Barriers to Night Shift Wellness in the Emergency Department: A Qualitative Study

Research has demonstrated that night shift nursing and ancillary hospital staff face challenges ranging from sleep disorders to increased medication errors. Night shift work in the emergency department can pose unique wellness barriers worth exploring, given the patient population and the demanding, high-risk setting.

This qualitative descriptive study was conducted via online focus groups in the emergency department of a 355-bed teaching hospital. A total of 18 night-shift staff from clinical and nonclinical roles participated. A reflexive thematic analysis framework was used for coding and theme development. Data saturation was achieved by conducting additional focus groups, and credibility was ensured through reflexive journaling, member checking, deep immersion in the data, and triangulation across separate focus group meetings.

Seven themes emerged: "Sleep as a balancing act," "Night shift workers want a life, too," "Night shift work impacts health," "Impaired professional effectiveness," "Fewer hands make for heavy work, which makes for fewer hands," "Organizational structures and schedules burden night shift," and "Shift vs shift (night shift problems)." The individual barriers were described as influencing and exacerbating one another.

Participants identified both personal and work barriers as important to their wellness. Consistent with previous research, sleep, health, and social concerns were priorities. In the current study, participants also identified impaired professional effectiveness as both a measure of and a barrier to their wellness. Understanding these challenges and their impact on staff could inform interventions to improve the quality of life on the night shift.