ArticleNeonatal Nurse and Neonatal Nurse Practitioner Fatigue
Section snippets
Workforce Shortages and Shift Work
Across the United States, neonatal intensive care units (NICUs) are faced with staffing shortages of neonatal nurses and neonatal nurse practitioners (NNPs).1., 2. This comes at a time when hospitals are challenged to ensure that patient care is safe, effective, efficient, timely, equitable, and patient centered.3 Inadequate nurse staffing places NICU patients at risk for adverse outcomes,1 and can cause burdensome workloads for nurses and NNPs.2 In an effort to improve clinical coverage in the
Shiftwork
According to the Centers for Disease Control & Prevention (CDC), 15 million Americans are “shift workers”.4 Shift work is defined as work scheduled outside of the normal “9 am to 5 pm” daytime, five days per week work routine, and generally includes early morning hours, late evening, and/or night hours. Shift work can improve worker continuity and productivity without increasing expenditures, particularly in businesses that require 24 hours a day operations, such as hospitals.5 Shifts that last
Physiology of Sleep
Sleep is an important restorative function of the body. It is important in the regulation and maintenance of the physical, psychological and emotional health of the individual, and is closely tied to resiliency.18 The body regulates sleep through the interaction of two systems: the sleep/wake homeostasis system and circadian rhythm system. Both sleep intensity and sleep duration mediate these two systems. Sleep/wake homeostasis regulates the intensity of sleepiness or alertness based on the
Short and Long Term Health Consequences of Disturbed Sleep
Most adults require between 7 and 9 hours of good quality sleep each day for the restorative processes of the body to be realized.18 Even short and/or temporary sleep disturbances, such as those related to disturbed sleeping or sleeping for 6 or less hours, can have negative effects on neurobehavioral measures.20 Poor sleep leads to increased secretion of cortisol, insulin, and ghrelin, and decreased secretion of leptin. Collectively, these imbalances lead to increased blood sugar and abnormal
Social Context
The social context which contributes to neonatal nurses' and NNPs' poor sleep patterns is complex and includes many factors. In some settings, practicing while sleepy or fatigued seems to be socially acceptable. Some may believe that they are not affected by the effects of fatigue and claim to not be sleepy, when, in fact, studies have demonstrated that individuals are poor judges of their level of fatigue.25 Many neonatal nurses and NNPs work twelve hour shifts and rotate between day and night
Possible Interventions
Using evidence gleaned from researchers and experts on sleep related fatigue, the following are proposed:
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Neonatal nurses and NNPs must be knowledgeable about sleep physiology and hygiene, and the effects of sleep related fatigue so they can actively take steps to avoid or mitigate them through:
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Optimizing the home and sleep environment in order to achieve 7–9 hours of quality sleep each day, even when working consecutive shifts.16
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Utilizing environmental modifications such as proper lighting
Conclusion
Sleep related fatigue of neonatal nurses, including NNPs, is a serious but common health issue that can lead to personal and patient safety problems if not effectively addressed. Elements contributing to sleep disturbances and related fatigue are multifactorial, and include personal, work group, organizational and administrative factors. Improving individual knowledge and accountability while working collaboratively with employers and regulatory bodies to address these issues can improve safety
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