DHB junior doctors are lobbying hard for shifts with fewer days in a row and fewer night shifts in a row. This is because they know fatigue leads to greater risk of mistakes. They also know that patient care and engagement is not as good when they are sleep deprived or not rejuvenated sufficiently between rosters.
Nurses are also on shifts, do overtime, work nights and need to have recovery time to be on form. A New Zealand research project about nurses shift work was launched earlier this month.
Studies in Australia and the United States of America show nurses get less sleep on work days than non-work days and how much less depends on the shift pattern they are on.
Massey University’s Sleep/Wake Research Centre and School of Nursing, in collaboration with the New Zealand Nurses Organisation, is running the project designed to take an evidence-based approach towards managing shift work and fatigue for hospital nurses.
The Safer Nursing 24/7 project, led by Professor Philippa Gander, aims to improve health service delivery by improving both patient safety and the safety, health, quality of life and retention of nurses.
Project manager Dr Karyn O’Keeffe says, “Less sleep is directly related to increased risk of clinical errors, struggling to stay awake at work, and drowsy-driving on the way home.
“The hours of sleep someone gets in the 24-hour period before their shift significantly affects their ability to remain awake at work, and is a significant predictor of errors and, near errors. Sleep-deprived nurses report a higher number of patient-care errors, and an American study found nurses struggled to stay awake on 20 per cent of their shifts,” Dr O’Keeffe says.
NZNO has worked collaboratively with the team from Massey University from the project’s inception, both sitting on the advisory board, and in helping with seed funding to support the Health Research Council funding bid. NZNO principal researcher Leonie Walker is a member of the study team and helped develop the study protocol and survey.
“There is a huge variety of shift patterns worked in New Zealand. We have different lengths of shift and different patterns of day and night rosters operating. We need to discover the pros and cons and practicalities of these to develop some evidence-based guidelines for safe and appropriate shift rostering,” Walker explains.
“It’s a bigger problem for some than others, depends on physiology, other life issues, age and also the nature of the work.”
Walker says a shift in an operating theatre for example might be more or less fatiguing than a shift in an outpatient clinic or a special care baby unit but we just don’t know at this stage.
The literature is clear about the risks of error increasing with fatigue. A recent systematic review by NZNO policy adviser Jill Clendon and Veronique Gibbons showed the errors for 12 hour shifts were higher, other things being equal, than for 8-10 hour shifts.
“Equally important to us is the risk to nurses of chronic fatigue – to their health, and for example driving home drowsy,” Walker said.
Walker suggests we need to research our hunch that there are factors other than shift length alone, particularly the pattern of the shift changes that will be just as important.
Safer Nursing 24/7 is a collaboration between the researchers and the nursing community, and is supported by an advisory group of key nursing representatives, as well as an expert in epidemiology and biostatistics. Nurses and District Health Boards are being invited to participate in three main activities:
- Completing an online survey of the work patterns of nurses nationwide in six practice areas.
- Development of new education and training materials on how shift work affects fatigue and how to improve sleep, particularly when working shifts.
- Consultation on a new Code of Practice for shift work in hospital-based nursing.
Research funders: The project has received major funding from the Health Research Council, with additional funding from the New Zealand Lottery Grants Board, McCutchan Trust and Massey University.
Click here to watch a short video about the project.