What Really Happens on a Hospital Night Shift?

Research and design by Nursing Schools Site

http://www.rncentral.com/nursing-library/hospital-night-shift

"Long Hours for Nurses Affect Patient Mortality" - by Pfeifer, Gail M. MA, RN

AJN, American Journal of Nursing:

April 2011 - Volume 111 - Issue 4 - pp 14-15

 

http://journals.lww.com/ajnonline/Fulltext/2011/04000/Long_Hours_for_Nurses_Affect_Patient_Mortality.7.aspx

 

Lack of time off is an important factor contributing to injuries and fatigue in nurses, according to a study by Trinkoff and colleagues, which suggested that nurses need time off to rest and recuperate in order to protect their own health. Now that same team of researchers has released a new study that suggests that hospital administrators and policymakers have even more reason to consider nurses' working conditions, finding that extended work schedules among nurses may be linked to a greater risk of patient death, at least when certain conditions are present.

The study surveyed a total of 633 nurses at 71 acute care hospitals in Illinois and North Carolina. In addition to questions about shift length and hours worked, the nurses were asked how often they worked 13 hours or more at a stretch, the amount of time off between shifts, the number of breaks lasting 10 minutes or more, the number of days worked in a row, whether on-call duty was mandatory, and whether they ever worked when ill.

Deaths from pneumonia and acute myocardial infarction occurred more often in hospitals where nurses worked long hours. Along with long work shifts, a lack of time off from the job was strongly linked to patient deaths from pneumonia and abdominal aortic aneurisms.

Patient deaths from congestive heart failure and pneumonia were associated with nurses working while sick.

"This suggests that nurses are not at their best if they have to work while sick. Yet they may have to work because of staffing constraints," said the study's lead author Alison M. Trinkoff, a professor at the University of Maryland School of Nursing, in an interview with AJN.

According to Trinkoff, an ideal nursing work environment should allow nurses to get sufficient sleep and arrive at work well rested. Nurses should be encouraged to take their allotted vacation time and sick days—and be respected for doing so. On-call duties should be kept to a minimum to prevent phone calls from interrupting rest and sleep. Even more crucial, she said, nurses shouldn't be called back to work on their days off.

During long shifts, according to Trinkoff, nurses should be allowed to take naps, preferably away from the unit. Several hospitals have policies allowing naps and areas where nurses can take them. 

Electroencephalographic studies show that 15-to-20-minute naps increase alertness, especially in those with partial sleep deprivation. "Naps are very useful," said Trinkoff, adding, "Nurses need to be able to speak up when they are exhausted—without blame—so napping breaks can be implemented in more hospitals."

Trinkoff recommends scheduling relief nurses to cover for full-time staff during peak hours, such as 10 AM to 2 PM, to ensure that nurses receive their work breaks. Meals and break times should be enforced. Relief nurses could also reduce the workloads of older nurses, keeping these experienced staff members at the bedside. In addition, early and late shift starting times should be staggered to help day-shift nurses get adequate rest and maximize efficiency, especially when rotating shifts.

Despite the popularity of 12-hour shifts, which many nurses like because it allows for a three-day workweek, Trinkoff sees benefits in offering shorter shifts. Many nurses aren't suited to 12-hour shifts, and those who can't adapt often leave hospital work. Offering four- or eight-hour shifts could help to attract and retain nurses with young children, older nurses, or those with medical concerns. Nurses with different circadian preferences or sleep disorders or who take medications with peak periods of effectiveness might also prefer shorter shifts. For instance, Trinkoff said, "If a nurse is a morning person, don't put her on nights." Finding ways to reduce fatigue during work hours not only protects nurses, it also protects patients.

—Carol Potera

Trinkoff AM, et al. Nurs Res 2011;60(1):1-8.

© 2011 Lippincott Williams & Wilkins, Inc.

"I Answered the Call—Now Please Give Me a Job"- by Reeder, Pamela BSN, RN

AJN, American Journal of Nursing:

April 2011 - Volume 111 - Issue 4 - p 11

 

http://journals.lww.com/ajnonline/Fulltext/2011/04000/I_Answered_the_Call_Now_Please_Give_Me_a_Job.2.aspx?WT.mc_id=EMxALLx20100222xxFRIEND

 

 When I started nursing school in 2008, a frequent topic of discussion among students was which department we wanted to work in upon graduation. Favorites included the ED, trauma, critical care, labor and delivery, and pediatrics. We saw ourselves reaching for diplomas as eager nurse managers welcomed us onto the units of our choice.

