Researchers at the University of Manitoba (Winnipeg, Canada) conducted a web-based survey of 536 critical care nurses (88% female; mean age, 42 years), from 11 Canadian provinces and territories. The respondents worked primarily 12-hour shifts, on a day/night rotation, with 15% working only night shifts. Between two consecutive night shifts, 72% had six hours or less of daytime sleep, and 20% got four hours of sleep or less. A large number of the respondents indicated they were sleepy, sluggish, felt irritable, forgetful, stressed, chilled, hungry, nauseated, and they also experienced considerable eyestrain.

One-quarter reported personal injury or near injury that was directly attributable to their fatigue, and 16% reported incidents or errors affecting patients that were directly attributable to their fatigue. On their drive home, 43% reported having fallen asleep while stopped at a traffic light, 31% reported having fallen asleep while driving, and 20% reporting having had a motor vehicle crash or near miss. The study was presented at, the associated professional sleep societies annual meeting (SLEEP), held during June 2011 in Minneapolis (MN, USA).

“Some of the qualitative data about these accidents or near accidents are chilling,” said lead author and study presenter Diana McMillan, RN, PhD, from the faculty of nursing at the University of Manitoba. “They talked about being totally disoriented. They talked about looking up at the road and wondering where they were. They talked about frequently getting home and wondering how they got there.”

“This situation is critical; nightshift work is fraught with both homeostatic and circadian challenge. It's a perfect storm,” added Dr. McMillan. “We need to do something to change this, not only for critical care nurses but for all nurses. Although there is a considerable amount of evidence to suggest there are strategies out there that we can be implementing, the uptake is not good.”

“There's been a lot of attention to this issue for medical residents, and that's clearly an issue, but nationwide there's a huge shortage of nurses, especially in hospitals and critical care settings, and so nurses are increasingly being pressed to work more than one shift,” commented on the study Professor Nancy Redeker, PhD, RN, dean of scholarly affairs at Yale University School of Nursing (New Haven, CT). “Some nurses do it because they want to earn extra money, but most are getting pressured to do it, and in the case of residents they're doing it because they're trainees and they're required to do it.”

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