Night Night

Sleep Factors and the Night Shift
By: Brooklyn Barney, Sami Dalessio,

McKenna Foxworthy, Molly Hughes,
Holly Hunt, Kaitlyn Jensen, Emily
Kingsley, Miguel Nava, & Lindsey Warne
Lab Group A
Introduction
“Nurses who work the night shift often

experience high levels of sleepiness as
a normal biological consequence of
working during a dip in the circadian
rhythm (2am-6am).” - Jeanne Geiger-
Brown, MD
Introduction ● Incidents associated with
decreased sleep:
○ Medication errors
○ Poor judgement
○ Reduced
alertness/stimulation
from environment
○ Job related injuries and
accidents
○ Motor vehicle accidents on
ride home
○ Long term health
impairments
Clinical Question
In night nurses, how does the

implementation of fatigue
countermeasures (napping and
sleeping schedule), compared to
no countermeasure, affect safe
practice?
Summary of No national standard/protocol
to aid in safe practice related to
Current Practice
fatigue in night shift nurses.
Some hospitals have begun

implementing specific
schedules to decrease fatigue.
Some allow napping during

breaks, but none have
specifically set nap breaks.
Napping:
Synopsis of Current
● Sleep deprivation
Literature Research
Findings Related to ● Napping effects
○ Mental
the Issue ○ Physical
○ Safety
● Hospital environment
● Manager and nurse

attitudes
Synopsis of Sleep Schedule:
Current Literature
● Nurses employ different
Research
sleep schedules: switch
Findings Related sleeping, same sleeping,
to the Issue - shifted sleeping
Sleep Strategies
● Nurse preference and most
effective sleep schedule
● Difference in time off

requirements between
shifts
Strengths and Limitations
Strengths: Limitations:
■ Consistent with previous research ■ Hawthorne effect

■ Randomized control trial ■ Small sample population
■ Adequate sample size ■ Studies conducted in different
■ Valid scales used to measure countries
sleepiness and effectiveness of ■ Difficult to conduct a “blind” study
napping with this topic
■ Approved by Institutional Review ■ Small response rates
Board ■ Lack of diversity- gender, age, race,
■ Use of specific inclusion and culture
exclusion criteria ■ Low accuracy instruments of
measurement
Evidence Based ● Taking two 15 minute naps
Nursing or one 30 minute nap
Recommendations during the night shift.
● Nurses switching from the

night shift to the day shift
or those switching from day
to night need two days
between scheduled shifts.
● Average cost of medication
errors each year per
Cost Analysis: hospital is approximately
Resource Nurse $600,000
● Nationally, medication
errors account for 5.1 billion
US dollars annually
● Implementation of 2 part-
time resource nurses in the
ICU
● RN’s on average make
$69,000-$72,000 ($70,852
in Arizona)
Cost Analysis: It is imperative that healthcare
workers are educated on the
Sleep Educator importance of work fatigue, and
the prevention of medication
errors.
Nurse manager compiles

educational materials and videos
to present to staff about circadian
rhythms and sleep hygiene ($10
dollars to print)
Education is PREVENTION!
Nap Pods
● $ 16,000
● Studies show taking 20

minute naps
rejuvenates the nurse
● Arm rest has timer

control
Overall Application
Timeline:
● Week 1: Nursing manager will compile sleep education and resources.
● Week 2: Unit nurses will review the informational materials.
● Week 3: Purchase sleep pod and hire resource nurses
● Week 4: Orient the resource nurses to the unit
● Week 5: Utilize a quiet room on hospital floor for sleep pod (break room)
● Week 6: Inform nursing staff of new sleeping regulations and put sleep
plan into action on upcoming shifts
Risk vs. Benefit
● Risk: ● Benefit:
○ Less staff available in case of ○ Nurses experience less fatigue
Rapid Response ○ Fewer medication errors
○ Nurses can wake up less ○ Less drowsy when driving home
refreshed and more fatigued ○ More likely to participate in
than intended patient care
○ Nurses can abuse the sleep ○ Lower burnout rate
protocol (i.e. sleeping longer ○ More likely to float to the floors
than the limited 30 minutes) with sleeping protocols
○ Lack of personal relationship
between the patient and the
“resource nurse”
Evaluation of ●
●
Nurse manager in charge
Calculate/analyze total # med
Medication Errors errors over one year on night shift
● Implement nap protocol
● Collect med error data for one year
● Compare data with naps against
data without out naps
Expected finding: errors will decrease

in a moderate (15-30%) with nap
protocol in place
Evaluation of ● Initial survey
○ Feelings towards work fatigue
Nursing Staff ● Implement nap policy for 1 year
Satisfaction ● Retake the same survey
○ Feelings towards work fatigue
● Compare numerical result to
nurses’ feelings of fatigue with
and without nap protocol
● Analyze nurses’ perception of
effectiveness of naps on the night
shift
Expected finding: nurses will feel more

