By Sylvia Foley, AJN senior editor

Table 1. Guidelines for Hospital Nurses on Implementing Naps on the Night Shift (click to enlarge)Nurses who work the night shift often struggle with high levels of sleepiness. But while onsite napping is effectively used to counter worker fatigue in other safety-sensitive industries, the practice has yet to win wide acceptance in nursing.

Curious about why this is so, nurse researchers Jeanne Geiger-Brown and colleagues recently conducted a pilot study. They report their findings in this month’s CE–Original Research feature, “Napping on the Night Shift: A Two-Hospital Implementation Project” (for some night shift napping ground rules, see, at right, Table 1: Guidelines for Hospital Nurses on Implementing Naps on the Night Shift—click table to enlarge).

Here’s an overview:

Purpose: To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps.

Methods: In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units. Unit nurse managers’ approval was sought, and further explanation was given to a unit’s staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period.

Results: Successful implementation occurred on only one of the six units, with partial success seen on a second unit. Barriers primarily occurred at the point of seeking the unit nurse managers’ approval. On the successful unit, a total of 153 30-minute naps were taken. A high level of sleepiness was present at the beginning of 44% of the naps. For more than half the naps, nurses reported achieving either light (43%) or deep (14%) sleep. Sleep inertia was rare. The average score of helpfulness of napping was high (7.3 on a 1-to-10 scale). Nurses who napped reported being less drowsy while driving home after their shift.
Conclusion: These data suggest that when barriers to napping are overcome, napping on the night shift is feasible and can reduce nurses’ workplace sleepiness and drowsy driving on the way home.

Implications. Finding that collaboration at all levels was crucial to successful implementation, the authors stressed the need to address nurse managers’ perceptions of and concerns about napping.

The authors also pointed out that staff nurses’ reluctance to take breaks seemed influenced in part by unit culture. After reminding readers that nurses’ fatigue “poses clear dangers for both nurses and patients,” they ask, “Do we only consider implementing evidence-based practice when it’s convenient for management and staff?”

For more, read the article, which is free online, and listen to our conversation with the lead author.