Josée Gobeil is no longer with us, but this story is written in the present tense as a tribute to her hard work, empathy and service as a nurse. Through a few correspondences with her and her friend, I felt her commitment to the greater good. I thank her family for having consented to share her story. Thank you, Josée.
MISSING OUT ON CHRISTMAS
Sitting on the window seat of the plane to head home for the holidays, coursing through the clouds, I thought of Josée. The air was filled with the Christmas and New Year’s fiesta. As the bells jingled and lights covered the city below, I imagined Josée leaving her house for her night shift nursing job from 11:30 p.m. to 8 a.m. at the Jewish General Hospital. “For 35 years, I have worked every second weekend and almost every holiday. My family spent Christmas and New Year’s Eve without me, while I was working nights,” said Josée. “Most of the time I cannot even have a dessert at the party organized by the ICU department,” she continued.
She contently shared that only in the last two years had she taken Christmas off to spend time with her family. Her family is eagerly planning for her retirement, which is going to be soon. Josée’s work took a toll on her social life. She shared, “When you work nights and weekends, you miss the parties and all the fun. Sometimes movie shows finish at 10 p.m. and by that time I must reach the hospital. Other than going to a restaurant I can’t do much.”
As an assistant head nurse, Josée assigns nurses to patients on different shifts, giving her a unique perspective on their challenges. She highlighted one reason why new nurses left hospitals for private clinics. “Most of their parents are nurses and they don’t want this lifestyle. They don’t want to work on New Year’s Eve. So, they work in a private clinic to have a real holiday.”
SLEEP AND WORK STRESS
As an assistant head nurse in the ICU department, Josée faces unique challenges. “It’s hard to assign shifts. Old and new nurses have a very hard time because each has their unique challenges. New nurses are figuring out a way to manage their schedules. So, in the morning, they share how hard it is for them. I understand that. But I must assign the patients to nurses. I can’t take them home. So, when I come home, I am still thinking about this. I can’t sleep!” she shared.
She stressed that the new government mandates to increase patient beds had added to her stress. “Before COVID, we had 22 beds, now we have 24 and by the end of July [2024] they want 27 and gradually even more. But we have fewer and fewer nurses. How can I assign nurses to the patients when they are already complaining?” She expressed this concern multiple times in our call. Josée reaches home by 9:30 a.m. and sleeps – rather she must try to sleep to recover – from 10:30 a.m. to 4 p.m. while her brain is still at work.
Due to difficulty falling asleep, especially since the pandemic hit, Josée started popping 5 mg of melatonin every morning – when melatonin levels naturally drop. “…then it became a habit. I have never stopped since. During the pandemic, my husband and daughter were at home. Both working and having lunch together and I couldn’t sleep. I saw on my Fitbit” – which was gifted by her friend, aware of her sleep issues – “that my deep sleep is a bit longer when I take melatonin.” With all the stress, her Fitbit showed a total of 3 hours-4.5 hours of sleep a day.
The stress makes it hard to sleep. For someone working day shifts, they have some time before sleeping to calm down and get over the work stress. But not for me. So sometimes I sleep at 12 p.m. and then it’s even harder. I have seen the sun, people are having drinks, it’s nice outside, everyone is having fun. And I must stop everything and go to bed.
SLEEP ON OFF DAYS
Josée’s natural sleep need becomes evident on off days. Free from hospital stress, she sleeps for 8-9 hours at night. When she drives to her idyllic countryside home, within woods where deer roam around her house, she sleeps 10-12 hours per day. For someone with such a sleep need, getting only 4-6 hours on work days must be a mental and physical challenge.
On the first off day, i.e. when she doesn’t have to go to work the next day, it’s hard for Josée to adapt to the new ‘day schedule’, akin to the other night shift nurses we interviewed. After coming home from work, they starve themselves of sleep until night to build up the sleep drive. She said, “I only go to bed at night by 11 p.m. and sleep until 7-8 a.m. Often, in the middle of the night, I wake up scared that I missed my alarm clock, and I missed my shift. On the first night I have a bad sleep.”
Gradually she adapts and sleeps at 10 p.m. But any deviation from that schedule, like watching a movie until 1 a.m., “I am back on the night work schedule,” she said, “I can’t sleep at night. So, I set a reminder to sleep by 10 p.m.” It seems like her internal clock becomes very rigid and sensitive. “When I have to go back to my work”, Josée mentioned that she can’t sleep in the afternoon as she isn’t tired, “but I try to go to sleep 8-10 p.m. and then leave for work.”
SLEEP, NIGHT SHIFT WORK AND MOTHERHOOD
Josée started her nursing career in 1989, and she chose to do the night shift because she was never an early riser, and nobody wanted a permanent night shift. “When I was young, I didn’t have any sleep problems. Rotating shifts were very hard for me. So, I started doing nights, and it became easier due to habit.”
