Strategies to Beat Fatigue

Sleepy Nurse
Too little sleep and poor quality sleep is an issue for many nursing assistants, according to research from the Center for Promotion of Health in the New England Workplace.

By June Lemen

Sleep deprivation is bad for everyone, no matter what your line of work is. 

In the short term, sleep deprivation has negative effects on alertness and concentration. In the long term, chronic sleep deprivation is a factor in serious diseases like diabetes, obesity and cardiovascular illness. Fatigue resulting from sleep deprivation also tends to increase the possibility of injuries and errors. 

Healthcare workers, especially those who provide around-the-clock care, are at an even greater risk of sleep deprivation than people in other professions. 

The effect of fatigue on nurses has been well-studied: Sleep-deprived nurses have been shown to make errors two to three times as often when they work longer shifts. But the effect of sleep deprivation on nursing assistants has not been studied, until now. 

Research conducted by Asst. Prof. Yuan Zhang shows that sleep deprivation can negatively affect nursing assistants. The results were published in the January issue of Geriatric Nursing. This study is one of many that look at health impacts of stressful working conditions on healthcare workers by the Center for Promotion of Health in the New England Workplace (CPH-NEW).

Nursing Assistants on the Front Line of Care 

Nursing assistants, or aides, are vital to the healthcare workforce. According the Bureau of Labor Statistics, employment of nursing assistants is projected to grow 18 percent from 2014 to 2024, much faster than the average for all occupations. 

“Nursing assistants are on the front lines of providing patient care to the elderly,” says Zhang. “They need to be well-rested to do their jobs well and to assure resident safety and quality of care.” 

However, Zhang’s 2016 CPH-NEW study reported that 46 percent of nursing assistants had short sleep duration — less than six hours of sleep per day — and 23 percent reported poor sleep quality. 

“Considering the danger of medical errors resulting from fatigue, nursing aides being sleepy on the job is not just a mere inconvenience,” says Zhang. “The safety and well-being of elderly long-term-care residents could be at stake.” 

Previous studies on nurses’ sleep quality focused primarily on the effect of work schedules. However, this study by CPH-NEW shows that it’s not just the schedule that affects nursing assistants’ sleep. 

Causes of Disruptive Sleep 

Multiple aspects of a nursing assistant’s job affect sleep, including: 

  • Nursing assistants have stressful jobs. The work is physically and emotionally exhausting. 
  • They may work night or rotating shifts, long shifts, or they may work more than one job because the wages are low. 
  • Assault among nursing aides is all too common. In a 2013 CPH-NEW study by Dr. Helena Miranda and others, 34 percent of aides reported being assaulted over a two-year period. 
  • Job stress adversely impacts health, including sleep. 

Break the Cycle of Sleep Deprivation 

For nursing assistants with chronic sleep problems, fatigue adds to the stress, leading to a loop: Stress at work creates poor sleep and poor sleep creates more stress at work. This can be dangerous not only to patients but also to workers themselves and the general public because sleepy drivers are more likely to cause traffic accidents when commuting home after work. 

What can be done to break the cycle and head off fatigue problems? Start by making the workplace safe and conducive to overall health. According to the National Institute for Occupational Safety and Health (NIOSH) and The Joint Commission, focusing on policies related to work schedules, violence prevention and patient handling can have the most impact for preventing fatigue and ensuring that nursing aides feel and function at their best on the job. For example: 

  • Structure work schedules to allow sufficient time for sleep between shifts. This means at least ten consecutive hours off duty to allow for seven to eight hours of sleep. 
  • Provide education to nursing aides on using lift equipment to avoid injuries, procedures for preventing and handling assaults and the importance of protecting their rest and sleep time to help nursing staff feel their best. 

The American Nurses Association offers these tips for nurses and nurses aides to help improve sleep: 

  • Make sleep a priority on your off time and set aside enough time. 
  • Protect the quality of your sleep by avoiding caffeine, alcohol or heavy foods right before bedtime. 
  • Make your bedroom cool and dark so you can fall asleep quickly and stay asleep. 

If healthcare workers are going to provide quality care to their patients, research shows they need to be well-rested. 

"Managers in health care organizations can help to ensure patient safety if they design and implement work policies and prevention programs with priority on worker safety and well-being," says Zhang. 

The well-being of patients and workers depend on it.