What are the signs and symptoms of nurse fatigue?

We all know that our patients hate to have their sleep interrupted. New studies show that interrupting their sleep may be detrimental to their healing as well.

Now there’s another sleep issue with implications for patient welfare that’s not getting nearly enough attention, says sleep expert (and fellow nurse) Ann E. Rogers* in the Spring 2014 issue of Scrubs. That’s nurse fatigue.

Rogers says it’s a critically important issue because it affects the health and safety of nurses, their patients and the public. In fact, according to the the Joint Commission, “fatigue resulting from an inadequate amount of sleep or insufficient quality of sleep over an extended period can lead to a number of problems, including:”

• lapses in attention and inability to stay focused
• reduced motivation
• compromised problem solving
• confusion
• irritability
• memory lapses
• impaired communication
• slowed or faulty information processing and judgment
• diminished reaction time
• indifference and loss of empathy

Of course, we all want to get more sleep, but when you’re working several rotating, 12-hour shifts per week, something has to give. So what’s the solution? Here’s what the Institute of Medicine found in its “Keeping Patients Safe: Transforming the Work Environment of Nurses” report:

To reduce error-producing fatigue, state regulatory bodies should prohibit nursing staff from providing patient care in any combination of scheduled shifts, mandatory overtime, or voluntary overtime in excess of 12 hours in any given 24-hour period and in excess of 60 hours per 7-day period. To this end:

• HCOs and labor organizations representing nursing staff should establish policies and practices designed to prevent nurses who provide direct patient care from working longer than 12 hours in a 24-hour period and in excess of 60 hours per 7-day period.
• Schools of nursing, state boards of nursing, and HCOs should educate nurses about the threats to patient safety caused by fatigue.

If your workplace isn’t yet on board with these recommendations, try these tips to help you catch your ZZZs whenever you can:

Survival Strategies for the Night Shift

• Lights on and off: Since your circadian clock is set by light and darkness, a brightly lit nurses’ station is good for helping keep you awake during your shift. Put on your shades (UV-blocking wraparound are best) as you leave the hospital, and continue a lights-out policy at home until you’ve slept. If you don’t have blackout shades for your bedroom, wear eyeshades. Avoid exposure to LED lights (computers, tablets, clocks, phones) before you head to sleep and ban them from your bedroom.
• Take a nap: Studies have shown that short naps can help night nurses remain vigilant during their shifts. If your workplace allows you to sleep during your break, a 15- to 20-minute snooze can be restorative.
• Do not disturb: Turn off your phone, turn on the white noise machine or try earplugs—sound can disturb your sleep. Make sure that family members and friends are aware of your need to sleep, and don’t tolerate interruptions.
• Catch some rays: If the sun is still out when you wake up, expose yourself. It will help signal your brain that it’s time to rise and shine.
• Mix protein and carbs: Eating for sustained energy is important, especially when you’re going against your circadian clock. While your body may naturally crave sugar, aim for small protein-and-carb combos for snacks. An apple and peanut butter, hummus and veggies, yogurt and fruit—all will help keep your glucose on an even keel.

Common Signs of a Sleep Disorder
You’re allocating the time to get eight hours, but you’re still not well rested, so what gives? If any of the following sound familiar, then, according to the National Institutes of Health, you may have a sleep disorder (consult your healthcare provider if you think you do):

• It takes you more than 30 minutes to fall asleep at night.
• You awaken frequently during the night and then have trouble falling back to sleep.
• You awaken too early in the morning.
• You often don’t feel well rested despite spending seven to eight hours or more asleep at night.
• You feel sleepy during the day and fall asleep within five minutes if you have an opportunity to nap, or you fall asleep unexpectedly or at inappropriate times during the day.
• Your bed partner claims you snore loudly, snort, gasp or make choking sounds while you sleep, or your partner notices that your breathing stops for short periods.
• You have creeping, tingling or crawling feelings in your legs that are relieved by moving or massaging them, especially in the evening and when you try to fall asleep.
• You have vivid, dreamlike experiences while falling asleep or dozing.
• You have episodes of sudden muscle weakness when you’re angry or fearful, or when you laugh.
• You feel as though you cannot move when you first wake up.
• Your bed partner notes that your legs or arms jerk often during sleep.
• You regularly need to use stimulants to stay awake during the day.

* Ann E. Rogers, PhD, RN, FAAN, is the the Edith F.Honeycutt Chair in Nursing at Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta.