Clinical and Experimental Emergency Medicine

The Korean Society of Emergency Medicine (대한응급의학회)
권호 표지
DOI QR코드

DOI QR Code

Night shift preparation, performance, and perception: are there differences between emergency medicine nurses, residents, and faculty?

  • Richards, John R. (Department of Emergency Medicine, University of California Davis Medical Center) ;
  • Stayton, Taylor L. (Department of Emergency Medicine, University of California Davis Medical Center) ;
  • Wells, Jason A. (Department of Emergency Medicine, University of California Davis Medical Center) ;
  • Parikh, Aman K. (Department of Emergency Medicine, University of California Davis Medical Center) ;
  • Laurin, Erik G. (Department of Emergency Medicine, University of California Davis Medical Center)
  • Received : 2017.08.28
  • Accepted : 2017.10.03
  • Published : 2018.12.31
⟨ Previous Next ⟩

Abstract

Objective Determine differences between faculty, residents, and nurses regarding night shift preparation, performance, recovery, and perception of emotional and physical health effects. Methods Survey study performed at an urban university medical center emergency department with an accredited residency program in emergency medicine. Results Forty-seven faculty, 37 residents, and 90 nurses completed the survey. There was no difference in use of physical sleep aids between groups, except nurses utilized blackout curtains more (69%) than residents (60%) and faculty (45%). Bedroom temperature preference was similar. The routine use of pharmacologic sleep aids differed: nurses and residents (both 38%) compared to faculty (13%). Residents routinely used melatonin more (79%) than did faculty (33%) and nurses (38%). Faculty preferred not to eat (45%), whereas residents (24%) preferred a full meal. The majority (>72%) in all groups drank coffee before their night shift and reported feeling tired despite their routine, with 4:00 a.m. as median nadir. Faculty reported a higher rate (41%) of falling asleep while driving compared to residents (14%) and nurses (32%), but the accident rate (3% to 6%) did not differ significantly. All had similar opinions regarding night shift-associated health effects. However, faculty reported lower level of satisfaction working night shifts, whereas nurses agreed less than the other groups regarding increased risk of drug and alcohol dependence. Conclusion Faculty, residents, and nurses shared many characteristics. Faculty tended to not use pharmacologic sleep aids, not eat before their shift, fall asleep at a higher rate while driving home, and enjoy night shift work less.

