Night Owls: Nursing on the Night Shift

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By Jennifer Larson, NurseZone feature writer 

A typical evening, Anywhere, U.S.A.:

7 p.m. The sun is sinking below the horizon, and many people are gratefully leaving work for the day. Some lucky souls are sitting down at the dinner table with their families.

11 p.m.  Bedtime. The streetlights are burning full strength. A sleepy toddler asks for a glass of water when his mom checks on him before turning in for the night.

2 a.m.  Not a creature is stirring, not even the proverbial mouse.

6 a.m.  The alarm clock rings, signaling one hour to eat, shower and get the kids ready before reporting for duty at the hospital.

That schedule might seem familiar to some, but not for one group of nurses.

Their routine might look something like this:

7 p.m. Arrive at work. Bid a hurried "hello" to other nurses as they exit the hospital.

11 p.m. Yawn. Pause for a quick cup of coffee and a bag of chips from the vending machine. Check on a sleeping patient.

6 a.m. Finish up notes from the long night’s work, and drain another mug of coffee. Look forward to climbing into bed when most people are just starting their work days.

Night shift nurses-- “the forgotten nurses” as they sometimes call themselves--are the men and women who care for patients when most other people are fast asleep.

It is a tough job, too, many veteran night shift nurses say.

According to Teresa, Haas, RN, it can be hard to figure out a workable schedule, especially with a family.

“We try to be flexible,” said Haas, a mother of three. But she acknowledged that it can be challenging to get enough sleep during the day, eat on a normal schedule and balance the demands of family life.

Exhaustion sets in

Others are more blunt about the drawbacks to working from 7 p.m. to 7 a.m. in a world that functions on the opposite schedule.

Tom Glander, RN, spent two years on the night shift in a hospital intensive care unit right after graduating from nursing school. He found it hard to sleep during the day because the bedroom wouldn’t be quite dark enough, and his neighbors made enough noise to keep him from falling deeply asleep.

Eventually, he developed a very bleak attitude toward nursing because he was so exhausted.

“After 4 a.m., I’d feel like burnt toast,” Glander said, remembering how it felt to work nights after barely sleeping during the day. “I’d come home totally fried.”

Kathy Ward, RN, called working the night shift “torturing your body, cycling between vampire and rooster.”

“You’re constantly at odds with the world,” said Ward, who admits to not being a natural night person.

Indeed, night shift work is not natural for most people. The National Center on Sleep Disorders Research Center notes that the human body’s natural rhythms prepare a person to sleep at night. A job that requires a person to work during the dark night hours and sleep while the sun is up can play havoc with those rhythms.

In fact, people who work night shifts experience some of the greatest amounts of sleep loss. The center estimates that 60 to 70 percent of shift workers have problems sleeping.

Margaret Lawrence, a nurse who works on Staten Island in New York, has found that her mood often bears the brunt of her sleep deficit. She rarely gets more than four or five hours of sleep when she’s working nights.

“After I wake up…I am real agitated and unhinged,” she said. “I get angry easy, which is not my personality at all. To say my fuse is short is an understatement.”

The exhaustion that results from a lack of sleep can be dangerous, too.

Andrea Fassiotto, RN, reported that she felt tired more often than not when she was a night shift nurses. It took a lot of effort to maintain a normal diet and exercise routine.  But it was the sleep debt that was the biggest problem. She found herself nodding off at inappropriate times.

“When it happened when I was driving, I knew it was time to get off nights,” said Fassiotto, who worked the night shift for 12 years.

The health risks

Sleep deficit is not the only physical drawback of working the night shift.

The Journal of the National Cancer Institute recently published a study about the effects of night work on nurses’ health.

According to the study, which used data from Harvard’s Nurses’ Health Study, night shifts increase the likelihood that a worker will not only succumb to certain unhealthy habits like smoking and overeating but also be more likely to develop colorectal cancer.

In fact, women who worked 15 years on the night shift or longer were 35 percent more likely to develop some type of colorectal cancer than women who work during the daytime. The tendencies to weigh more and smoke contributed to the increased likelihood, the study’s authors noted.

Many night shift nurses admitted to developing bad eating patterns. They noted that hospital cafeterias close at night, leaving them with high-calorie vending machine food, takeout and delivery pizza as typical meal options.

People tend to associate mealtime with certain times of day, said Melanie Polk, director of nutrition education at the National Cancer Institute. But working at night can throw off a person’s internal clock, so they end up skipping regular meals or trying to eat meals on a day worker’s schedule.

“That may lead to snacking when you’re not hungry. It may also lead to eating more meals than normal,” Polk said.

Said Ward: “Its really hard to eat a balanced diet because you never know what meal you’re eating.”

She also said that she’s so addicted to caffeine that “I can no longer get a wake-up jolt from coffee.”

Many veterans of the night shift also said they’re relieved to be working during the day now.

“What I like most now is that I get up at 5:45, leave the house at 6:10, get to work at 6:30 and leave at 3 p.m. Done,” said Glander. “And I have the whole afternoon  and evening to be a normal person. To go to family events. To take in a movie. Work on projects. Watch TV. Hang out with my daughter and wife. I get to bed by 10 p.m., and it’s all good.”

Fassioto is glad to be working during the daytime, too. “I love it,” she said.

Successful adjustments

But some nurses said they actually enjoy working the night shift. They prefer the more laid-back atmosphere that often accompanies late nights on the ward. 

“I am one of the oddballs who actually prefers working evening and night shifts,” admitted Meg Nelson, BSN, RN, who lives in Columbus, Ohio.

The night shift can be great for people who are naturally night people and are willing to be patient with their bodies through the adjustment periods. The pace is much slower, Nelson said, because many patients sleep through the night. She also has experienced a greater sense of autonomy and independence on the night shift—and even an occasional bonus for doing such work.

Haas also likes that there is less hustle and bustle on the night shift. “It’s a lot more relaxed,” she said, adding that she can spend more time with patients when things are less hectic.

Nursing student Donna Fritz, who lives in Ocala, Florida, said that she gets to spend more quality time with her patients at night because there tend to be fewer interruptions.

“Also, the night shift is a better time to do the comfort things like back rubs, baths or snacks to help patients prepare for sleep,” Fritz said. “I’ve been able to sit and listen when a patient couldn’t sleep and needed to talk. You rarely have time for that during the day.”

There is a personal upside to working the night shift for Daisy Miller, RN.

“By working nights, I am able to attend my children’s school activities, doctor’s appointments, etcetera,” said Miller, who has worked at night for the past eight years.

According to Polk, many nurses who succeed at adapting to the night shift are the people who plan ahead.

“It really depends on how well a person adapts to making their work hours occur at night when most of the rest of the world is doing the opposite,” she said. “For some people, it works out just fine.”

Donna Woods, RN, found herself enjoying working the night shift, even though she only planned to work at night for a year or so, until a day shift opened up. For the past four years, she has been a night shift charge nurse on a mother-baby care unit. She has developed close ties to her fellow nurses and the efficiency with which they do their jobs.

“The night shift does not sweat the small stuff,” Woods said. “I am very proud of our night shift and have no plans to transfer to the day shift.”

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