“We expect night shift workers to continue to be fathers, mothers, daughters, wives and, sometimes, come home and take care of their older or sick parents and still perform their 105%.”
– Beniamin, a nurse clinician
Red eyes, irritability and impatience – these are the glaring signs of the participants who spend a night without sleep as a part of my research study. For obvious reasons, they consent not to drive home. They often say, excitedly, that they feel buzzed. Not coincidentally so: 17-21 hours of sleep loss is equivalent to having a blood alcohol content of 0.05% – 0.08%, the maximum legal blood alcohol concentration. In Canada, nearly 1 in 5 drivers report driving while having trouble keeping their eyes open. Internationally, fatigue is estimated to be a contributing factor in the same proportion of road crashes.
DRIVING AFTER SHIFT WORK
Beniamin was amongst those people who would feel drowsy driving home after a night shift. He was an ICU nurse at the Jewish General Hospital who worked rotating shifts for 29 years. His schedule circled from four days a week of 12-hour day shifts followed by four days of 12-hour night shifts the following week. Returning home from the hospital involved a 22 km drive, south of highway 440 to Laval, which typically would take about 30 minutes against the morning traffic. “It happened to me five times in the last year that I had to stop driving to sleep,” said Beniamin, who stopped his night shift job not because he was any less passionate about his work, but due to overwhelming exhaustion. “Once I was just two minutes away by drive from my house – so close – but I refused to continue driving. So, I left the car and walked home. I didn’t want something bad to happen to me or others on the road.”
Fortunately, Beniamin never got into an accident, but his colleagues did.
Often, the lapses in attention due to drowsiness, muscle weakness and dozing come without a warning. But Beniamin managed to evade accidents by training himself to recognize the signs of drowsiness and fatigue. “I learned to recognize the signs half an hour before I would doze off. So, I never dozed off during the drive.” He learned that from his colleagues while volunteering to drive the charter bus twice a year.
READING THE SIGNS
On nudging him to share all the signs he notices, he explained, “Losing attention is a big sign. If I came home by bus and I missed my bus stop, that is a sign. If I miss the exit while driving and realize it later even though I am not asleep, that is a sign. Slowing down on highways unconsciously or missing the radio news when you were ‘focusing’ on the news are other signs.” He went on, “If I lose the sense of direction I am driving towards or for a moment if I become unaware of the time and place I am in, it is a bad sign. At night if you see blurry, smeary lights on the road like you don’t have your glasses, it is a sign to stop.”
Due to their fleeting nature, these signs may go unnoticed by many. “You should stop and sleep or you should drink coffee. This is the rule of commercial driving, otherwise, you provoke a tragedy.” He considered himself lucky to have learned these signs. “This is not something we learn in nursing school. I had good trainers at my volunteer work and the trips were always with two drivers.”
For Beniamin, these signs intensified especially in the last five years. “Before that, I was exhausted, but I was functional, it is normal. Now it was a bit too much.” He shared a specific example from his work: “On my night shift in the ICU, some colleagues were answering my red alarms even when I was awake. On a red alarm, you need to jump. It is an emergency alarm. But I was not jumping. I would look at the monitor, but I was not moving. My colleagues would exclaim, ‘Red alarm, Ben!’ But I wasn’t conscious enough of the surroundings.”
SEEKING HELP FOR EXHAUSTION
I was curious why these signs had intensified so drastically over the past five years, especially since Beniamin had previously mentioned that his ability to cope had improved with time. He responded, “I am not sure if COVID played a role. I think we underestimated the psychological toll that COVID took on us in hospitals. Or perhaps I am just growing older.”
Beniamin navigated through a process of understanding his exhaustion and sleep issues. He discussed these with his colleagues and doctor but found no satisfactory answers and felt misunderstood. “Initially I tried taking time off between the shifts but that didn’t work well. I was tired, always tired. When I spoke about this to my colleagues, they suggested taking some time off and relaxing. So, I took a vacation. But it did not solve the problem. I looked up on the internet, including medical resources. But they were focusing on palliation or coping strategies rather than solving the root of the problem.” I was now eager and hopeful to hear what his doctor had to say – after all, doctors are health experts. “I spoke with my physician. He was a nice person, but we again concluded that I was just tired. He also suggested that I take some days off and offered me to give a letter. But that was not the solution I was looking for. It wasn’t in my values to call in sick when I was not. I want to do my job, do my part for society.” At this point, I could see Beniamin’s frustration. He felt misunderstood, exhausted and hopeless in finding a solution. So, at 50, he was certain that he needed constant day shift work and a more organized life. He resigned from his job.