confident in their ability to perform
Summary
● Unsafe practice occurs on night shift at a higher rate than

day shift
● Lack of adequate sleep leads to clinical errors
● Napping prevents fatigue and allows nurses to feel
refreshed
● Nurses who adjust sleep schedule to sleep during the day
are most adaptive to the night shift and well rested
● Implementation: Two 15 minute or one 30 minute paid
nap
Summary (cont.)
● Hire a ‘resource nurse’ and sleep educator, install nap pod

in staff lounge
● Cost: $86,000 for the first year and $70,000 thereafter
● Risk: abuse of sleep protocol, resource nurse lack of
relationship with the patients, nurses waking up groggy
● Benefits: less fatigue, fewer patient care errors, higher
morale
X
References
Chang, Y., Wu, Y., Lu, M. R., Hsu, C., Liu, C., & Hsu, C. (2015). Did a brief nap break have positive benefits on information processing among nurses working on
the first 8-h night shift? Applied Ergonomics, 48, 104-108. doi:10.1016/j.apergo.2014.11.005
Edwards, M. P., McMillan, D. E. & Fallis, W. M. (2014). Napping during breaks on night shift: critical care nurse managers’ perception. Dynamics, 24(4), 30-35.
Geiger-Brown, J., Sagherian, K., Zhu, S., Wieroniey, M. A., Blair, L., Warren, J., Hinds, P. S. & Szeles, R. Napping on the night shift: A two hospital
implementation project. American Journal of Nursing, 116(5), 26-33. Doi: 10.1097/01.NAJ.0000482953.88608.80
Hammacher Schlemmer. (2017). The productivity boosting nap pod. Retrieved from http://www.hammacher.com/Product/12199
Johnson, A. L., Jung, L., Brown, K. C., Weaver, M. T., & Richards, K. C. (2014). Sleep deprivation and error in nurses who work the night shift. The Journal of
Nursing Administration, 44(1), 17-22. doi:10.1097/NNA.0000000000000016
Kaliyaperumal, D., Elango, Y., Alagesan, M., & Santhanakrishana, I. (2017). Effects of sleep deprivation of the cognitive performance of nurses working in shift.
Journal of Clinical and Diagnostic Research, 11(8), CC01-CC03. doi: 10.7860/JCDR/2017/26029.10324
Lahue, B. J., Pyenson, B., Iwasaki, K., Blumen, H. E., Forray, S., & Rothschild, J. M. (2012). National Burden of Preventable Adverse Drug Events Associated with
Inpatient Injectable Medications: Healthcare and Medical Professional Liability Costs. Retrieved October 25, 2017, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031698/
Lin, P., Chen, C.HJ., Pan, S., Pan, C., Chen, C., Chen, Y., Hung, H., Wu, M. (2012). Atypical work schedules are associated with poor sleep quality and mental
health in taiwan female nurses. International Archives of Occupational and Environmental Health, 85, 877-884. doi: 10.1007/s00420-011-0730-8
National Sleep Foundation. (2017). Shift work and sleep. Retrieved from https://sleepfoundation.org/sleep-topics/shift-work-and-sleep
Oriyama, S., Miyakoshi, Y., & Kobayashi, T. (2013). Effects of two 15-min naps on the subjective sleepiness, fatigue and heart rate variability of night shift nurses.
Industrial Health, 52(1), 25-35. doi: 10.2486/indhealth.2013-0043
Petrov, M. E., Clark, C. B., Molzof, H. E., Johnson, R. L. Jr., Cropsey, K. L., & Gamble, K. L. (2014). Sleep strategies of night-shift nurses on days off: Which
ones are most adaptive? Frontiers in Neurology, 5. DOI: 10.3389/fneur.2014.00277
“I’m so tired”- Philip
Moya

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Sleep Factors and the Night Shift

By: Brooklyn Barney, Sami Dalessio,

“Nurses who work the night shift often

In night nurses, how does the

Some hospitals have begun

Some allow napping during

● Manager and nurse

● Difference in time off

■ Consistent with previous research ■ Hawthorne effect

● Nurses switching from the

Nurse manager compiles

● Studies show taking 20

● Arm rest has timer

● Week 1: Nursing manager will compile sleep education and resources.

● Week 2: Unit nurses will review the informational materials.

● Week 3: Purchase sleep pod and hire resource nurses

● Week 4: Orient the resource nurses to the unit

Expected finding: errors will decrease

Expected finding: nurses will feel more

● Unsafe practice occurs on night shift at a higher rate than

● Hire a ‘resource nurse’ and sleep educator, install nap pod

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