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Is healthy sleep achievable for nurses who work rotating shift work?

It’s a thought-provoking question posed by Dr Lisa Matricciani, a sleep researcher and lecturer in Nursing at the University of South Australia, and fellow authors in a recent guest editorial in the December 2022 – February 2023 issue of the Australian Journal of Advanced Nursing (AJAN).

According to the editorial, sleep is often-recognised as important for health and wellbeing but is usually the first thing people give up when life gets too busy. For nurses, who typically undertake rotating shift work throughout their careers, this is especially true. Some may accept poor sleep as inevitable, while others are on the constant hunt to unlock the key to improving sleep and reducing fatigue.

“Sleep is important for everyone but for nurses, most of them are working rotating shift work, so there are some things that are out of their control,” Dr Matricciani explains to the ANMJ.

“For example, a lot of sleep recommendations focus on set fixed sleep and wake up times. For nurses and midwives working rotating shift work, and even other disciplines, that’s just not possible. One day you might be working a late shift and you finish at 9.30pm at night. Other times you might be working a night shift, so forming that consistent sleep schedule is really difficult.”

Dr Matricciani’s research into sleep has largely focused on children and how their sleep patterns, particularly duration and consistency, have changed over the years.

Now, with poor sleep among healthcare workers a growing area of interest, she is turning her attention to nurses.

The COVID-19 pandemic increased and highlighted the day-to-day demands of nursing and effects on sleep, the editorial states. The prevalence of sleep disturbances among healthcare workers and nursing students was 31% and 27% respectively, compared to 18% of the general population.

“Given that sleep is important for cognitive, emotional and physical wellbeing, sleep may be especially important for nurses – a demanding profession that often requires shift work – a known risk factor for poor sleep.”

Dr Matricciani is currently embarking on several research projects focusing on sleep and nurses and nursing students, with the aim of improving healthy sleep across the profession.

Studies highlighted in the editorial show poor sleep has been associated with reduced quality of life, weight gain, hypertension, poorer cardiometabolic health, and diabetes among nurses. It also contributes to medical errors, reduced job productivity and burnout.

Dr Matricciani points to successful strategies to raise awareness of the importance of sleep such as Victoria’s six-week ‘Happy People at Work’ wellness program, which promotes energy, mood, stress reduction, and sleep. Piloted in 2017 among 874 nurses and midwives, the trial found 59% of 807 respondents reported that they gained strategies to help with sleep, yet, 45% said they were still learning how to effectively apply strategies.

Another potential solution recommends nurses need to develop good sleep strategies early on in their careers, beginning at the undergraduate level. Part of Dr Matricciani’s research is exploring ways to enhance student and new graduate nurses’ awareness of sleep and its influence on health and work.

“It is possible that nurses who receive sleep education early on in their undergraduate training may be less likely to experience poor sleep during their graduate year and future career,” the editorial states.

“Sometimes, the population as a whole, we often wear our sleep deprivation as a badge of honour, that we’re working really hard by not getting enough sleep,” Dr Matricciani tells the ANMJ.

“But actually, sleep is really important to make sure that we work efficiently and to the best of our abilities.

“What the literature seems to be suggesting is that people are not really aware of the importance of sleep and they lack strategies to achieve a good night’s sleep. Educating nurses early on in their careers on the importance of sleep hopefully means they’ll develop healthy habits throughout their career.”

Dr Matricciani shares her top five healthy sleep tips for nurses navigating the stressors of the job and shift work.

Create a comfortable sleep environment

Elements of a comfortable sleep environment include a comfortable mattress and pillow, and a dark quiet room at comfortable (cooler) temperature. The National Sleep Foundation suggests a room temperature of 18 degrees may be best.

Get sunlight, particularly early in the day

For nurses, particularly those who work 12-hour shifts and may drive to work and drive home when it is dark, try to go outside during your break if there are limited windows in your work environment.

Avoid bright lights and screen use close to bedtime

This might be especially important after an afternoon shift where people may watch television to help them relax and unwind. Most people stay awake to watch the end of a television program and this pre-bed activity, particularly if started later in the evening, may delay bedtimes and curtail sleep duration.

Monitor your caffeine and alcohol intake

Caffeine promotes wakefulness and the effects may last 4-6 hours after consumption.

Consuming caffeine close to bedtime may make falling asleep difficult. Nurses may like to consider when they plan to go to sleep after an early, afternoon and night shift and thus avoid caffeine 4-6 hours prior. Alcohol also affects sleep. Although alcohol may help people fall asleep faster, it can disrupt sleep quality, which is also important for health and wellbeing.

Budget time for sleep

Consider your personal, work and family commitments and try to organise your time so that you prioritise time for sleep. The National Sleep Foundation suggests adults need 7-9 hours of sleep each night.