Surviving nights

Davis, Peter

doi:10.1016/j.joon.2006.03.010

« Previous Next »Journal of Orthopaedic Nursing
Volume 10, Issue 2 , Pages 63-64, May 2006

Surviving nights

83 Fosse Road, Newark, Notts, United Kingdom

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Most of us have worked nights at some time in our career and many nurses still are or have done little else. Whether in the community or large hospitals the work takes on a different ambiance and demands a different type of stamina. Nurses provide 24h care 365 days of the year and often at the expense of their own lives and health.

In the United Kingdom the risks to patients and harm to health care professionals of working nights and long hours has long been recognised. Recently, the European Working Time Directive has led to junior doctors reducing their long hours but having to work full night shifts rather than be on call. Thus our medical colleagues also now have to learn how to survive at night and keep patients safe through making sound care decisions.

Our body’s daily functions are controlled by an internal clock situated in the suprachiasmatic nucleus in the hypothalamus. This area is close to the optic nerve as it passes to the visual centers of the brain and thus is regulated by light. At night many of the processes that are active during the day start to slow down as we prepare for sleep.

The issue is are we safe? When working nights we never make up all the hours of sleep we lose and have to manage daytime sleep and fatigue at night by keeping the sleep debt to a minimum. Fatigue has long been known to reduce performance. For example, Lamond and Dawson (1999) demonstrate that 20–25h without sleep reduces psychomotor performance to the level of someone with a blood alcohol concentration of 0.10% (UK legal driving maximum level is 0.08%). Also your risk of having an accident while driving following 24h without sleep is doubled.

As professionals we cannot use tiredness as an excuse for any mistakes we may make and as such we must ensure that this does not occur. In the UK, the Royal College of Physicians (Horrocks and Pounder, 2006) have recently produced guidelines for junior doctors that reinforce what many nurses have discovered for themselves, but are still very useful:

•associate your bedroom with sleep do not watch TV or use computers there;

•before your first night lie in late and take an afternoon nap (2

h);

•take a nap during the night (20–45

min but no more than 45);

•maximise your exposure to bright light during the night (desk lamp/overhead lights);

•eat and drink properly, do not start the shift hungry or dehydrated;

•small amounts of caffeine can be used to maintain alertness;

•when you get home go straight to bed;

•avoid alcohol and sleeping tablets to aid sleep.

Orthopaedic nurses care for many trauma patients involved in road traffic accidents due to tiredness; we need to be careful not to compound their problems by mistakes we may make due to tiredness.

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