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So many healthcare workers find themselves working for an employer that requires shift work, whether that is in a clinical hospital setting with various shifts or in the pre-hospital setting in emergency medicine with twenty-four hour shifts being a common place. Sometimes they are required to even work a split shift or be on call or have inconsistent working hours. I would like to explore some of the risks and effects shown to be detrimental to both the health of the health care worker but also quite possibly the safety of the patient.
Discussion
The human body is made to live in homeostasis with the circadian rhythm governing the sleep wake cycles. The cycles of the sun setting, the light and darkness of each day is made to help to keep that circadian rhythm in check by producing melatonin as the body senses the darkness of the night approaching. The body requires approximately eight hours of sleep each night to maintain a normal homeostasis. Shift work, and all the various work schedules required of health care workers simply do not allow for this kind of sleep schedules.
According to the National Sleep Foundation (2018), symptoms of shift work disorder include: excessive sleepiness when you need to be awake, alert, and productive; insomnia, or the inability to sleep when you need to- this can mean trouble falling asleep, or waking up before you’ve slept sufficiently; sleep that feels unrefreshing or insufficient; difficulty concentrating; lack of energy; irritability or depression; difficulty with personal relationships. They also mention that this is usually a chronic problem for shift workers and can be disruptive of their daily life.
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One study sought to find a correlation between shift work and health care workers to find links to sleep disturbances associated with sleep deprivation and other disorders, as well as quality of life. An interesting find was that almost half of the study participants stated they “were somehow or totally dissatisfied with their sense of well-being’. Diabetes mellitus was also shown to be significantly higher in shift workers versus morning workers, as well as a tendency toward a higher prevalence of restless leg syndrome. They concluded that shift work and variable work hours does in fact disturb the circadian cycle and the body does not adapt well to these changes creating sleep disturbances. This is all due to impairment of sleep quantity and quality. (Nena E., et al 2018)
In another study a statistically significant impairment in cognitive function was found among nurses who worked shifts. This study focused on nurses since they are commonly found working shift work and overnight long hour shifts. Nurses are entrusted to care for the delicate medical needs of patients and attention to detail of many aspects of patient care. This study found that shift working nurses had decreased alertness and impaired cognitive function due to poor sleep quality. They concluded that shift working nurses do suffer from sleep deprivation which directly affect their ability to perform safe patient care. (Kaliyaperumal, D., et al 2017)
Sleep Deprivation and Attention Performance
In EMS we are expected to be able to recall information in a distracting, demanding and often critical situations and perform our skills with competency. It is also a common theme among EMS workers to not only be shift workers, but also have unstable shift hours, or twenty-four to forty-eight hour long shifts. Emergency medical workers are expected to make life saving decisions and perform skills excellently at any point in our shifts, which we have seen that most are in a sleep deprived state. Sleep deprivation does cause multi tasking performance impairment, especially ones that are very cognitively challenging. (Chua, E., et al, 2017)
Conclusion
Sleep disturbances and sleep deprivation are a critical concern in the healthcare field, and even more so in such variable shift work. Education on importance of high quality sleep should be of high priority in the health care field. We are highly trained in excellent medicine and patient care and we are taught that our own safety is top priority, yet we are not given the opportunities to let our bodies function properly without proper sleep. Health care workers in shift work experience a high risk of diseases, feelings of unwellness, impaired judgment, impaired reaction and reasoning, all of which have a strong tie with sleep deprivation and disturbances.