A CALL FOR CHANGE
Beniamin, who has a son and wife, said, “These issues should be addressed. We expect especially a new nurse to be available overnight, to never be tired, to always be happy and smiling and to not have other goals in life other than nursing. COME ON! This is not realistic. We expect night shift workers to continue to be fathers, mothers, daughters, wives and, sometimes, come home and take care of their older or sick parents and still perform their 105%.” He crinkled a side of his face with a shoulder shrug as if he was stating the obvious.
“During my nursing education in Quebec, they taught us ‘don de soi’ which means ‘give yourself’ and inculcated the ‘patient first’ psyche. I think this was true when nurses were single, lived and slept in hospitals. This is not realistic anymore. But we still teach the same.” He urged that the system should adapt with time to the realities faced by the nurses and prepare the students for those realities rather than painting a floral portrayal. “[The system] does not talk about the depression we need to face or the time you need to give yourself to become zen.” In this context, he referred to the education system as “a bit sick”. Elaborating on that expression, one should question: if the health and life of nurses are not prioritized, how can they ‘give themselves’ to the patients?
While discussing a pressing issue of nurses’ demands from the government with his colleagues and the head nurse, Beniamin, who describes himself as witty, quipped, “We just need a cottage to spend time together,” implying that they need some time for themselves. He continued, “We should have laws that are permissive and not restrictive. Organizations themselves are not an issue. Unions make the rules. They deal with the government. Even though they do not start with bad intentions, we arrive in this situation. So, the unions need to set better policies, educate the nurses on sleep issues, give choices for shifts, and encourage them to also have a social life. In nursing, we should stop being ministers and just be professionals. Why don’t the mega-institutions like CIUSSS and CISSS hire sleep specialists? Sleep is a critical part of everybody’s life. It affects our health.”
Beniamin frequently highlighted the challenges of maintaining a social life because it was hard for him to have one. His schedule looked like this: “On night shifts, I would finish my work at 7:30 a.m., reach home by 8:45 a.m., and go to bed at 9 a.m. for about six hours. I would be fine after I woke up and would spend time with my family. Then I would get ready to reach the hospital for my shift at 7:30 p.m. During the day shift, I would reach home by 9 p.m., spend about half an hour with family and go to bed by 10 p.m. But I would not fall asleep immediately, nor would I wake up easily in the morning even after 8-9 hours of sleep. I wouldn’t feel refreshed. I believe I was better after sleeping after a night shift than on the day shift. But my family’s perception was the opposite.”
Beniamin immigrated to Quebec from Romania. Being a new nurse, doing a night and rotating shift work wasn’t his choice – either back in Romania, or in Quebec now. “In Romania I had to choose between a 12 or 8-hour shift. 8-hour shifts didn’t suit me. The schedule was one week of day shifts followed by one week of evening shifts then one week of night shifts. So, I worked 12 hours of day shift, followed by 12 hours of night shift and then 24 hours off. Then restart the cycle. That is crazy but that was life. Accept it or look for another job. When I came here [in Quebec], I had to start on rotating shifts. When you gain seniority, you can apply for different shifts. But even after [gaining seniority] I did not change my schedule because it was necessary for me to come home for my son even if it was just to sleep. He has ADHD and when he was younger, he would not sleep until I arrived home. It was important for me to be with him in the evening. So, I was stuck with that schedule.”
AN ANECDOTE
Like many, he would get anxious if he could not fall asleep on time to get sufficient sleep before going to work. As a result, he would call in sick, feeling unable to function effectively. He shared an anecdote from his early days in this profession about how challenging it was to adjust to his ‘crazy’ schedule in Romania. Back in 1996, when having AC in an apartment or a cell phone was uncommon, Beniamin decided to go to his parents’ property in the countryside to sleep after the night shift. Their apartment was cooler than his. “After a 20 km drive, I was tired. So I parked my car in a safe place, and I slept ALL day in the car. In the morning my uncle saw my car while going to his work, and while coming back, the car was still in the same place.” To fall asleep all day in a car parked on the road rather than on a cool comfortable bed speaks volumes about the depth of his sleep drive.
Beniamin is now a nurse clinician in the vascular access team in the same hospital, working day shifts. He is happy with his job and appreciates a more organized life. “Before, I could never believe anyone waking up without an alarm. But now there are times when I wake up before my alarm wakes me up.”
I am happy for Beniamin. We wrapped up with his words reflective of his lessons. He said, “Take care of yourself. You live for yourself too and not just for your research.” I wished him good sleep – perhaps his happiest wish.
