Nursing

Night Shift Nurse Survival Guide: Resources, Tools & Tips

October 24, 2019 |

AdventHealth University

Fewer roles in healthcare are as misunderstood as that of night shift nurses, whose invaluable contributions to the well-being of patients and the success of nursing teams are consistently under-appreciated. It’s understandable that the work of night shift nurses goes unrecognized, because they are caring for patients while the rest of the world sleeps. Yet few nurses face more challenges and make more sacrifices for their profession than those assigned to the night shift.

For example, patients are likely to feel vulnerable at night: they are in unfamiliar surroundings, they are trying to sleep in a strange bed, they are usually in discomfort if not outright pain. And as any nurse who has worked the night shift will tell you, patients are as likely to be awake through most of the shift as they are to sleep through it.

Counterbalancing the challenges faced by night shift nurses are the many benefits that come with working through the night, such as spending days pursuing outside interests or advancing nursing careers. The resources and tips in this guide are intended to keep night shift nurses healthy, rested, and ready to provide their patients with high-quality care. As a great number of happy night shift nurses can attest, it is possible to enjoy time with family and personal pursuits while working the night shift.

Section One: The Role of a Night Shift Nurse

The most common misconception about night shift nurses, according to Grace Eire on the Little Things blog, is that all is calm at night. In fact, night shifts are just as busy as day shifts. As Eire writes, “People don’t stop being sick just because it’s nighttime.” Of course, nurses working the day shift have tremendous workloads, so they sometimes leave what Eire refers to as “less desirable” tasks for the night shift.

Having to deal with tired patients trying to sleep in an unfamiliar bed is only one of the ways the shift is tougher than day and afternoon (swing) shifts. For example, another disadvantage for night shift nurses is they may lack access to resources, such as a full-service cafeteria and other support operations. Here is a look at some of the unique challenges that night shift nurses must overcome, as well as ways to retain nurses who work the night shift.

A Night in the Life of a Night Shift Nurse

In many hospital departments, such as intensive care units and emergency rooms, the activity level doesn’t change from shift to shift. In other departments, activity may appear to decline at night because there are fewer staff and visitors around, but night shift nurses are kept as busy as their counterparts on other shifts. Night shift nurses often spend much of their work time responding to calls from patients, keeping them clean, monitoring and changing IV lines, and performing similar nursing duties.

Night shifts generally have fewer nurses and other staff working than other shifts, so nurses working at night depend on their nursing team for support. This means during their quiet times, night shift nurses are often kept busy helping other nurses. Throughout their shifts, night nurses try to ensure their patients get as much sleep as possible, because rest is important for their recovery. However, many report their patients are often tired, uncomfortable, and anxious in strange surroundings, all of which make patients grumpier than they are at other times of the day.

Sacrifices Made by Night Shift Nurses

The physical and emotional effects of working through the night and sleeping during the day are exacerbated by the feeling many night nurses experience of being excluded from work and social activities. This is just one of the challenges faced by night shift nurses that their counterparts on other shifts are unlikely to experience.

The greatest threat to the health of night shift nurses relates to the effects of chronic sleep deprivation. A study reported by Scrubs Magazine found that nurses slept one to four hours fewer per week when they worked the night shift. Among the risks resulting from sleep deprivation are a doubling of the chances of being in an auto accident after getting less than six hours of sleep in the previous 24 hours and a quadrupling of the risk after getting fewer than five hours of sleep.

These are among the elevated health risks faced by nurses working the night shift:

Night shift workers have a 42% higher risk of type 2 diabetes. (Occupational and Environmental Medicine)
Mortality from all causes is 11% higher for women who work more than five years of rotating night shifts, and mortality from cardiovascular disease is 19% higher. (American Journal of Preventive Medicine)
Night shift work disrupts metabolite rhythms affecting the functioning of the liver, pancreas, kidneys, and digestive tract, which may be linked to the increased incidence of gastrointestinal disorders and debilitating metabolic disorders among night shift workers. (Proceedings of the National Academy of Sciences)

Challenges of Leading a Hospital Night Shift

In addition to coping with a chronically tired nursing staff, nurse leaders face unique hurdles in keeping the night shift appropriately staffed, ensuring safe practices, and making decisions about when to notify a doctor in the middle of the night about a patient’s status. Managing the night shift nurses presents challenges for nurse leaders charged with ensuring their departments run well and their employees are motivated and growing in their careers.

Health Leaders cites studies that found errors and on-the-job injuries increase dramatically on night shifts, due primarily to the human tendency to lose focus and alertness at night, even with plenty of rest. Still, nurse managers can help night shift nurses perform at 100% effectiveness by devising work schedules that ensure sufficient rest between shifts. Managers should also watch for signs of fatigue in nurses on the night shift and encourage them to take regular breaks. In the past, few hospitals allowed night shift nurses to sleep on the job, but many now see the benefit in allowing nurses to take short nap breaks.