Keywords

References

  1. Smith-Coggins R, Broderick KB, Marco CA. Night shifts in emergency medicine: the american board of emergency medicine longitudinal study of emergency physicians. J Emerg Med 2014; 47:372-8. https://doi.org/10.1016/j.jemermed.2014.04.020
  2. Camerino D, Sandri M, Sartori S, Conway PM, Campanini P, Costa G. Shiftwork, work-family conflict among Italian nurses, and prevention efficacy. Chronobiol Int 2010;27:1105-23. https://doi.org/10.3109/07420528.2010.490072
  3. Ramazzini B. De morbis artificum diatriba [diseases of workers]. 1713. Am J Public Health 2001;91:1380-2. https://doi.org/10.2105/AJPH.91.9.1380
  4. Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ 2016;355:i5210.
  5. Lowson E, Middleton B, Arber S, Skene DJ. Effects of night work on sleep, cortisol and mood of female nurses, their husbands and children. Sleep Biol Rhythms 2013;11:7-13. https://doi.org/10.1111/j.1479-8425.2012.00585.x
  6. Smith-Coggins R, Rosekind MR, Hurd S, Buccino KR. Relationship of day versus night sleep to physician performance and mood. Ann Emerg Med 1994;24:928-34. https://doi.org/10.1016/S0196-0644(94)70209-8
  7. Smith MR, Fogg LF, Eastman CI. A compromise circadian phase position for permanent night work improves mood, fatigue, and performance. Sleep 2009;32:1481-9. https://doi.org/10.1093/sleep/32.11.1481
  8. Manomenidis G, Panagopoulou E, Montgomery A. The 'switch on-switch off model': strategies used by nurses to mentally prepare and disengage from work. Int J Nurs Pract 2016;22: 356-63. https://doi.org/10.1111/ijn.12443
  9. Adams J, Folkard S, Young M. Coping strategies used by nurses on night duty. Ergonomics 1986;29:185-96. https://doi.org/10.1080/00140138608968259
  10. Slanger TE, Gross JV, Pinger A, et al. Person-directed, non-pharmacological interventions for sleepiness at work and sleep disturbances caused by shift work. Cochrane Database Syst Rev 2016:CD010641.
  11. Liira J, Verbeek JH, Costa G, et al. Pharmacological interventions for sleepiness and sleep disturbances caused by shift work. Cochrane Database Syst Rev 2014:CD009776.
  12. Jorgensen KM, Witting MD. Does exogenous melatonin improve day sleep or night alertness in emergency physicians working night shifts? Ann Emerg Med 1998;31:699-704. https://doi.org/10.1016/S0196-0644(98)70227-6
  13. Wright SW, Lawrence LM, Wrenn KD, Haynes ML, Welch LW, Schlack HM. Randomized clinical trial of melatonin after night-shift work: efficacy and neuropsychologic effects. Ann Emerg Med 1998;32(3 Pt 1):334-40. https://doi.org/10.1016/S0196-0644(98)70010-1
  14. Bailey B, Alexandrov L. A survey to describe sleep-facilitating substances used by Canadian emergency physicians. CJEM 2005;7:93-102. https://doi.org/10.1017/S148180350001304X
  15. Handel DA, Raja A, Lindsell CJ. The use of sleep aids among Emergency Medicine residents: a web based survey. BMC Health Serv Res 2006;6:136. https://doi.org/10.1186/1472-6963-6-136
  16. Bonnell EK, Huggins CE, Huggins CT, McCaffrey TA, Palermo C, Bonham MP. Influences on dietary choices during day versus night shift in shift workers: a mixed methods study. Nutrients 2017;9:193. https://doi.org/10.3390/nu9030193
  17. Persson M, Martensson J. Situations influencing habits in diet and exercise among nurses working night shift. J Nurs Manag 2006;14:414-23. https://doi.org/10.1111/j.1365-2934.2006.00601.x
  18. Gan Y, Yang C, Tong X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med 2015;72:72-8. https://doi.org/10.1136/oemed-2014-102150
  19. Sharma A, Laurenti MC, Dalla Man C, et al. Glucose metabolism during rotational shift-work in healthcare workers. Diabetologia 2017;60:1483-90. https://doi.org/10.1007/s00125-017-4317-0
  20. Shy BD, Portelli I, Nelson LS. Emergency medicine residents' use of psychostimulants and sedatives to aid in shift work. Am J Emerg Med 2011;29:1034-6. https://doi.org/10.1016/j.ajem.2010.06.004
  21. Franke AG, Bagusat C, McFarlane C, Tassone-Steiger T, Kneist W, Lieb K. The use of caffeinated substances by surgeons for cognitive enhancement. Ann Surg 2015;261:1091-5. https://doi.org/10.1097/SLA.0000000000000830
