This guidance has been devised following a series of agency nurses who have allegedly been asleep when on duty. Clients have provided evidence from mobile phones of pictures/video to support their allegations. In many cases the person has denied being asleep and various explanations have been given including claiming they were praying, resting their eyes, had a headache and were avoiding bright light or had not been provided with a break or fluids so were dehydrated and exhausted.
There are many reasons why some staff prefer night work, it may be due to child/family care responsibilities etc. An important recognition is that when working nights there are usually fewer people around and it is inevitable that for some individuals, they feel more tired and sleep less than on daytime shifts.
Its also recognised that working night shifts can have a physical or psychological impact on individuals so it is important that you look after yourself, your colleagues as well as your patients/client when working nights. This begins before you work your night shift.
Promoting good bedtime patterns
It is important to have good habits whether sleeping during the day or at night. Keeping to a regular sleep schedule – going to bed at the same time and waking up at the same time – is recommended as a way to promote good sleep.
The Dos and Don’ts Guidance
It is essential for night workers to learn how to manage their daytime sleep.
Here are some tips to help:
Preparing for the first night
It is advisable to get extra sleep before working the first night shift. If you do not sleep before your first shift you could be awake for 24 hours or more.
Strategies to adopt during the shift to reduce risk of falling asleep on duty
Getting through the first night is usually easy but by the second or third fatigue begins to become an issue.
Ross (2011) suggests the following strategies:
1. Eat your main meal before going on shift - and have a lunch half-way through the shift and another light meal when you get home. Eating small amounts often throughout the night will keep your energy levels up. Find out what works for you but avoid a heavy meal before going to sleep.
2.Keep moving during the shift – when you have a quiet moment walk about and stretch. You could do this while checking on patients. If you are doing a 1:1 ask for cover for 5 minutes every couple of hours so you can walk to the toilet, make a drink etc.
3. Keep hydrated - but do not drink too much caffeine. Avoid caffeine towards the end of the shift as it can make going to sleep difficult when you get home. The effects of a cup of coffee can be felt within 20 minutes and can last up to 3 or 4 hours depending on the strength of the drink and your individual tolerance. Remember it is not only coffee that contains caffeine; cola drinks, tea, and some over the counter pain killers or cold remedies can also contain caffeine.
4. Keep your mind active – through your shift by talking to colleagues. Remember while you talk to colleagues you must respect the need to keep the noise level low for the patients/clients in your care so that they can sleep/rest.
5. Power napping and rest breaks - evidence is divided on the use of power napping due to the time it takes following a power nap to regain full alertness. If napping is allowed appropriate facilities should be available with scheduled breaks being more than 40 minutes to allow employees sufficient time to have a short nap, refresh themselves and regain alertness before resuming work. In some organisations sleeping on a break is not permitted so it is important to establish if this is allowed by asking the nurse in charge/shift leader. Some organisations refer to Waking Shifts which mean you are not permitted to sleep at any time in this shift even when on breaks. You should have a minimum of 20 minutes break away from the work environment if the shift is longer than 6 hours. Most Trusts allow between 45-90 minutes unpaid break. You must ensure you know the time you are required to return to duty and do not rely on others to call you to remind you to return to duty. If you are allowed to sleep, ensure you have your own alarm on your phone set to allow time for you to freshen up and to return alert on duty. If you are unable to take your break away from the work environment during a night shift, then you should discuss this with the Nurse in Charge and report this to your agency for them to address with the Client/Organisation you were working in.
6. Circadian nadir/body clock - this is the time when the natural body clock is at its lowest between 3am and 6 am. Night workers can feel cold, shaky, nauseous, sleepy, and drowsy at this time. This is a normal reaction as the body is programmed to be less active at this time. It can be difficult to stay awake especially if work demands are low. Eat and drink something warm (avoid caffeine) during this period and try to keep busy. If possible, schedule your break during this time.
Getting home safely
The end of a night shift is recognised as a high- risk period for car accidents, particularly towards the end of a few back-to-back shifts. If you are driving to and from work be vigilant to the risks of fatigue. If you do feel yourself falling asleep at the wheel pull of the road if it is safe to do so and have a short nap.
Avoid driving for long periods or a long distance after a period of night shifts or long working hours. It is advisable to have a rest or sleep and travel later in the day. It may be better to use public transport or share a lift with a co-worker and take it in turns to drive. This would help to reduce costs and having someone else in the car can help you both remain alert.
Park in well-lit areas if you are arriving and/or finishing work when it is dark. If you have concerns about your personal safety when travelling to or from work on a night shift or any unsocial shift, speak to your agency .
Coming off nights and back onto day shifts
Adjusting back to days can be difficult and your shift pattern should allow enough time to recover from night shift work before going onto the next shift.
Limit 12-hour night shifts to two to three consecutive shifts and when changing from night shifts to day shifts or vice versa, allow a minimum of 2 nights of full sleep to ensure adjustment to the new schedule.
Have a short sleep when you get home from your last shift and try to carry out normal daytime activities when you wake up and go to bed at your regular time that night to get back into routine.
Looking after your health
Working shifts can increase demands on your health.
Maintaining a good work life balance is important so:
Shift workers can be more at risk of gastrointestinal complaints, diabetes, and cardiovascular problems.
If you find it difficult to adjust or cope with shift work, your physical or mental health is being affected or you are unable to adjust your sleeping patterns and are suffering from chronic fatigue then you should seek advice and support. You can see your GP for advice. If you have a long-term condition that is affected by shift work or need to take medication at certain times of the day you should seek advice from your GP on how to manage this. If you are pregnant and having difficulty coping with shift work, you should seek advice from your GP or midwife.
Registered Nurses & Midwives have a duty under the NMC Code to manage risk (NMC, 2018) you must:
Shift work is an inevitable part of providing 24-hour care. By following the advice above night workers can protect their own health and the health and safety of the people they are providing clock care to.
Nursing and Midwifery Council (2018) The code: standards of conduct, performance and ethics for nurses and midwives, London: NMC
Ross B (2011) The first time: surviving the night shift, Nursing Times, 31st August 2011