Performance and sleepiness in nurses working 12-h day shifts or night shifts in a community hospital.

Hospitals are around-the-clock operations and nurses are required to care for patients night and day. The nursing shortage and desire for a more balanced work-to-home life has popularized 12-h shifts for nurses. The present study investigated sleep/wake cycles and fatigue levels in 22 nurses working 12-h shifts, comparing day versus night shifts. Nurses (11day shift and 11 night shift) were recruited from a suburban acute-care medical center. Participants wore a wrist activity monitor and kept a diary to track their sleep/wake cycles for 2 weeks. They also completed a fatigue test battery, which included the Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale (KSS), at the beginning, middle and end of 4 duty shifts. Daily sleep duration was 7.1h on average. No overall difference in mean daily sleep duration was found between nurses working day shifts versus night shifts. Objective performance on the PVT remained relatively good and stable at the start, middle, and end of duty shifts in day shift workers, but gradually degraded across duty time in night shift workers. Compared to day shift workers, night shift workers also exhibited more performance variability among measurement days and between participants at each testing time point. The same pattern was observed for subjective sleepiness on the KSS. However, congruence between objective and subjective measures of fatigue was poor. Our findings suggest a need for organizations to evaluate practices and policies to mitigate the inevitable fatigue that occurs during long night shifts, in order to improve patient and healthcare worker safety. Examination of alternative shift lengths or sanctioned workplace napping may be strategies to consider.

Local Anesthetic Systemic Toxicity (LAST): Designing an Educational Effort for Nurses That Will Last.

PURPOSE: To improve knowledge and raise awareness of nurses who assist certified registered nurse anesthetists or anesthesiologists with peripheral nerve block or spinal block procedures about a potential life-threatening local anesthetic systemic toxicity (LAST) event. DESIGN: An evidence-based practice project design. METHODS: Nurses in units where nerve block procedures were performed (ie, postanesthesia care unit, preoperative, operating room, outpatient services, labor and delivery unit) received a pretest about their knowledge of LAST events, participated in a 30-minute educational session, and then completed a post-test. The data were analyzed for differences and statistical significance. Included in the test was a question about the nurse's comfort level with managing a LAST event. FINDINGS: The findings demonstrated a knowledge deficit related to LAST events. The average of all three units combined pretest scores was 60% and post-test scores increased to 95%. The average comfort level of all three units was 3.5/10 (35%) before the educational in-service program and increased to 7.9/10 (79%) after education. CONCLUSIONS: Nurses working in units where nerve blocks are performed are lacking in knowledge of the signs and symptoms and the correct course of treatment for a LAST event. This could lead to poor outcomes of a very high-risk low-volume event.