Although the duties and responsibilities are no different for a nurse that works after the sun is down, the night shift (or shift work) does present unique challenges. The workplace atmosphere and schedule related to the night shift requires a nurse to make significant adjustments to his or her daily routine and personal life. With the majority of patients asleep during the late shift, nurses must also find ways to manage what is considered a less busy (or less stressful) workload in between the continuous monitoring of patients throughout the night.
While shifts vary according to a healthcare facility or hospital, the typical night shift is between the hours of 11:00 p.m. and 7:00 a.m. Some nurses may start a shift as early as 8:00 p.m. At the end of a night shift, nurses return home where they usually rest and rejuvenate in the early hours of the day. Unfortunately, sleeping throughout the day is sometimes difficult to achieve. Once awake, a night nurse often tends to their personal life, and then remains up until it’s time for their next shift.
“One factor to take into consideration when working the night shift is it might take some time for your body to adjust to a night shift schedule,” Joy Becker, a nurse from the D.C.-based overnight infant care agency Let Mommy Sleep said.
Learning how to adapt to a different sleep schedule is one of the hardest obstacles that a night shift nurse must overcome – especially since their sleeping pattern is one that is in reverse to the majority of the population, including their family and friends.
Below you will find 10 survival tips for nurses that work the night shift:
1. Get an Adequate Amount of Sleep
“Working at night interrupts your natural sleep pattern,” says Fran Laukaitis, RN, MHA, and Chief Nursing Officer at Methodist Charlton Medical Center in Dallas, TX. “You have to schedule your sleep.”
She suggests nurses take measures to create an environment conducive for sleep by using curtains that darker the room; and disconnecting things that will disrupt sleep, such as the door bell, phones and electronics.
“Going back to sleep once you’re up is next to impossible,” Laukaitis said.
It’s important for nurses to make sleep a priority at home. Night shift nurses must teach their bodies how to properly fall asleep (and remain asleep) for long periods of time without any interruptions.
According to the National Sleep Foundation (NSF), night shift nurses should keep the same bedtime and wake time schedule (even on weekends); use eye masks and ear plugs to eliminate noise and lights from a sleep environment; as well as avoid consuming alcohol and caffeinated beverages/foods close to bedtime.
2. Use Caffeinated Products Wisely
“Coffee was a must for me, or something caffeinated,” Becker said.
The NSF suggests drinking a caffeinated beverage, such as coffee, tea or cola, to help maintain alertness during a night shift. Taking about 20 to 35 minutes to improve an individual’s level of alertness, caffeine is an effective method for offsetting fatigue. However, it is important not to overdo caffeinated products, as drinking too much coffee can have it’s own issues.
3. Make Healthier Meal and Snack Choices
The meals and snacks a nurse selects before and during the night shift can have a significant effect on energy, stamina, and performance levels. It is important to choose the items that provide energy but do not cause sleepiness or a ‘crash-and-burn’ effect later on in the shift.
Adopting a ‘grazing’ approach towards eating while working the night shift is also suggested, meaning a nurse consumes smaller, more frequent light meals with raw salads, nuts, fruit, and vegetables. Opt for well-balanced meals that include high-protein, complex carbohydrate, and low-fat foods .
Additional tips for making beneficial dietary choices while on the night shift include:
- Browse the local health food store for tasty snack options. “I always bring some hard candy or a granola bar for a little “sugar boost” when I needed it,” says Becker. It’s suggested to avoid eating large amounts of refined sugar (such as doughnuts, cookies and cakes), which can deliver an instant boost of energy, but can also lead to extreme mood swings and a crash later on in a shift.
- As the body ages, the more difficult it becomes to digest gluten, which can cause a blockage in the bowel . Try choosing gluten-free bread when making sandwiches for work to aid a healthy bowel system that moves more efficiently, and contributes to higher energy levels in nurses.
- Dried fruit provides a sweet boost of energy with fewer harmful effects on the body than the typical sugar-filled junk food item.
- Lessen the chances of fatigue and headaches caused by dehydration by drinking fruit juice and water.
4. Monitor Your Health
Working the night shift can have a detrimental effect on a nurse both physically and mentally if he or she does not effectively monitor their health. The NSF reports shift workers face a higher risk of experiencing insomnia, daytime sleepiness, high blood pressure, diabetes, menstrual irregularities, colds, and weight gain than day shift employees.
5. Bond with Your Co-Workers
Laukaitis has practiced nursing in five states over the past 39 years, and has spent 15 of those years working evenings and nights (six of which were exclusively devoted to the night shift). She says that the night shift creates a completely different environment from the day shift; one that causes a nurse to become more resourceful since there is fewer managers, directors, and physicians on duty.
“They [Nurses] have a great deal of autonomy, and because they rely so much on each other, they tend to have a special camaraderie,” says Laukaitus.
Bonding with co-workers not only makes the night shift easier to handle, but thorough communication between co-workers can also help increase the likelihood that a shift will run smoothly.
“Night shift nurses generally do not have as much interaction with the patient’s family as the day shift,” she continues. “For this reason, communication from the day shift to the night shift must be thorough.”
6. Find Constructive Ways to Keep Busy
“Another factor to take into consideration about the night shift is it tends to be more “low key,” which can make the shift feel longer,” says Becker. “During [the] day shift, the nurses are very busy with doctors in and out, and other staff such as supervisors, directors, kitchen staff, building service staff, which in return makes day shift very busy.”
