This study is the first to evaluate sleepiness in night-shift nurses using the ESS and the MSLT, but not the first to document at least subjective reports of nurse sleepiness, the investigators wrote. The authors of a Japanese survey of 4,407 nurses estimated at least 26% of those respondents suffered from excess sleepiness, and in a survey of 502 American nurses, two-thirds said they struggled to stay awake during their shifts. Dr. Subramanian pointed out that in studies of emergency room doctors and nurses, as well as workers in other intense, high-stress occupations, vigilance dwindles and sleepiness mounts after eight and especially 10 hours.
This can have serious consequences for patients and healthcare workers alike, he warns.
Excessive sleepiness “correlates very robustly with medical errors, incorrect operation of medical equipment, and falling asleep while driving.” In fact, some hospitals provide shuttle buses to transport night-shift workers to and from work, fearing they may be too exhausted to drive.
The Accreditation Council for Graduate Medical Education (ACGME) has limited work weeks for medical residents to 80 hours and no more than 24 hours’ continuous time on duty, but “that has clearly not worked: ICU residents still are extremely sleepy even when they adhere to the ACGME regulations,” Dr. Subramanian said. He recommended no one shift last longer than eight hours, and that healthcare workers be required to demonstrate they are not sleepy when they report to work.
Dr. Subramanian and his coauthors also found the ICU nurses had a higher mean body mass index than the floor nurses, which might suggest they eat more as a way of coping with higher stress levels. “Most nurses are women, and in addition to working 12-hour shifts, they’re probably taking care of their families,” he explains. “They’re not going home and catching up on their sleep.” TH
Norra MacReady is a medical writer based in California.