Section Two: Information and Resources for Night Shift Nurses

No matter the shift, workers must report for duty fully prepared to perform at their best. This means being thoroughly rested and feeling healthy and strong. It is imperative for nurses working the night shift to get sufficient sleep, eat nutritious meals, and engage in regular physical activity. These resources can help night shift nurses ensure they are able to maintain peak performance all through the night.

Adjusting to the Night Shift Sleep Cycle

Finding time to sleep is only one part of the overarching challenge of adopting a flexible schedule for meals, socializing, exercise, and favorite activities. Yet without sufficient sleep, all areas of a person’s life suffer. The National Sleep Foundation describes shift work disorder as a condition that arises from long-term night shift work and increases the risk of some chronic illnesses. Among these illnesses are heart disease, ulcers, obesity, and gastrointestinal and metabolic diseases.

To help night shift nurses get sufficient sleep, the U.S. Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health has developed an online training module designed to teach night shift nurses and their managers about the health risks associated with shift work and long work hours. The program also presents strategies that nurses and other night shift healthcare workers can use to counteract these health risks by adopting behaviors at work and outside work that reset circadian rhythms and ensure proper sleep patterns.

Statistics About Nurses on the Night Shift

A review of research related to nurse shift work conducted by the Sigma Theta Tau International Honor Society of Nursing determined that nurses—study subjects were almost exclusively female—who work entirely on the night shift have a greater risk of obesity (7.4%) or being overweight (18.6%), while nurses who do shift work for five or more years have elevated risks of breast cancer and death due to cardiovascular disease. In addition, the survey found that the risk of experiencing irregular periods increased 13% for each year that a nurse works rotating shifts.

Conversely, night shift nurses have a lower incidence of some diseases than their counterparts working other shifts: nurses who worked 10 or more years of rotating shifts are 44% less likely to contract melanoma, and those who work more than 15 years on the night shift are 50% less likely to develop Parkinson’s disease. However, nurses who work rotating shifts have a much higher prevalence of irritable bowel syndrome, and night shift nurses are more likely than their coworkers on other shifts to experience depression and high states of anxiety.

Considering the impact night shift work has on a nurse’s health, family, and social life, it is not a surprise that hospitals often find it difficult to keep the night shift adequately staffed. A study published in the journal Research in Nursing & Health establishes a correlation between nurse-to-patient ratios and successful patient outcomes and lengths of stay (LOS). The study found that while nurses on the night shift spent 64.4% of their work hours providing patient care compared to 60.2% for nurses working the day shift, patient outcomes were worse on the night shift than during the day. For all shifts, the researchers found that patient outcomes and LOS improved as nurse-to-patient ratios fell.

Resources for Night Shift Nursing Leaders

Night shift nurse managers soon learn that nurses on their watch require a different leadership style than their counterparts on other shifts. The policies and procedures set by nurse managers and health administrators are key to ensuring that night shift nurses have opportunities to contribute to the organization in many different ways and to advance toward their career goals.

For example, while all nurses need to develop strategies to cope with the stress that is inherent in their work, night shift nurses have fewer support services at their disposal during their work hours. RN Journal describes how the increased risk of health woes and the disruption of social life inherent in night shift work are made worse by the lack of experience many night shift nurses have because many are recent nursing school graduates.

Nurse managers must adopt strategies that combat the factors that contribute to the negative impact of shift work. First, they have to qualify potential night shift nurses to confirm that they are well suited to working the night shift, particularly whether they will be able to adjust their sleep patterns and circadian rhythms to compensate for night work. They must also make night shift nurses aware of the health risks associated with working at night and encourage them to eat a nutritious diet, exercise regularly, and get sufficient rest, even if doing so requires taking “micro naps” as work breaks.

Section Three: Tips and Tools That Help Nurses Thrive on the Night Shift

Night shift nurses must make an extra effort to ensure they get sufficient rest, nutrition, and exercise to avoid fatigue, burnout, and illness. The tips for working night shift nurses presented here can help them establish healthy and restful routines that keep them functioning at their best in their work life and home life.

How to Establish a Restful Sleep Pattern

Nurses working the night shift can reduce the chances that they will suffer from chronic fatigue and insomnia by understanding the causes of sleep-related problems and learning techniques to help them establish a healthy sleep routine. American Nurse Today recommends that nurses have a set time when they go to sleep and wake up. The mistake many night shift nurses make is to plan their sleep time around their personal activities rather than the other way around.

Sticking to set sleep and wake times requires that nurses give up some opportunities to socialize with family and friends or take part in other favorite activities. Still, maintaining a regular sleep schedule that guarantees seven to eight hours of sleep is one of the best ways for night shift nurses to stay healthy and alert. To avoid the interruptions that are common to people who sleep during the day, nurses should find a quiet sleep area that is free of distractions. Just as with getting a good night’s sleep, it helps day sleepers to establish a pre-sleep routine, avoid caffeine, and maintain a comfortable temperature in the sleep area.

