For several years, Washington State University researchers have been looking at how fatigue affects the way we perform, especially in the workplace. They’ve worked with companies in the transportation industry. They’ve worked with the military. They’ve worked with policing agencies.
And now Dr. Lois James is turning her attention to nurses.
She has a million dollar grant from the federal Agency for Healthcare Research and Quality to look at whether 12-hour shifts, kind of the industry standard, are good for nurses and their patients. And then, there’s a second question: how can you compare the job performance of nurses who work the night shift versus those who work the day shift?
“The human is not a nocturnal animal. We’re not designed to sleep during the day and work at night," James said. "So, nurses who work those 12-hour night shifts are really battling their bodies.”
James and her colleagues will test 100 nurses who work for Providence Health Care in Spokane, 50 work days and 50 work nights. For a few days before they come to the WSU Spokane campus for testing, they’ll wear actigraphs on their wrists, like a wristwatch, that will monitor their body functions. And then, they will make two trips to campus, once after working three consecutive 12-hour shifts and once after three consecutive days off. They will take a driving test in a simulator to test their skills. And they will also go to a simulation lab with lifelike high-tech manikins and perform duties they often do at work.
“They’re all based around a patient care scenario, but it will include multiple different components; for example, inserting an IV, medication calculation, having to monitor charts, check vitals, recognize if something is going wrong. So we can see if a mistake is made, is it a consequence of not having seen the code, for example, or is something else going on," James said.
"We hypothesize that three consecutive shifts will result in significant impairment compared to when nurses are tested when they’re arguably well-rested after days off. The other hypothesis is that nurses of consecutive shifts following night shifts will be significantly worse off than consecutive shifts following day shifts,” she said.
Lois James’s views are based on her experience working with police officers who work odd shifts.
“We’ve found that officers working what’s called a graveyard shift, but what is essentially the night shift, are at much greater risk of collision when tested in our driving simulator," James said. "And that’s one of the reasons why we added that as a component to this nursing study because we’re not just interested in patient care, we’re also interested in nurse safety and we don’t want nurses to work these consecutive 12-hour shifts and then be at increased risk for having a collision when they drive home.”
The goal of the study is to provide objective evidence for hospitals and other health care facilities to help them with scheduling for nurses. James says that could certainly lead some to shake up the status quo and it might be unpopular with some nurses.
“It’s quite a popular shift schedule," she said. "On the one hand, the idea of consolidated time off is appealing, for family life and a variety of other reasons. Another thing that I’ve certainly heard, anecdotally, is the idea of continuity in patient care. Nurses like to stay with a particular patient and be able to monitor them and track them throughout a long period of time, as opposed to having to hand them over to someone else after a shorter shift.”
James says the testing will begin during the next few months and continue during the next two years. The last year of the study will be devoted to analyzing data and writing papers.
