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Eyes Wide Shut

Wallis, Laura

AJN The American Journal of Nursing: March 2014 - Volume 114 - Issue 3 - p 14
doi: 10.1097/01.NAJ.0000444476.03350.26
In the News

Evidence mounts that sleep deprivation leaves nurses error prone.

Laura Wallis

It may be time to put the myth that a nurse can get by on just a few hours’ sleep to bed. A recent report is the latest of numerous studies showing that fatigue hinders nursing performance and puts patients at risk. Johnson and colleagues investigated whether sleep-deprived night-shift nurses made more patient-care errors than their better-rested colleagues. They examined demographic data and sleep diaries of licensed nurses working full-time on the night shift at three different urban hospitals. Of the 289 nurses, 162 reported being sleep deprived; 75% of those nurses got 4.7 hours’ or less sleep in 24 hours. The sleep-deprived nurses were significantly more likely than their colleagues to make patient-care errors.

“This study documents the importance of nurses’ sleep to providing safe patient care,” says Jeanne Geiger-Brown, associate professor at the University of Maryland School of Nursing in Baltimore, who has written extensively on the subject. “The results are consistent with other data that show relatively little sleep between shifts among night nurses.”

Other studies of note include a 2004 examination of increasing shift lengths and patient safety; errors were three times more likely when hospital nurses worked 12.5 hours or more at a stretch, and many who worked the long shifts weren't resting adequately in between. Geiger-Brown's own March 2012 study, which examined sleep, sleepiness, fatigue, and performance among nurses on 12-hour shifts, revealed average sleep times between 12-hour shifts of just 5.4 hours.

And this year, Linda Scott, who also coauthored the 2004 study, published a report on fatigue and “decision regret” among critical care nurses, in which tired nurses were more likely to express concern that they had made the wrong decision for their patients.

But if nurses are to get more rest, institutional norms and expectations may need some adjusting. Scott also conducted a 2010 study on the feasibility of fatigue countermeasures. Although strategies such as napping and rest breaks improved alertness and helped prevent errors, there was significant guilt associated with taking these breaks, which discouraged some nurses from taking them. And some facilities do not support their use.

Despite the growing body of research showing that long shift lengths are associated with poor-quality patient care, nurses overall tend to be satisfied with their work schedules, enjoying more consecutive days off when they work longer shifts. That may be a significant obstacle to improvement, especially because nurses who regularly pull long shifts may not be the best judges of their own fatigue levels.

“Cumulative sleep deficits over days, weeks, [and] months result in an inability to accurately judge one's ability to perform safely,” says Geiger-Brown. “The only safe way to practice is to obtain sufficient sleep before work, which for most people is at least six hours of uninterrupted sleep. Seven to eight hours is better. Nurses who think they function well on three to four hours of sleep are deluding themselves and putting others at risk.—Laura Wallis

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