Adjusting to Life as a Night Owl

Some night shift nurses stay awake on their nights off to avoid the “hangover” feeling that commonly occurs when alternating between sleeping during the day while working and sleeping at night on their off days. Whether they adjust their sleep times to their activities or follow the advice above and stick with set sleep hours, nurses must maintain healthy eating and exercise routines whether or not they keep vampires’ hours.

In an interview with the National Sleep Foundation, a night shift nurse identified as Sarah L. says it can be challenging to motivate herself to participate in social activities after stressful work shifts. To avoid the “night shift hangover,” she groups her night shifts together and tries to exercise before her shift as often as possible so she can “experience daylight.” On the day after her last shift in a group, she takes a “short sleep” of a few hours and then goes to bed early to be rested for the next day. As with many night shift workers, Sarah relies on naps for a quick energy recharge.

Taking Advantage of the Benefits of Working the Night Shift

Many night shift nurses find that having their days free allows them to explore other interests, some of which are related to their work as nurses and some that develop their interests outside of work. A primary advantage of working the night shift for many nurses is having the time to spend developing new nursing skills and pursuing personal interests.

Scrubs Magazine lists four benefits for nurses working the night shift:

There are no checkout lines when they go grocery shopping in the middle of the night.
They have the satisfaction of knowing that while they spend the day curled up in bed, the rest of the world is hard at work.
They spend more time than their counterparts on other shifts in direct contact with patients and less time attending to the needs of their patients’ family members, who are usually home in bed during their shift.
Because fewer people work the night shift, the nurses bond more strongly as a team and work more closely with one another.

Tips for Staying Connected and Involved — at Work and With Family and Friends

It is common for night shift nurses to feel excluded from activities and events involving their coworkers and social occasions with family and friends. Night shift nurses need to be allowed to contribute to and participate in programs designed to improve patient outcomes, boost teamwork and morale, and advance nursing careers.

American Nurse Today lists five ways nurses can take advantage of night shift work to achieve career objectives:

Stay visible and involved, even if doing so requires coming to work early or staying late. Participate in staff meetings and unit practice councils. This allows nurses to represent the interests of their coworkers and describe the obstacles faced by night shift workers.
Establish relationships with administrators and unit directors to advocate for better working conditions for the night shift in particular and also for all nursing staff.
Participate in learning opportunities in clinical and leadership-development classes and discuss career goals with managers.
Network with like-minded nursing professionals, whether by joining and participating in a professional organization or by attending a nursing conference. Sharing ideas and problem-solving approaches with colleagues promotes discussions about achieving best practices for night shift nurses.
Be patient, because the challenges faced by night shift nurses, as well as those faced by all nurses, will not be solved anytime soon. Keep in mind that, over time, nurses can have a positive impact on clinical routines and leadership practices.

The blog Confident Voices in Healthcare offers tips for working night shift nurses who are looking for ways to ensure they meet their family obligations:

Enlist family members in efforts to get sufficient rest on work days and off days. Make sure they know each day’s sleep schedule so they can avoid unnecessary interruptions during those hours.
Plan each week with family to set times to spend together, whether sharing an activity or catching up with the details of each other’s lives.
Automate as many regular tasks as possible, such as grocery shopping and paying bills. If doing so is practical, pay a service for personal house cleaning and other chores.

The Invaluable Contributions of Night Shift Nurses

Not every nurse has the traits to thrive while working the night shift. However, for those willing to adapt their lifestyle to the requirements of night shift nursing, the rewards of working through the night can be a boost to their careers and their personal lives. Whether by making sure their patients are getting the sleep they need to speed their recovery or by calming patients when they are feeling vulnerable — in distress in a strange place in the middle of the night — night shift nurses contribute in unique and important ways to the work of healthcare teams, departments, and hospitals.

By taking advantage of the resources and tips presented here, night shift nurses can achieve peak performance on the job and reach their career goals while maintaining strong connections with their family, friends, and community.

Sources

American Journal of Preventive Medicine, “Rotating Night Shift Work Can Be Hazardous to Your Health”

American Nurse Today, “Long-Term Night Shift Work Increases the Risks of Common Cancers in Women”

BMJ Quality & Safety, “‘Care Left Undone’ During Nursing Shifts: Associations With Workloads and Perceived Quality of Care”

Cleveland Clinic Consult QD, “Night Shift Nurses Get a Seat at the Table”

Emerging RN Leader, “Leading Your Night Shift”

Frontiers in Neurology, “Sleep Strategies of Night Shift Nurses on Days Off: Which Ones Are Most Adaptive?”

Health Leaders Media, “Night Shift Nurses Need Management’s Support”

Little Things, “Night Shift Nurses: 9 Things You Never Knew About Their Grueling Job”

Medical News Today, “The Impact of Shift Work on Health”

Medical News Today, “Life Hack: How to Cope With Night Shifts”

National Institute for Occupational Safety and Health, NIOSH Training for Nurses on Shift Work and Long Work Hours