“If I couldn’t even figure out what goes into my lunch box, how could I possibly have multitasked . . . on a busy unit?”
Awake for 40 hours.
Photo by Jeff Greenberg. The ImageWorks.
I recently had the disorienting experience of being awake for 40 hours. This had to do with a family member’s interminable emergency department visit, a 3 a.m. car breakdown, and a post-ED MRI and medical visit.
I’ve never been up for 40 hours in my life. I didn’t pull “all-nighters” in school before exams, and never worked longer than a double eight–hour shift. Partying the night away wasn’t in my DNA. So this experience was strange and new, and something I pondered over for days afterward.
An ‘otherworldly’ state.
By the time I’d been up for 24 hours straight, I was operating at a level about two beats behind everyone around me. Physically, I felt a little off-balance, as though I might fall if I didn’t step carefully. My brain seemed mired in muck, and I found myself trying to recall what I knew about depleting bodily stores of ATP. Preparing to return to work around hour 26, I stared into my lunch box. I couldn’t remember what food I was supposed to pack for the day.
Later in the afternoon, after the MRI had been completed, we sat down with the doctor to discuss the results. I was pretty sure this was not going to be good news. As the physician walked into the room, I think she was trying to put me at ease when she remarked, “You look pretty good for someone who’s been up for 40 hours.” I had a sudden, hysterical urge to blurt out Gloria Steinem’s remark on her 40th birthday: “This is what 40 looks like.” But all I managed in response was, “Oh.”
My low level of functioning, especially my inability to think clearly, was unfamiliar, otherworldly, and a little frightening. I had a sick family member and animals to care for. All depended on me for their safety and sustenance. I couldn’t stay in this shape for long and still be of use to anyone.
How much sleep deficit is too much?
A few nights of sleep passed before I felt close to normal. As I relaxed again into my usual routine, I was still examining this experience. I see much of my daily life through the lens of my nurse-self, so I kept wondering about sleep and work. Do nurses who are acutely or chronically sleep-deprived experience anything like my physically and mentally altered state? How much sleep deficit is too much? If I couldn’t even figure out what goes into my lunch box, how could I possibly have multitasked if I were back on a busy unit? Could even a barcode system have ensured that I got the right meds to the right patients?
All of this made me think about today’s debates over 12-hour shifts, especially when such long shifts are worked for many days in a row. (“Please, please, we’re short again tomorrow. Can you come in an extra day?”) A lot happens when we don’t give our bodies time within a 24-hour cycle to rest and repair.
Fighting night-shift fatigue.
The short- and long-term health hazards of regularly denying ourselves the “luxury” of sleep are discussed in “Fighting Night-Shift Fatigue” in this month’s issue (free until June 4). While staff on the night shift are more likely to experience disrupted sleep, fatigue is a nursing problem that has probably affected most of us at some point in our careers. The consequences of sleep deficits are well-documented, and new research is looking specifically at 12-hour shifts and their effects on nurses.
This month’s news article on fatigue shares some known risks—did you know that according to the AAA Foundation for Traffic Safety, less than four hours of sleep in 24 hours increases a driver’s risk of crashing by 11.5 times?—and points out a new position statement from the American Academy of Nursing, Reducing Fatigue Associated with Sleep Deficiency and Work Hours in Nurses.
Have you ever experienced intense fatigue as a nurse?
12 hour shifts are a curse!! Welcome a pilot study to establish the benefits or drawbacks of them. Young nurses prefer 12 hours as they have more time to socialise. Having being there myself (matured nurse), productivity is not improved over the last few hours of the shift.
Handovers are slim, documentation is incomplete, and quality of care delivery is reduced. In Australia high acuity areas do 12 hour shifts, the work is intense, patients are sick.
It is impossible to expect a human being to function at a demanding level for a long period of time. What is worse, is that colleagues will not necessarily help or understand ones plight.
Finishing a busy 12 hour night in ICU, some mornings I have been unable to stand up or deliver a coherent handover, worse still if fellow colleagues are not sympathetic, you are going home carrying immense guilt, because the expectation is you should perform…… Expectation from yourself and peers!!
Truck drivers are not allowed to be on the road after being on duty for a certain amount of hours, yet we in the medical community believe that we can and should be working with people’s lives in the balance for 12 hours or more. The reality being that nurses quite often don’t get their lunch break, much less the 2 fifteen minute breaks required in a 12 hour shift, means that we are working at a high level of stress and strain. We accept conditions that place ourselves and our patients at risk because the facilities that we work for demand it of us and we fall in line because the organizations that claim to represent our interests stand arm in arm with the AHA. Until bedside nurses unite to stop the madness and reclaim our own voice from the executives and administrators who have zero interest in our wellbeing we will fighting uphill, exhausted and understaffed.
Sleeplessness from working nights is a huge issue. Once after a 4 day stretch of 12 hour shifts, i was doing the AM insulin rounds. I pondered for several minutes and realized I could not remember how to draw up insulin. Luckily, I had enough senses left to ask for assistance. After analyzing the situation the next day, I realized I could not see the unit marks on the syringe because of the massiv fatigue. I quit working nights as I realized that I am not a night person at all and this situation really placed my patients and my license at risk.
I think it might be more apropos to ask, “Have you ever NOT experienced intense fatigue while working as a nurse?” I think 12-hour shifts are the invention of the devil, a my grandmother used to say. They’re not really 12 hours, it’s harder to get overtime at the end because the incremental percentage is smaller for an hour after 12 than an hour after 8, so there’s more pushback from management. The research on increased error rates in nursing mirrors similar studies in many other occupations, such as the truck drivers you cited, and pilots. Further, when staff work two or three days a week, we know that continuity of care is disrupted, especially important when you consider that people are sicker and have more, not less complicated care needs. Then you throw in the not-so-wild card of those fewer (exhausted) RNs per patient census because they’ve been replaced (not) with LPNs and unlicensed personnel, and you have to start to wonder if perhaps all these factor together don’t account for a large proportion of errors and suboptimal outcomes->readmissions we’re seeing.
Here’s a bold suggestion: How about some forward-thinking hospital system pilots a study of…. eight-hour shifts? Imagine how many underemployed RNs would welcome the chance to be home for dinner, not have to worry about being late for daycare pickup, be able to run errands and get to the dentist in the morning but still be home before midnight, or to have dinner, tuck the kids into bed, and still be back to see them before they leave for school? What. A. Concept. ::::humming a few bars of “Everything Old Is New Again.”::::