“When I started working different shifts, I quickly realized that it’s hard and overwhelming. It takes a big toll on your life. It’s hard to maintain a work-life balance along with the sleep issues caused by shift work. And that sucks.”
SLEEP, ANXIETY, AND TRANSITION SHOCK
Fresh out of nursing school, Norah [name changed] was plunged into the busy and sleepless world of nursing in a hospital in Vancouver.
The world where, as a new nurse, you need to learn new rules, adapt to shift-specific expectations, establish new personal routines, and devote yourself to the patients while building collaborative relationships within the hospital. The world within that is conflicted about your competence and confidence due to the transition shock, and is filled with pressures of fulfilling your ambitions, responsibilities and student debts. Importantly, the world of sleepless nights and sleepy days. All the reasons to provoke anxiety!
New grads are often blindsided by the realities of a nursing career. As a consequence, beyond the passion for the profession, a nursing career most often equates with an involuntary breeding ground of unhealthy habits.
It starts with an oxymoronic habit. “You drink a lot of coffee, take a lot of melatonin.” Norah recalled, “Your sleep is messed up and your circadian rhythm is thrown off. I had ‘raccoon eyes’ and I would look like I had smudged the mascara.” The list continued. “I didn’t have time to socialize, and I barely saw my family. I was working on the weekends and not everyone is free on Monday at 2 p.m.!” Norah shared that she had lost weight because she wasn’t eating regularly, while some of her colleagues gained weight as they snacked more on the night shift. “I would pass out after coming home from the day shift and sleep through lunchtime after coming back from the night shift,” she admitted. Physical activity was nearly nonexistent, aside from the occasional yoga session. “For someone like me who loves physical activity, it was hard. I was sleeping through the off days.” All the reasons to worsen anxiety!
Norah quickly realized that sleep issues dictated her life, keeping her from living a fulfilling life. Most of the time that she wasn’t working, she was sleeping. The primary cause of her sleep complaints was the rotating shift schedule that she had to follow as a new nurse.
SLEEP AND ROTATING SHIFTS
Let’s slice through Norah’s week.
Norah’s week began with two 12-hour day shifts from 7 a.m. to 7 p.m., followed by two 12-hour night shifts from 7 p.m. to 7 a.m., and then three days off. Carrying an accumulated sleep debt from the past week, Norah would enter another week.
“After my first exhausting shift, I would pass out at 8 p.m. without having dinner. Then, I would wake up at 5 a.m. [to get ready for the next one].” Norah got nine hours of sleep, seemingly ‘enough’. But work anxiety would shatter the dream of a restful sleep. She recalled, “The quality wasn’t good. I would get anxiety nightmares. I would wake up in the middle of the night, frightened that had I missed my alarm, and missed my work.”
After the second day shift, Norah would sleep until 11 a.m. the next morning. Starting her day by noon, she couldn’t nap before the night shift – “If I am lucky, maybe half an hour,” she said.
Naturally, after 12 hours of staying awake, Norah would feel sleepy by 11 p.m. on her night shift – when she is expected to be fully alert. With no opportunity to sleep for another eight hours, she would try some techniques to stay awake. “If you are short-staffed, you cannot have a nap on the shift. By 3 or 4 a.m., you start to fall asleep at the nurses’ station. It’s a risk to the patient. So, I would keep the brightness of my computer full and splash cold water on my face to stay awake,” she said. Knowing the perils of sleep loss, Norah shared that her colleagues would watch out for each other’s work multiple times to prevent serious mistakes.
Coming home from the night shift by 8 a.m., Norah would sleep until 2 p.m. “Then I would be awake for the rest of that day” – which was until the next day at 8 a.m. when she would finish her second night shift. This amounts to about 17-18 hours of continuous wakefulness, which has a long list of negative effects on the mind and body.
Finally reaching the most awaited day off, Norah would sleep from 8 a.m. to 6 p.m. the next day, only to stay up until 3 a.m. the following night. “It just gets worse,” she admitted. It’s another cycle of disrupted sleep, anxiety-provoking situations, and more sleep disturbances, each fueling the other.
