Sleep Patterns of Emergency Department Nurses on Workdays and Days Off

Shift workers, particularly night workers, are prone to disrupted circadian rhythms and sleep deprivation resulting in fatigue and sleepiness, thereby endangering patient safety. Little is known about the sleep patterns of emergency nurses who work highly variable around-the-clock schedules to meet the demands of fluctuating patient census and acuities throughout the 24-hour period.

The purpose of this pilot study was to determine whether there are shift-related sleep pattern differences in emergency department nurses over seven consecutive 24-hour periods that include both workdays and days off.

A New Jersey mailing list (1514 members) was rented from the Emergency Nurses' Association. Three hundred on this list were systematically sampled and invited by mail to participate. The final sample consisted of 35 emergency nurses. Participants wore actigraphs for 24 hours each day for 7 days and completed sleep diaries upon awakening from their daily main sleep periods. Queries included caffeine and hypnotics usage. The nurses also completed the Standard Shiftwork Index General Biographical Information Section for demographic and scheduling data. Participants received a $50 honorarium upon completion of the protocol. The actigraph data were downloaded into a personal computer using Act Millennium and analyzed with Action W software (Ambulatory Monitoring, Inc., Ardsley, NY, USA).

Sleep durations ranged from 6.6 to 8.1 hours on workdays and from 6.2 to 8.1 hours on days off. There were no significant shift- or workday-related differences in sleep patterns. However, trends indicated that, regardless of shift, workday sleep became more disturbed and less efficient toward the end of the week. Daily caffeine usage was reported by 85.9% of the sample.

Shift working nurses need to obtain adequate and consistent sleep on workdays and days off throughout the work week to reduce fatigue and to provide safe patient care. Understanding the sleep patterns of emergency nurses and their schedules is critical to facilitating the development of shift-specific sleep promotion interventions to enhance sleep and thereby counteract fatigue.