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May 25, 2018

40 hours without sleep: One nurse's experience—and 5 ways hospitals can ease sleep deprivation

Daily Briefing

    Writing in the American Journal of Nursing's "Off the Charts" blog, a nurse describes "the disorienting experience of being awake for 40 hours" to draw attention to the importance of proper sleep for nurses, which the American Academy of Nursing (AAN) addressed in a recent position statement.

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    A nurse's experience

    In the blog post, the nurse recounts what the nurse's first-ever experience staying awake for 40 hours straight. The nurse notes that that particular long day was the product of a family medical episode and a car breakdown. The experience "was strange and new, and something I pondered over for days afterward," the nurse writes.

    In the piece, the nurse describes the physical and mental effects of staying awake for an extended period of time. "By the time I'd been up for 24 hours straight, I was operating at a level about two beats behind everyone around me," the nurse writes. "Physically, I felt ... as though I might fall if I didn't step carefully." In addition, the nurse reports having had a "low level of functioning" and an "inability to think clearly."

    The nurse states, "I couldn't stay in this shape for long and still be of use to anyone."

    The experience left the nurse curious about the relationship between sleep and work performance and how sleep deprivation affects nurses. The nurse asks, "Do nurses who are acutely or chronically sleep-deprived experience anything like my physically and mentally altered state? ... How could I possibly have multitasked if I were back on a busy unit? Could even a barcode system have ensured that I got the right meds to the right patients?"

    With these questions in mind, the nurse draws attention to a recent position statement from the on sleep deficiency in nurses American Academy of Nursing.

    The dangers of fatigue

    AAN in the position statement warned that sleep deficiency can "affect nurses' work readiness and health, safety, and well-being." AAN stated that sleep-deprived nurses are at a greater risk of endangering both themselves and patients.

    In addition, AAN cited a report from the AAA Foundation for Traffic Safety, which found that people who get just four to five hours of sleep in a 24-hour span are at a 4.3 times greater risk of crashing their vehicle. The academy also cited data from RAND, which show insufficient sleep has the potential to cost the U.S. economy at least $411 billion a year and a total 1.2 million working days a year.

    While a number of efforts have been made to combat nurse fatigue, AAN said there is more to be done, and outlined five actions nurses and employers can take to prevent sleep deprivation and associated consequences among nurses:

    1. Nurses and employers should "educate themselves about the health risks linked to shift work and long work hours," as well as evidence-based interventions that could reduce those risks;

    2. Employers should use evidence-based strategies when creating their employees' work schedules, as well as create policies and programs that "promote sleep health and an alert workforce;"

    3. Employers should "promote a workplace culture that promotes sleep health to achieve optimum functioning, health, safety, and sense of well-being of their workforce;"

    4. Employers should recognize how turnover, patient safety, and other costs are related to nurse fatigue and shift work appropriately; and

    5. Continuing education courses should be developed for nurses and their managers—specifically courses that "relay evidence-based personal practices and workplace interventions to maximize sleep health and alertness in nurses."

    AAN stated that health care organizations, individual nurses, and public health and governmental agencies can help enact change and "ensure that nurses are fit to provide excellent patient care around the clock as well as help nurses maintain their own health, safety, and sense of well-being" (Caruso et al., Nursing Outlook, November-December 2017; "Off the Charts," American Journal of Nursing, accessed 5/24).

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