DROWSY DRIVING
Now imagine this: it’s 7:45 a.m. You are finally leaving the hospital after a long and stressful night shift, having been awake for about 18 hours. You step out of the chaos, the business and the noise of the call bells, and you are walking towards your car still carrying some anxiety with you. You sink into the car with a huge sigh, relieving the weight of your exhaustion and dreaming of your bed.
The first thing you must do – not sleep, but drive.
It’s a scary thought. I can barely make it from my couch to my bed when I am sleepy. It was scary for Norah too. “I would jam my hair in my window. If I dozed off, it would wake me up by yanking off my hair. I would also blast rock music to stay awake,” she shared. Thankfully, her commute was only 15 minutes long, which felt very long. “But,” she added,
I don’t see much literature on driving home after day shift. You are working 12 hours in a stressful situation; you haven’t slept well, and your circadian rhythm is messed up. It’s difficult to drive home even if it is during regular hours.
SLEEP AND PILLS
Despite the struggle, the exhaustion, and the stress, it’s frustrating to know that you won’t get enough sleep, won’t feel satisfied with your sleep and won’t feel rested before the new week starts. Involuntarily, you succumb to a ‘quick fix’.
Norah was taking sleeping pills and caffeine, “just to wire myself and feel alive,” she said. She took melatonin on the off days because it is available over the counter. “I wasn’t taking it when I needed to go to work the next day because I would wake up drowsy and feeling groggy. But over time,” which was one month for her, “my body got used to melatonin. It was fast for me. Anyways, it is not meant to be taken regularly.”
Even when ineffective, she continued taking it, holding onto the hope of grabbing even the smallest benefit it might have on her sleep.
CALL FOR CHANGE
After four months of nursing practice, Norah is now pursuing a master’s degree where she is investigating the effects of shift work on sleep – perhaps inspired by her own experience.
She is still passionate about patient care. “A part of me wants to go back to nursing practice [after MS]. I trained for it for so long. I like to help people.” She sadly continued, “But the work environment just doesn’t allow for longevity or having fulfilling careers.”
Many of her friends shared the same complaints of constant exhaustion and sleep issues. “Some of them discussed going to another area of nursing like public health that could allow them to have more work-life balance and better sleep. But some stay for financing reasons or because they always wanted to be nurses. For new graduates, it’s a shock because they don’t teach you this [in school].”
One can argue that given the precipitous decline in nurse retention in hospitals and high attrition of new nurses, new graduates are an opportune population to target for a meaningful change. Norah shared her two cents on ways to improve workplace longevity and patient care quality. Norah urged that the new grads should be made aware of the toll nursing can take on their lives.
“The only thing they tell us [in nursing school] is ‘There is a difference between school and the real world’ – we know that! But they don’t teach you how to deal with the challenges of sleep during shift work. It’s really hard.” She continued, “The nursing schedules are pretty much set in stone. Two days – two nights – three days off. Through new graduate support programs, nursing schools or hospitals should give us practical advice and inform strategies to manage sleep. Example: “What do you do when you are drowsy on the shift?”
Finding coping mechanisms and a routine that suits your sleep after working at odd hours can be a frustrating and lonely journey, as other storytellers have shared with us. “I never really figured it out. I was the only new graduate in my unit. The others were very seasoned nurses, used to night shifts. They would say, ‘You will be sleep-deprived forever, you just get used to it.’ I don’t think anyone I have talked to has shared a positive coping strategy.”
Norah shared her concern about limited access to sleep-related resources. “There are probably plenty of educational programs, but we are unaware of those or not sure where to access those.” Perhaps access to a sleep specialist and a ‘one-stop-shop’ compendium of important sleep-related resources should be made available by the institutions.
Surprisingly, Norah’s unit was not equipped with designated nap rooms, which she suggested should be changed for quality naps. The nurses were using the lunchroom or a couch, which are uncomfortable.
Now, despite these demands of Norah’s MS program, her sleep is restful as it was before the nursing job.
We hope that one day the passion and dedication of nurses to patient care will be matched with improved workplace conditions that support healthy sleep, allowing them to have fulfilling, balanced lives.
