The problem or issue that has been discussed in this article is regarding the impact of physiological or psychological effects on nurses, who have to work long night shifts, on the safety of their patients. The nurses who have to work on their night shifts have to face a number of social and health related problems. Night shifts disrupt the synchronization that exists between the natural environment and the internal clock of our body. Due to this disruption, the nurses suffer from social isolation, increased injuries, accidents, and sleep disturbances. They also suffer from various physiological effects like changes in,
- the rhythms of their core temperature
- their immune functioning
- their various hormonal levels
- their activity rest cycles (Swansburg, 2005)
Due to lack of sleep, their body feels fatigued and their health deteriorates because of stress. The different psychological effects arise due to social isolation as night shifts disrupt their personal and family life-giving rise to relationship and communication problems and issues.
Thus, slowly their tiredness and fatigue becomes apparent in their work, which brings us to the issue of patient safety. Although many people may not be aware of the impacts of the above problem, its effects could be severe on the patients. The nurses with their long hours of work and, sometimes, mandatory night shifts, have to face problems with their mental and physical health, affecting their work and quality of care for patients. Due to their emotional exhaustion, the nurses become irritated and their relation with the patients becomes sour.
Some studies regarding patient safety due to impact of mental and physical health of the nurses on night shifts were conducted after in 1999 by the Institute of Medicine or IOM had announced that around ninety eight thousand people in the US annually die due to mistakes made by hospitals. Institute of Medicine had carried out another survey in 2003 on the various factors in nursing profession and their impact on the safety of the patient. They had concluded saying that ample evidence had been found associating long night shifts and the nursing staff with numerous errors and extremely adverse reactions, like urinary tract infections, pneumonia, infection after operations and some patients even had to increase their stay in the hospitals. (Doyle, 2003)
Brief review of the research relevant to the problem and some information about the problem
Institute of Medicine also found that if these nurses are made to work in shifts that are longer than 12 hours in a day then they endanger their patient safety because of their fatigue. They do not pay proper attention to their patients since they fall asleep while on duty further increasing the risk of making life-threatening errors. Institute of Medicine further reported that due to their physiological and psychological problems the nurses start to ignore the acute needs of their patients most of whom cannot even get out of their beds and thus, cannot call for help.
Thus, it is not a surprise for us that the risk of making severe errors increases by almost three times when the nurses have to work longer hours without any sleep or proper break between their shifts. It has also been observed that no matter how long the night shifts are scheduled to be for the nurses, working at late hours always increases the odds of causing a minimum of one error per patient. In addition, almost two thirds of the nurses having to work night shifts fall asleep while on duty. This leaves the patients in a very vulnerable situation.
These nurses working strenuous long night shifts not only have to face stress and fatigues but also have to struggle against their regular circadian rhythm and also their biological tendency of falling asleep at night. Institute of Medicine observed that a majority of nurses became highly irritated while attending the patient’s call making it difficult for the patients too. The patients are not taken proper care of and just like the nurses; they too suffer from stress and fatigue.
However, in their cases this stress or fatigue could be very harmful especially if they are old or are suffering from major illness. In 1999 a study carried out by the Minnesota Nurses Association which is affiliated to the United American Nurses, observed that more than two-thirds of the nurses expressed intensifying frustration towards their job and more towards their patients when having to work on night shifts without rest.
A lot of research has been done, mainly by the Institute of Medicine to find out about this problem and the sole result of all the researches is that these nurses need proper sleep and rest if they are required to take good care of their patients and show efficiency in their work. If this problem persists then not only will the lives of the patients be in danger but also the nurses will face accidents and injuries in their lives. In addition, their job satisfaction will be very low, due to which the customer satisfaction of the patients and their families will also decrease. (Page, 2004)
What question needs to be answered regarding the problem or issue
The main question that needs to be answered regarding the above problem is how many hours the nurses should put into their work so that they do not suffer from stress or fatigue and at the same time are efficiently able to care for their patients. The Institute of Medicine has recommended the hospitals that the state has strictly prohibited nurses to work no more than twelve hours in a minimum of twenty hour period which comes to at the most sixty hours of work per week. This includes both their night and day shifts. These figures have to be maintained if we want the nurses to take care of their patients effectively.
The hospital authorities should not force the nurses and threaten them with their jobs, as this will only jeopardize the lives of the patients under their care. The nurses should be slowly let to adjust themselves to the night shifts and should learn how they can adjust their internal rhythms to their working hours. Only when the nurses feel good about their work will they be able to take proper care of their patients. A study by the Sleep journal also reports that to reduce errors in patient care the nurses should complete all challenging work before 4 am and then get proper rest. (Perrons, 2006)
Doyle, Christine E; 2003; Work and Organizational Psychology: An Introduction with Attitude; Psychology Press.
Page, Ann; 2004; Keeping Patients Safe: Transforming the Work Environment of Nurses; Institute of Medicine (U.S.). Committee on the Work Environment for Nurses and Patient Safety; National Academies Press.
Perrons, Diane, Colette Fagan, Linda McDowell, Kath Ray, Kevin Ward; 2006; Gender Divisions and Working Time in the New Economy: Changing Patterns of Work, Care and Public Policy in Europe and North America; Edward Elgar Publishing.
Swansburg, Richard J. & Russell C. Swansburg; 2005; Management and leadership for nurse administrators; Ed: 4; Jones & Bartlett Publishers.