep inertia)
  • Create a nap room that is quiet, safe, clean, close to the unit, has a private area for each user, and that is not a multi-use or lounge area
  • Offer places to lie down such as beds, couches, stretchers or reclining chairs
  • Offer amenities such as blankets and pillows or a locker so staff can bring their own
  • Use dimmer switches in the room and keep lighting low
  • Include timers to alert nappers at the end of the nap period

Source: Fallis et al (2011); Geiger-Brown and McPhaul KM (2011)

 

Conclusion

The sleep health of nurses must be a priority to optimise nurses’ health and safety, and the wellbeing of the patients in their care. Action at the individual and organisational level supporting good sleep health practices and policies will promote healthier, more effective and safer nurses.

For information and advice, visit the National Sleep Foundation website here.

Readers' comments (7)

  • Little One

    So we've known for a while that napping is good for you when working night shifts and yet Nurses at my trust have recently been disciplined for gross misconduct for sleeping in the staff room on their breaks. Doctors have on-call suites with proper beds to relax in when they are not required on the wards, why aren't areas like this provided for Nurses so that we can benefit from the restorative quality of having a nap overnight? And why are Nurses still being disciplined for napping when we know the benefits? It needs to become an acceptable practice rather than people sneaking off and feeling guilty. I don't get paid for my breaks so if I decide to nap for 30 minutes then why should I fear disciplinary action?

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  • Adam Roxby

    Hello there.
    I think this is a very important article. I have felt dire during some of my night shifts and while I do try and have a napp during my shift it's not always the case.
    I have also flet very unsafe driving home at times which worried my wife no end.
    Fiannly, I need a good day or so to get back to normal so on the whole the extra money may be draw but for me it's not that worth it.
    I agree with Little One, we need to create a culture that views napping as am important fuction to maintin our health not as something to feel ashamed about.

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  • I certainly agree with this article regarding the benefits of napping. However, in my experience, in a certain London hospital, nurses 'nap' a lot longer than 40 minutes. In some cases, i have witnessed qualified staff sleeping for 90 minutes - 150 minutes. And then, there begins a rush to get 'everything done' before the morning staff arrive. Unsafe and totally unprofessional. It seems to be the culture of the ward ,though. I am a student nurse now and would like this culture to change.

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  • At the Trust where I work, although our night shifts are 10 1/2 hours long we do'nt have an official break and it is Trust policy for staff to be disciplined if caught napping.

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  • Yes why should we feel ashamed to admit we have a nap in our breaks. I work mainly nights on a busy ward and I use my hour break to eat my supper and then have half hour shut eye. I am one of those who don't need an alarm clock as I just tell my self to wake up at at a certain time and then like magic I open my eyes at said time. I obviously don't go in too deep a sleep. After my power nap I feel refreshed and ready to take over what ever is happening on the ward. I am cut out for nights and love working them. The night goes too quick for me and I sometimes wish I had an extra hour to fit in all I want to do! But we are made to feel guilty for napping at night. I can't see the problem as long as nurses come back on the ward ready to work. i know there are some who come back looking and feeling groggy but they would probably feel like that without a nap and are usaully nurses who are made to work nights even though they can't cope with it, due to this silly rotation. I say scrap rotation and let nurses who can cope with nights do them. I'd like to know who makes these rules about not napping at night and see if they would like to go all night without resting their eyes and then look after the patients and I bet they would rather be tucked up in their own beds all night!

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  • i work in a nursing home on the night shift and it is a sackable offence if caught napping. we also have to sit in the reception room, not allowed television of any stimulas to keep us awake. I find this crazy as studies do suggest that there are benefits in power naps for nurses and carers.

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  • I developed a working at night guidance for the service I worked for in Sheffield Teaching Hospitals that was multidisciplinery not just nurses and midwives; afterall doctors also work night shifts.
    The guidance encouraged staff to do all the things above in the article. It also removed the curiosity and ambiguity for staff about sleeping during your break, which in the NHS is unpaid - we can question can any employer tell you what you can do when they are not paying you?!
    It is about upholding your duty to safe to your patients & your employer - if you need a nap do it in your break!

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