Nursing News

Coping with the Challenges of Shift Work


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By Kim McCarten, contributor

June 17, 2011 - Shift work can wreak havoc on your life: interrupting your sleep and making it harder to exercise, manage family obligations and keep some semblance of a social life.

Studies have shown that these factors create some inherent health dangers. For instance, interrupting the body’s circadian rhythm can increase the risk for heart disease and insomnia, and adversely affect a person’s eating habits, often causing them to gain weight. And there's an established link between shift work and high blood pressure, stroke, anxiety, depression, traffic accidents, menstrual irregularities and addiction.

Yet nurses working in acute care and other settings have found that working nights, rotating shifts and overtime is normally required in their career. Luckily, there are some proactive things nurses can do to mitigate the dangers.

Weighing the pros and cons of shift work

Along with affecting a nurse’s health, there are additional consequences of shift work that can be serious: RNs, by virtue of licensure, are legally responsible for the actions they take on the job, regardless of the type of hours worked. Fatigue and other conditions can compromise patient safety and put you at risk.

That has prompted some to consider their options.

"I have found...that most facilities that require 12-hours shifts have a high rate of burnout," said Anne Marie Pizarro, RN, who's worked at several hospitals and medical centers in Austin, Texas, in her 13-year career. "I decided early on that what was most important to me was flexibility and freedom."

The American Nurses Association notes that currently, 16 states have restrictions on the use of mandatory overtime for nurses.

That's why Pizarro made a change and started working as a physical rehabilitation nurse (PRN)--with 8-hour shifts. "I chose to give up certain benefits so that my time was mine." The change allowed Pizarro to start a side business that was more creative, as well as allowing her to spend more (regular) time with her family. "Having a meaningful outlet gave me resilience ... and kept me balanced, happy and excited about what I do."

But for those staying on a more traditional career track, there can be some benefits from shift work, as well.

Working the second or third shift often means more pay, for instance. These times are usually less busy than a regular day shift, with less traffic and distractions, leaving nurses more time to focus on patients. And for nurses with children, it can provide free time during the day for school activities, and help minimize childcare costs.

How a person copes with shift work, however, can vary by the individual. Research published in 2008 by the U.S. National Library of Medicine showed in one study, an “adaptive” attitude was more important than the hours worked when it came to coping and adjusting.

Either way, shift work can be a challenging schedule for many--so taking proactive steps is essential. 

Here are a few suggestions for coping with the challenges of shift work, based on current resources from the National Library of Medicine, the National Institutes of Health, the National Institute for Occupational Safety and Health, and the American Nurses Association:

Sleep 

Nurses have the potential for acquiring Shift Work Sleep Disorder (SWSD). Sleep for night workers is usually less refreshing, and shorter. Your body and brain functions tend to slow during nighttime and early morning hours. This combination of less good rest and working against your body's natural cycle can increase the risk of accidents, slow your judgment and increase stress. Rotating shifts can exacerbate sleep problems, with forward rotating shifts (from day to afternoon to night) tending to be a bit easier.

How to cope:

• If you're feeling fatigued during your shift, try to nap during breaks, or try more frequent, shorter breaks throughout your shift to rest.

• Stop consuming caffeine at about the 5th or 6th hour of your shift.

• Don't feel pressure to sleep immediately when you get home, but don't put it off too long or you could get a “phantom second wind” that will throw you off your schedule.

• Stick to your sleep routine, even on the weekends.

• Wear sunglasses on the way home to minimize your exposure to strong light, which can keep you awake longer if you plan to sleep fairly soon after your shift.

• Avoid sleep aids/pills.

Eating/diet 

The body isn't designed to properly process food and nutrients eaten at night, according to Philip Morgan, associate professor at the University of Newcastle, who's working with some companies in Australia to proactively manage shift/night worker health issues.

Eating on this type of schedule can increase insulin resistance and the ratio of LDL/HDL cholesterol. You can be tempted to grab some energy from high-sugar or unhealthy foods. And you might find that foods you could tolerate during the day do not agree with you when you eat them at night.

How to cope:

• Eat a high-protein meal just before your shift.

• Eat your main meal a couple of hours before your shift.

• Watch out for “the second dinner:” the temptation to eat a big meal with family then another big meal during your shift.

• If someone brings in sweets, move (or remove) them, and consider bringing in healthier, more sustaining, options.

• Bring your lunch/snacks if there aren't easy, healthy options conveniently available.

• Stay hydrated.

Exercise and general health maintenance

Taking care of sleep and your diet will go a long way to controlling other health risk factors, and there are other steps you can take:

• Exercise before work, for maximum energy and stress management.

• Maintain a healthy body weight (and be particularly vigilant about small weight gains, which can easily become a bigger problem).

• Check in with your doctor when you begin rotating shifts, as this type of schedule can effect the efficacy of some prescriptions.
 
• Self-awareness is key: watch for changes in mood, reaction to stress, any signs of depression or anxiety--and take steps to address these changes.

• Try incorporating yoga, kickboxing, knitting, meditation or some other form of relaxation.

• Take your health seriously.

Family/social life

Don’t neglect the people and connections that are important to your mental and emotional health:

• Maintain your social connections with friends, even if it requires a bit more planning; these relationships help you to do your job well and enjoy life.

• Find other shift workers/colleagues online and keep in touch virtually as well as in real life.

• Take the time to make plans with family.

• Schedule down time just for yourself; ideas might include set times for getting a manicure, visiting a museum, taking a class, etc.

Finally, if there is something your hospital or facility can do to improve the health of shift workers, don't be afraid to make a suggestion--employers are increasingly aware of the importance of a healthy work environment.

"If nurses were given the flexibility to work with their schedule and time," said Pizarro, "I feel like more facilities would have less burnout and a happier staff."

Whether or not you can control when and how much you work, nurses and other healthcare workers need to be as vigilant and proactive about their health as they are with their patients’ health.

Awareness, consistent scheduling and actions that promote your health and happiness will help you manage the challenges that can come from this aspect of your professional life.


 

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