 

We'd read the articles, listened to the media reports. There was a nursing shortage! So we answered the call, hitting the books, working grueling clinical rotations.

Three years later, most of us can't find jobs.

We understand the reasons—the downturn in the economy, too few nurses retiring, part-time nurses working more hours. Intellectually, it makes sense, but that doesn't pay the bills or student loans. In fact, when my husband and I were considering how to pay for the $45,000 bachelor of science in nursing program to which I'd been accepted, I insisted we not use the money in our 401(k), certain that a hospital sign-on bonus would take care of a hefty chunk of the loan. I view that person from three years ago the same way that I see my adolescent self, and cringe at my naïveté.

Incidentally, my 401(k) savings came in handy during my job search, paying for things like food and shelter—the most fundamental level of need in Maslow's hierarchy, as I learned in my nursing fundamentals class. (Now I can at least understand the basic theory behind my needs not being met.)

The California Institute for Nursing and Health Care (CINHC) launched a much-needed pilot program in the Bay Area last year to help new RNs develop their skills and find jobs. The organization also worked with state nursing and education organizations to survey newly licensed nurses in California, the results of which were made available on CINHC's Web site in early November. These reveal that 85% of respondents would be willing to participate in unpaid internships; in fact, 47% would pay for such an internship. Ninety-three percent said their lack of experience prevented them from finding employment.

Other than more experience and, obviously, a job, what else do recent graduates need?

We need empathy. We need hugs. We need people to listen to our complaints. What we don't need are platitudes. In fact, here's a helpful list of what not to say to a demoralized new graduate:

* "Persistence pays off." We know. We are nothing if not persistent. Just ask the hiring managers we relentlessly pursue.

* "Just take any job." That's what we'd like to do. Please give us one.

* "Have you thought of relocating?" Yes. Where shall we go?

* "It's only temporary." In terms of days, months, or years?

I understand that recent graduates in many fields besides nursing have encountered as much difficulty in finding employment. In addition, recent anecdotal reports show a gradual increase in the number of health care workers being hired. I recently became one of these lucky few nurses. During my seven-month search for a full-time position, I'd taken a job at a rural mountain clinic that required a three-hour, round-trip commute and I'd volunteered every Saturday night for six months in the ED of a major hospital in my city. I credit the latter effort with helping me to ultimately land one of six new-graduate, full-time positions there. More than 640 new nurses had applied.

Many of my friends from nursing school are still searching for employment, and a couple of them have had to take jobs unrelated to nursing. I'm glad they're now employed, but I worry about the future of our profession when enthusiastic new nurses are forced to look elsewhere for employment. There's talk of another nursing shortage due to materialize in 2020. If today's graduates aren't given the opportunity to work as nurses, how much worse will this next shortage be?

 

© 2011 Lippincott Williams & Wilkins, Inc.

Nurses Embracing iPhones - NurseZone

Nurses Embracing iPhones - NurseZone

PBS NewsHour: "Are Nurse Practitioners the Solution to Shortage of Primary-Care Doctors?"

Check out this short PBS video!


PBS NewsHour: "Are Nurse Practitioners the Solution to Shortage of Primary-Care Doctors?"
http://video.pbs.org/video/1951907817#

Article on Compassion Fatigue

Many people go into nursing because they want to help people and care about them while caring for them. Nursing may not just be physically exhausting, but you have to remember to care for your mental health too. I found this article on Medscape about "compassion fatigue" that you can check out:


"The Online Journal of Issues in Nursing Compassion Fatigue: A Nurse's Primer" 
by Barbara Lombardo, RN, MSN, PMHCNS-BC; Caryl Eyre, RN, MSN
Posted: 07/22/2011; OJIN: The Online Journal of Issues in Nursing. 2011;16(1) © 2011 American Nurses Association

http://www.medscape.com/viewarticle/745294

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