Preparation for night shift work by nurses and physicians often involves a routine: pre- and post-shift sleep during daylight hours, use of sleep aids, and specific meal and beverage selection. As humans are diurnal by nature and require sleep at night in order for survival, night shift work represents an abnormal physiologic state with short-term effects on circadian rhythm for those working isolated night shifts, and long-term effects for career night shift workers (i.e., nocturnists). The evolution of a 24-hour society has created challenges requiring adaptation to an inverse light and darkness cycle. Neuropsychiatric ramifications include chronic fatigue, anxiety, depression, increased risk of medical errors, family discord, drug and alcohol abuse, and social isolation. The negative aspects of night shift work have been known for centuries: the Italian physician Bernardino Ramazzini, in his occupational medicine treatise De morbis artificum diatriba published in 1713, described bakers who “work at night, so when the others sleep they stay awake, while trying to sleep during the day like animals who escape the light: hence, in the same town, there are men living an antithetic life in comparison with the others.” Night shift work has been associated with deleterious health effects such as cardiovascular and gastrointestinal disease, certain cancers, suppression of immunity, diabetes, ageing, hormonal imbalance, increased risk of accidents, and premature death. Past studies of nurses and physicians have shown night shift work is a major factor in career dissatisfaction, burnout, work-family conflict, and dysphoria. However, faculty reported lower level of satisfaction working night shifts, whereas nurses agreed less than the other groups regarding increased risk of drug and alcohol dependence.Įmergency medicine nurses and physicians routinely provide continuous 24-hour coverage in the emergency department (ED) and are familiar with the challenges of working at night and maintaining optimal sleep. All had similar opinions regarding night shift-associated health effects. Faculty reported a higher rate (41%) of falling asleep while driving compared to residents (14%) and nurses (32%), but the accident rate (3% to 6%) did not differ significantly. The majority (>72%) in all groups drank coffee before their night shift and reported feeling tired despite their routine, with 4:00 a.m. Faculty preferred not to eat (45%), whereas residents (24%) preferred a full meal. Residents routinely used melatonin more (79%) than did faculty (33%) and nurses (38%). The routine use of pharmacologic sleep aids differed: nurses and residents (both 38%) compared to faculty (13%). Bedroom temperature preference was similar. There was no difference in use of physical sleep aids between groups, except nurses utilized blackout curtains more (69%) than residents (60%) and faculty (45%). Forty-seven faculty, 37 residents, and 90 nurses completed the survey.
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