To nap or not to nap on night shift – does it reduce fatigue? That is the question nurses at the Royal Children’s Hospital (RCH) in Melbourne asked in trialling the effects of scheduled sleeping during night shift.
Staff from the RCH’s Medical Short Stay Unit presented their findings at the Australian College of Nursing’s National Nursing Forum held in Hobart.
“Well-rested nurses are safe and efficient nurses. Many nurses find napping on night duty as an effective mechanism to decrease drowsiness or fatigue,” said presenter Patrick Prunster.
The trial was aimed to promote staff wellbeing and safety and reshape ward culture.
“Staff were aware that fatigue is a particular issue but staff tend not to take all of their scheduled breaks on night duty,” Patrick said.
While 6% of nurses never took all their breaks on day shift, a whopping 45% never took all their breaks on night shift, according to an in-house unit survey undertaken pre-trial (with a 55% response rate). Despite this, 90% of nurses considered breaks were important to patient care.
Alarmingly but perhaps unsurprisingly, 97% reported they considered they were unsafe driving home after night shift.
“The survey found nurses not taking breaks – this was an issue of nurses’ wellbeing and which has an impact on patient care.”
The staff identified six studies of napping on night shift; and found napping improved levels of fatigue in five of the six studies.
The definition of what constituted a nap varied in the studies – from 15 minutes to two hours.
“From the findings we found it was feasible that napping can reduce sleepiness and drowsiness driving,” Patrick said.
The RCH 24-bed acute medical care inpatient unit is staffed with a nurse to patient ratio of 4:1 during the day and 6:1 at night. There are 56 permanent RNs on 12 hour shifts.
The staff instigated a night duty nap planner and scheduled times for taking breaks and/or naps. This involved a ‘1 am huddle’ following a 12 midnight ward round overview. Staff took allocated 30 minute breaks and those who chose to nap used an old mattress in an effective sleeping space.
Barriers to nurses taking naps on night shift included: perpetuating a stigma of ‘laziness’ that accompanies night shift; the feeling that patient acuity and work load can make it difficult to take breaks; and patient load where colleagues were on break.
The trial highlighted a focus on staff wellbeing and occupational health and safety, Patrick said.
“Nurses need to prioritise their breaks. There was an inability for some nurses to delegate tasks.”
About 50% of staff completed a follow up survey six months post-trial. The findings recommended the need to:
- Liaise with ANUMs about the most effective way to schedule breaks for night duty.
- To develop a method where breaks can be applied.
- Nurses to be empowered to take scheduled breaks that their Enterprise Bargaining Agreement (EBA) entitles them to.
- Taking a scheduled nap during the course of a night shift improves nurses’ wellbeing.
“We want nurses to take their breaks. Policy must include adequate provision for staff to rest,” Patrick said.