Her younger self had a vibrant social life. Josée owned her time on the off days. After the night shift, she would go out with her friends, have drinks until midnight and sleep until late afternoon the next day, “I was alone, it was fine.” After having children, working nights was a double-edged sword. On the one hand, she enjoyed having breakfast and supper with her children, but on the other hand, it took a toll on her sleep when they were very young. “My sleep was very bad. I was working 12 hours initially,” she said.
“My son had a learning disability and was followed by a specialist. We would have an appointment around 1 p.m. So, I would sleep from 10 a.m. to 12 p.m., get him from the daycare, go to the appointment and drop him back at the daycare, THEN try to sleep again.” She continued, “When my children were young, I couldn’t put my phone down thinking their teachers could call me. Sometimes other people who didn’t remember that I was working would also call me.”
Importantly, when Josée tries to sleep, the rest of society is awake. “There is a lot of noise on the streets – children are going to school from my street or there is construction work noise outside my house. Thus, after coming back from work, my sleep is fragmented. I don’t get into deep sleep, per my watch. But when I sleep 8-10 p.m. before my shift, I see I go into deep sleep.”
DROWSY DRIVING
Like others’ stories we have covered, Josée has faced the dangers of drowsy driving while coming back to the south shore, which is a 35-minute drive from her work. “It happened a couple of times that I fell asleep at a red light. I woke up when the other cars honked,” she said worriedly.
It happened twice that I hit the sidewalk because I was falling asleep. Nothing bad happened. Thankfully my car detects the lanes and also stops if the car in front stops. But I got very stressed after those incidents, and I was scared to drive.
Josée’s coping strategy is to buy a super-hot coffee while going home – not to drink, as she said, “coffee doesn’t affect me anymore”, but to hold it. If she falls asleep, it spills and burns. “If I am too tired, I take little roads within the city or talk with my family which keeps me more attentive. On the highway, I easily fall asleep.”
Josée found what worked for her. However, it’s only a matter of time before the sleep drive takes over the driving. On average, 20% of all crashes in developed countries have been attributed to drowsy driving. In fact, 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.
Could institutions step in to address this critical safety concern? Could institutions provide taxi vouchers or shuttle services to the night shift workers like Josée, to arrive home safely and maintain road safety?
ANECDOTE OF SLEEP AND EMPATHY
As the person who assigns nurses to patients, Josée could either be empathetic towards nurses or stick with the strict rules. Having experienced how sleep affects the rest of the occupations during the day and work at night, she chose the path of empathy.
“When I see the nurses are tired because they can’t sleep in the day – this happens – I ask them to nap for 20 minutes during their shift and I cover for them,” she said.
Josée shared that she allows some nurses to take their dinner and nap breaks together, which amounts to 1.5-2 hours, so that the nurses can use this time to sleep. “Some strict nurses don’t allow this because of the rules. But when you work nights, if there is no risk for patients, it’s quiet, it’s dark, it’s natural to feel sleepy. If I see they are exhausted, and their eyes are red, then even if they go beyond their break time, I don’t wake them up. I or someone else cover for them.”
“I feel it’s a bigger risk for patients if the nurses work when they are very sleepy.” She shared an anecdote that ties sleep health to the retention of nurses in the health workforce. Josée shared, “In my experience, if we don’t help other nurses, they call in sick because they are tired, and we lack one nurse with already a dearth of staff. I would rather ask them to come and we support each other as needed but at least have someone attend to the patients. I understand that even if we decide to sleep in the day to be able to work at night, it is very hard. It is very hard to say “no” EVERY TIME – not to go out and not follow others when everyone else is enjoying themselves because you must sleep. It is only human [to feel this]. So, I can’t blame them.” Certainly, camaraderie is important in sustaining through nights in the hospitals.
CALL FOR CHANGE
Being stressed about assigning nurses to patients, Josée has a suggestion that could increase the retention of nurses in the hospitals.
“It would be great if our institution could let us work only one of every three or four weekends, rather than one of every two. This would help a lot of nurses because many nurses call in sick to rest or enjoy weekends. We try to tell them not to call in sick as it becomes hard to find a substitute. Everybody else is doing something on weekends. [If we change this policy], the nurses can have more time to socialize and have family time. This will prevent a shortage of nurses and absenteeism.”
Josée continued, “We tried to make this change, but it was refused because they were missing nurses. But even when we had more nurses, they never changed it. Some places already do this. Why can’t we?”
The lack of social life and family time, as experienced by night shift nurses, was also highlighted in Beniamin’s story. Night shift work is well linked with social life compromises. This raises an interesting research question: Is sleep connected to life and job satisfaction, and thus contributing to the retention of nurses in healthcare?
Through her experience, Josée recognizes that sleep is governed by factors beyond an individual’s control and that sleep affects every aspect of the nurse’s life – from maintaining a social life to motivation at work, patient safety, absenteeism and stress. Knowing this, she has built a work environment with empathy and camaraderie. Kudos to Josée!
