Alertness during working hours among eight‐hour rotating‐shift nurses: An observational study

Abstract

Most nurses work in shifts to deliver 24-h patient care globally (Pélissier et al., 2020). In South Korea, 82.1% of nurses in hospitals work in an eight-hour rapid rotating-shift system (i.e., different shifts every two to three days), including night shifts, and 2.8% work 12-h rotating shifts (Hospital Nurses Association, 2020). Shift work, especially night shifts, can induce fatigue in nurses owing to insufficient sleep and inadequate recovery time between shifts, thus affecting their abilities to provide high-quality care for patients owing to declined alertness (Ganesan et al., 2019;Min et al., 2021;Trinkoff et al., 2011). The decline in alertness from sleep deprivation is equivalent to the effects of blood alcohol concentrations (BAC) of 0.05%-0.1% (James et al., 2020). This is described as sleepiness (Geiger-Brown et al., 2012) and/or vigilance (Geiger-Brown et al., 2012) in previous literature. Scott et al. (2006) indicated that 65% of critical care nurses struggled to stay awake during their shifts, and 20% had fallen asleep at least once. Notably, more than half the nurses

Reduced alertness as a consequence of rotating shift patterns puts safe care delivery at risk

“…Nevertheless, shift-working is essential in healthcare to guarantee that patients are cared for 24/7. As highlighted by Min et al , this is especially important in the healthcare profession, where nurses must work rotating-shifts divided into three main variations 1. Undoubtedly, this study simply emphasises an issue that has been recognised for decades: there are obvious and identifiable patterns of reduction in alertness among rotating-shift HP, with night shifts substantially contributing to the decreased alertness and major errors 1 3 5.…”

“…The study used alertness score calculations based on the SAFTE algorithm model collected using Readiband actigraphs 1. Recruitment included 84 registered nurses who provided direct nursing care, worked in an acute care hospital with rotating-shifts, and had a work schedule that comprised days, evenings and nights at the time of participation, with only two withdrawals.…”

“…Specifically, rotating-shifts are more likely to cause a decreased alertness and increased tiredness effect on HP due to continuous changes in their sleep patterns. As the consequences of sleep deprivation are comparable to those of blood alcohol concentrations of 0.05%–0.1%, Min et al used objective metrics to identify the unique patterns of loss in alertness 1…”

“…As highlighted by Min et al , this is especially important in the healthcare profession, where nurses must work rotating-shifts divided into three main variations 1. Undoubtedly, this study simply emphasises an issue that has been recognised for decades: there are obvious and identifiable patterns of reduction in alertness among rotating-shift HP, with night shifts substantially contributing to the decreased alertness and major errors 1 3 5. The SARS-CoV-2 pandemic has compounded an already deteriorating situation, with established extended-duration work shifts linked to an increased risk of major negative outcomes and attentional deficits 4.…”

“…Moreover, healthcare organisations must implement effective techniques to promote staff alertness and sleep wellness. These include optimising the rest-to-work ratio, strictly adhering to rostered start-end times to minimise impact on rest breaks, and possibly implementing paid regular nap breaks during night shifts, as well as prioritising certain tasks at the start of a shift where possible due to the nature of the environment 1 5 6…”