  22. Seidl R, Peyrl A, Nicham R, Hauser E. A taurine and caffeine-containing drink stimulates cognitive performance and well-being. Amino Acids 2000;19:635-42. https://doi.org/10.1007/s007260070013
  23. Haskell CF, Kennedy DO, Wesnes KA, Scholey AB. Cognitive and mood improvements of caffeine in habitual consumers and habitual non-consumers of caffeine. Psychopharmacology (Berl) 2005;179:813-25. https://doi.org/10.1007/s00213-004-2104-3
  24. Wyatt JK, Cajochen C, Ritz-De Cecco A, Czeisler CA, Dijk DJ. Low-dose repeated caffeine administration for circadian-phase-dependent performance degradation during extended wakefulness. Sleep 2004;27:374-81. https://doi.org/10.1093/sleep/27.3.374
  25. Williams GW, Shankar B, Klier EM, et al. Sensorimotor and executive function slowing in anesthesiology residents after overnight shifts. J Clin Anesth 2017;40:110-6. https://doi.org/10.1016/j.jclinane.2017.04.002
  26. Grossman VG. Defying circadian rhythm: the emergency nurse and the night shift. J Emerg Nurs 1997;23:602-7. https://doi.org/10.1016/S0099-1767(97)90277-4
  27. Ruggiero JS, Avi-Itzhak T. Sleep patterns of emergency department nurses on workdays and days off. J Nurs Res 2016;24: 173-80. https://doi.org/10.1097/jnr.0000000000000121
  28. Dula DJ, Dula NL, Hamrick C, Wood GC. The effect of working serial night shifts on the cognitive functioning of emergency physicians. Ann Emerg Med 2001;38:152-5. https://doi.org/10.1067/mem.2001.116024
  29. Rollinson DC, Rathlev NK, Moss M, et al. The effects of consecutive night shifts on neuropsychological performance of interns in the emergency department: a pilot study. Ann Emerg Med 2003;41:400-6. https://doi.org/10.1067/mem.2003.77
  30. Geiger-Brown J, Rogers VE, Trinkoff AM, Kane RL, Bausell RB, Scharf SM. Sleep, sleepiness, fatigue, and performance of 12- hour-shift nurses. Chronobiol Int 2012;29:211-9. https://doi.org/10.3109/07420528.2011.645752
  31. Cheng YH, Roach GD, Petrilli RM. Current and future directions in clinical fatigue management: an update for emergency medicine practitioners. Emerg Med Australas 2014;26:640-4. https://doi.org/10.1111/1742-6723.12319
  32. Poudel GR, Innes CR, Bones PJ, Watts R, Jones RD. Losing the struggle to stay awake: divergent thalamic and cortical activity during microsleeps. Hum Brain Mapp 2014;35:257-69. https://doi.org/10.1002/hbm.22178
  33. Smith-Coggins R, Howard SK, Mac DT, et al. Improving alertness and performance in emergency department physicians and nurses: the use of planned naps. Ann Emerg Med 2006; 48:596-604. https://doi.org/10.1016/j.annemergmed.2006.02.005
  34. Ribeiro-Silva F, Rotenberg L, Soares RE, et al. Sleep on the job partially compensates for sleep loss in night-shift nurses. Chronobiol Int 2006;23:1389-99. https://doi.org/10.1080/07420520601091931
  35. Fallis WM, McMillan DE, Edwards MP. Napping during night shift: practices, preferences, and perceptions of critical care and emergency department nurses. Crit Care Nurse 2011;31: e1-11.
  36. Horne J, Reyner L. Vehicle accidents related to sleep: a review. Occup Environ Med 1999;56:289-94. https://doi.org/10.1136/oem.56.5.289
  37. Folkard S. Shift work, safety, and aging. Chronobiol Int 2008; 25:183-98. https://doi.org/10.1080/07420520802106694
  38. Steele MT, Ma OJ, Watson WA, Thomas HA Jr, Muelleman RL. The occupational risk of motor vehicle collisions for emergency medicine residents. Acad Emerg Med 1999;6:1050-3. https://doi.org/10.1111/j.1553-2712.1999.tb01191.x
  39. Barger LK, Cade BE, Ayas NT, et al. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 2005;352:125-34. https://doi.org/10.1056/NEJMoa041401
  40. Scott LD, Hwang WT, Rogers AE, Nysse T, Dean GE, Dinges DF. The relationship between nurse work schedules, sleep duration, and drowsy driving. Sleep 2007;30:1801-7. https://doi.org/10.1093/sleep/30.12.1801
  41. Gold DR, Rogacz S, Bock N, et al. Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. Am J Public Health 1992;82:1011-4. https://doi.org/10.2105/AJPH.82.7.1011