Nurses must find constructive ways to keep busy in order to survive the typically slower-paced atmosphere of the night shift. Becker says that usually only the nurses and patients are present during the night shift, which allows nurses to administer excellent patient care on a more intimate level.
“During night shift, most of your patients are sleeping which allows you more one on one time with your patients that are awake,” she notes.
“Try and get any extra work done that could get done on night shift to potentially help the day shift nurses,” Becker suggests. “Day shift is a very busy shift and I would always try and relieve them of some of the work if possible.”
7. Exercise or Get Active to Stay Alert
Nurses who work the night shift tend to experience the most fatigue and drowsiness around 4 a.m., and should avoid completing the most tedious or monotonous tasks during that time.
The NSF suggests engaging in a bit of exercise as a way to fight back when a feeling of fatigue starts to take over during the night shift. Staying active during breaks is an effective way to reboot energy levels, and may include taking a walk to the cafeteria, climbing a set of stairs, dancing to a song on the radio in the break room, or shooting hoops in the hospital parking lot.
8. Create a Healthy Balance on the Home Front
Nurses who work the night shift may experience bouts of feeling ‘out of the loop’ or isolated from family and friends. Night shift employees often find themselves working harder to maintain relationships with loved ones who have conflicting schedules.
“Help people understand you’re on a different schedule,” says Laukaitis. “Two o’clock in the evening for them is like 2 a.m. in the morning for you!”
Getting loved ones ‘on the same page’ also plays an important part in not only surviving the night shift, but also establishing a sleep schedule that allows a nurse to juggle his or her daytime and nighttime commitments. For example, it’s important to thoroughly explain to kids why it’s important that Mommy or Daddy must sleep during the day, or why they cannot tuck them in bed at night.
“You have to schedule everything (appointments, errands) just like you do on the day shift,” says Laukaitis. “You have to plan to sleep, and plan your other activities around [the night shift].”
Additional night shift survival tips for nurses who are married and/or have children include:
- Facilitate constant communication with loved ones through texts, emails, and phone calls.
- Post notes and responses on a bulletin board at home to keep families connected when face-to-face interaction is not possible.
- Couples who schedule a ‘date night’ at the end of a long work week have something to look forward to.
“When you’re not working nights, you have to conform to the rest of the world,” adds Laukaitis. “However you plan it, remember adequate sleep is a priority.”
9. Learn How to Accommodate the Circadian Clock
The circadian clock is the human body’s natural, internal inclination to follow a 24-hour cycle; it also plays a role in controlling the body temperature, hormones, heart rate, and other body functions. A nurse can increase his or her chances of surviving the night shift by gaining a better understanding of the circadian clock; and learning ways to counteract some of the physical effects of working at night, such as fatigue and drowsiness.
Night shift nurses are working at a time when the body normally believes it should be asleep. Part of the circadian cycle’s regulation comes from changes in light and darkness; it’s one of the most obvious ways the human body distinguishes between the morning and nighttime.
NSF states that because of the daily rhythmic activity cycle the body typically follows, most people generally start to crave sleep between the hours of midnight and 6 a.m.
Nurses who work nights can explore various ways on how to address and possibly ‘trick’ the circadian clock. An article in the Journal of Occupational & Environmental Medicine titled “Fatigue Risk Management in the Workplace” highlights the possibility of experiencing a beneficial effect from brighter light at night without the disadvantages.
Field trials in shift work operations (including those involving hospital nurses) reveal that when sub-480 nm light wavelength are filtered out by using eyeglasses with specially designed wavelength filters (called Zircs™) , an employee is able to block the harmful effects of light (such as the resetting of the circadian clock), which can significantly improve levels of alertness, sleep, and mood.
Workplace trials of Zircs™ show that shift workers experienced:
- Up to a 70% increase in energy during their night shift
- Prevention of normal increase in reaction time during night work hours
- Decrease in errors between 4 a.m. and 8 a.m. by 78%
- Up to a 38% improvement in subjective mood scores
10. Get Home Safely
The concept of surviving the night shift doesn’t only pertain to the time spent in the workplace, but also extends to what a nurse does after his or her shift ends. According to an Institute of Medicine report on “Sleep Disorders and Deprivation,” nearly 20 percent of all serious car crash injuries in the general population are linked to a sleepy driver who is not affected by alcohol or drugs.
In an effort to combat fatigue, many drivers will let down car windows or turn up the volume of the radio – an alarming signal that fatigue can greatly affect the safety of a driver. The NSF says that these methods of trying to stay awake and alert while driving do not work, and pulling over immediately is the best thing a nurse can do if he or she has reached this dangerous level of fatigue.
Additional tips on how to survive the drive home after working the night shift include:
- Carpool with another nurse when possible, and hold a conversation with the driver.
- When applicable, choose public transportation.
- Do not stop for drinks with co-workers as a way to unwind.
- Wear wraparound sunglasses when driving home in the morning so the body becomes less aware of the daylight.
- Embrace defensive driving techniques.
 Blachowicz E, Letizia M. The challenges of shift work. Medsurg Nurs. 2006; 15:274–279.
 “Ease shift work with healthy eating: welcome to the first in a Lamp series on health and fitness for nurses juggling shift work and busy lives. This month we look at how to eat properly when doing shift work.” The Lamp Mar. 2010: 39. Health Reference Center Academic. Web. 26 Dec. 2013.
 “Fatigue risk management in the workplace.” Journal of Occupational & Environmental Medicine. Feb. 2012; 2: 231-258.