Because society needs nursing services around the clock, nurses must work irregular hours and at night. This leads to disruption of circadian rhythms and to sleep deficits that can affect work readiness and the health, safety, and well-being of nurses. Long shifts, shift rotations, double shifts, and evening and night shifts pose short- and long-term health and safety risks for nurses, as well as danger to their patients. Sleep-deprived nurses are also at risk for car accidents. According to the AAA Foundation for Traffic Safety, less than four hours of sleep in the past 24 hours increases a driver's risk of crashing 11.5 times, compared with just 1.3 times after seven hours of sleep.

New guidelines from the American Academy of Nursing (AAN) suggest ways to reduce nurse fatigue (see http://www.nursingoutlook.org/article/S0029-6554(17)30600-0/fulltext). The AAN urges nurses and their employers to learn about the risks of shift work and find strategies to reduce these risks. Employers should set up evidence-based programs, policies, and systems that promote sleep health and safety. More continuing education courses for nurses and managers are needed that teach evidence-based personal and workplace practices to improve sleep and alertness, such as the American Nurses Association's Healthy Nurse, Healthy Nation initiative.

Studies of ways to relieve nurse fatigue support napping as a "powerful evidence-based intervention that is well researched and reduces fatigue and improves alertness in night shift workers," Jeanne Geiger-Brown, associate dean for research at the George Washington University School of Nursing in Washington, DC, told AJN.

Geiger-Brown's research, published in the May 2016 issue of AJN (http://links.lww.com/AJN/A113), found that 30-minute naps benefited nurses who work 12-hour night shifts. Nurses in the study all reported that napping reduced or fully eliminated drowsiness. They were most refreshed when they napped between 1 am and 4 am, whereas napping between 3 am and 5 am left the nurses groggy, Geiger-Brown said. Nurses who napped also reported feeling less drowsy on the drive home from work.

Finding places to sleep on nursing units is a challenge. An unused treatment room or small area to set up a cot can work. Like patient care assignments, nap breaks should be planned at the start of a shift to ensure safe patient coverage.

It takes time for nursing units to accept and implement napping strategies. A nurse manager's positive attitude toward napping plays a key role in setting up a successful program. "Unfortunately, napping is more an exception than a rule," Geiger-Brown said.-Carol Potera

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