Tips for Surviving and Enjoying the Night Shift
Whether you are a new graduate starting night shifts for the first time or an experienced night shift worker, these tips may assist you to improve your night shift experiences. We as night nurses carry a responsibility for the safety of those we care for, therefore part of that care is to look after our own needs in order to meet the needs of our patients; for example, by getting adequate rest and relaxation before we commence night shift.
The role of the night shift should not be minimised. What happens during the night shift is as important to the recovery of the individual in hospital as the activities that occur on any shift. The sometimes quieter routine of night provides opportunities for close patient communication, with more one-on-one time with patients who are wakeful or fearful and with no interruptions from telephones, family or friends visiting. The night shift can be a time for rich drama in nursing, with each night like a new adventure as it unfolds into a new day.
Nurses at night often become well-versed in making do, as support services available in the daytime are often non-existent or only on call during the night. Clinical skills and expertise are therefore even more necessary at night when working with fewer back-up resources available. When nurses work nights they live in an environment in which only they are out of phase.
Rosters affect circadian clocks. To minimise the impact of shift work on health, safety and well-being, rosters should rotate forwards, starting with morning shifts followed by afternoon then night shifts. Forward rotation is most in harmony with the body’s circadian rhythm and causes less disruption to the body. Our circadian rhythm adjusts to forward movement more rapidly. Allow at least 48 hours between rotations, especially after night shifts. Many people need to sleep much of the first day off between rotations. Ideally, shift workers should not work more than three night shifts in a row to minimise hormonal disruptions to the body. Short shift cycles with regular days off are closest to normality for the body’s circadian rhythm and cause less physiological disturbance.
How to sleep
Working abnormal hours (night shift) may lead to a loss of quality sleep. Ineffective sleep or sleep deprivation can lead to tiredness and fatigue, eye problems such as burning, twitching and heaviness of the eyelids, muscle tremors, skeletal-muscle weakness, lack of co-ordination, decreased attention span, apathy and depression. To compensate for disrupted sleeping patterns, some or all of the following may be helpful:
* Sleep as soon as possible after the night shift. If you delay sleep after the night shift, your body will begin to warm up and prepare for the day’s activity.
* Ideally, have one block of sleep only; if this is not possible, two blocks of sleep are preferable to a scattered sleep pattern.
* Night workers will sleep better during the clay if they can simulate night-time sleeping conditions.
* Sleep in a dark room or wear an eye mask. This is vital, as melatonin, the hormone of sleep which increases drowsiness, is suppressed by daylight even through closed eyelids.
* Sleep in a quiet part of the house, away from traffic noise and household activity.
* Tell family and friends about your schedule and ask them to call you only during waking hours. Give them a copy of your roster.
* Avoid caffeine three to four hours prior to sleep. Caffeine intake delays sleep onset and impairs sleep quality.
* Feel safe and comfortable. Lock doors and windows for a feeling of security.
* Eat a banana or drink some warm milk before going to bed. Both these foods contain L-Tryptophan, which is known to be a natural sleep inducer. L-Tryptophan releases serotonin, a sleep-inducing brain chemical.
* Avoid alcohol prior to sleep. It is a diuretic and interferes with the quality of sleep.
* If you cannot sleep, stay in bed and rest. Avoid negative thoughts and assure yourself that you are at least getting needed rest.
Working shifts often requires eating at night. At this time, the stomach and the digestive processes slow down and stop, and cannot digest food like meat and eggs. Diet issues include having mealtimes at irregular hours and eating to compensate for feelings of fatigue. Many nurses report diarrhoea or constipation, gastric and peptic ulcers, gastritis, nausea and weight gain clue to disrupted eating habits, as well as the consumption of more than usual amounts of caffeinated beverages. Weight gain can occur, as people eat regular daytime meals and continue to snack or graze throughout the night. If possible, take meals at approximately the same time each day, either midday or early evening irrespective of whether you are on night shift.
Keep fit and stress-free. Physical fitness improves the body’s ability to remain alert and helps us to relax at other times. Twenty minutes of exercise at least three times each week (though not just before bedtime) will help reduce stress and feelings of fatigue and increase our sense of well-being.
Social and personal life
Feelings of isolation and lack of control can quickly lead to depression. Plan quality time together with family and friends; look for opportunities and plan ahead. Even the most solid relationships require nurturing. Don’t let housework, chores or appointments take priority. Maintain outside interests: sports, hobbies, volunteer work and other activities that enrich our lives, reduce stress and keep us connected to our personal world. Manage your personal expectations and recognise your limitations. Learn how night shift work influences your body and your sense of self, and take time to develop positive strategies to manage those aspects of your life and work.
Joyce Clayden completed a Bachelor of Nursing at Nelson Polytechnic and works part-time as a night resource nurse for Nelson Marlborough District Health Board. She also works part-time casual for the Nelson Region Hospice Trust. Last year Joyce completed her Graduate Certificate in Hospice Palliative Care with Hospice New Zealand in partnership with Whltireia Community Polytechnic.
Copyright School of Nursing and Health Studies 2003
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