  42. Dorrian J, Lamond N, van den Heuvel C, Pincombe J, Rogers AE, Dawson D. A pilot study of the safety implications of Australian nurses' sleep and work hours. Chronobiol Int 2006;23: 1149-63. https://doi.org/10.1080/07420520601059615
  43. Steele MT, McNamara RM, Smith-Coggins R, Watson WA. Morningness-eveningness preferences of emergency medicine residents are skewed toward eveningness. Acad Emerg Med 1997;4:699-705. https://doi.org/10.1111/j.1553-2712.1997.tb03763.x
  44. Hermansson U, Knutsson A, Brandt L, Huss A, Ronnberg S, Helander A. Screening for high-risk and elevated alcohol consumption in day and shift workers by use of the AUDIT and CDT. Occup Med (Lond) 2003;53:518-26. https://doi.org/10.1093/occmed/kqg104
  45. Buchvold HV, Pallesen S, Oyane NM, Bjorvatn B. Associations between night work and BMI, alcohol, smoking, caffeine and exercise: a cross-sectional study. BMC Public Health 2015;15: 1112. https://doi.org/10.1186/s12889-015-2470-2
  46. Trinkoff AM, Storr CL. Work schedule characteristics and substance use in nurses. Am J Ind Med 1998;34:266-71. https://doi.org/10.1002/(SICI)1097-0274(199809)34:3<266::AID-AJIM9>3.0.CO;2-T
  47. Gestal JJ. Occupational hazards in hospitals: accidents, radiation, exposure to noxious chemicals, drug addiction and psychic problems, and assault. Br J Ind Med 1987;44:510-20.
  48. Anisimov VN, Vinogradova IA, Panchenko AV, Popovich IG, Zabezhinski MA. Light-at-night-induced circadian disruption, cancer and aging. Curr Aging Sci 2012;5:170-7.
  49. Bokenberger K, Strom P, Dahl Aslan AK, Akerstedt T, Pedersen NL. Shift work and cognitive aging: a longitudinal study. Scand J Work Environ Health 2017;43:485-93. https://doi.org/10.5271/sjweh.3638
  50. Lange T, Dimitrov S, Born J. Effects of sleep and circadian rhythm on the human immune system. Ann N Y Acad Sci 2010;1193: 48-59. https://doi.org/10.1111/j.1749-6632.2009.05300.x
  51. Gu F, Han J, Laden F, et al. Total and cause-specific mortality of U.S. nurses working rotating night shifts. Am J Prev Med 2015;48:241-52. https://doi.org/10.1016/j.amepre.2014.10.018
  52. Vyas MV, Garg AX, Iansavichus AV, et al. Shift work and vascular events: systematic review and meta-analysis. BMJ 2012; 345:e4800. https://doi.org/10.1136/bmj.e4800
  53. Dutheil F, Marhar F, Boudet G, et al. Maximal tachycardia and high cardiac strain during night shifts of emergency physicians. Int Arch Occup Environ Health 2017;90:467-80. https://doi.org/10.1007/s00420-017-1211-5
  54. Adams SL, Roxe DM, Weiss J, Zhang F, Rosenthal JE. Ambulatory blood pressure and Holter monitoring of emergency physicians before, during, and after a night shift. Acad Emerg Med 1998;5:871-7. https://doi.org/10.1111/j.1553-2712.1998.tb02816.x
  55. Rauchenzauner M, Ernst F, Hintringer F, et al. Arrhythmias and increased neuro-endocrine stress response during physicians' night shifts: a randomized cross-over trial. Eur Heart J 2009; 30:2606-13. https://doi.org/10.1093/eurheartj/ehp268
  56. Haus EL, Smolensky MH. Shift work and cancer risk: potential mechanistic roles of circadian disruption, light at night, and sleep deprivation. Sleep Med Rev 2013;17:273-84. https://doi.org/10.1016/j.smrv.2012.08.003
  57. Stevens RG, Hansen J, Costa G, et al. Considerations of circadian impact for defining 'shift work' in cancer studies: IARC Working Group Report. Occup Environ Med 2011;68:154-62. https://doi.org/10.1136/oem.2009.053512
  58. Lee A, Myung SK, Cho JJ, Jung YJ, Yoon JL, Kim MY. Night shift work and risk of depression: meta-analysis of observational studies. J Korean Med Sci 2017;32:1091-6. https://doi.org/10.3346/jkms.2017.32.7.1091
  59. Raj KS. Well-being in residency: a systematic review. J Grad Med Educ 2016;8:674-84. https://doi.org/10.4300/JGME-D-15-00764.1

Cited by

  1. Exploring the Prevalence and Patterns of Use of Sleep Aids and Stimulants Among Emergency Physicians and EMS Providers in Saudi Arabia vol.13, pp.None, 2021, https://doi.org/10.2147/oaem.s310324
  2. The influence of shift work on the psychomotor capabilities of emergency medicine residents vol.2, pp.6, 2018, https://doi.org/10.1002/emp2.12601