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Why Sleep Should Be Priority No. 1 for Nurses

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Megan Brunson, an RN in Dallas, lets nothing stand between her and quality sleep. A night nurse for the past 23 years, she knows firsthand the importance of getting enough z’s. In fact, she has perfected a sleep routine that would impress a bat. Home by 8 a.m., in bed by 9 a.m., sleep until 4 p.m. That is, unless she’s off for a few days. Then, it’s a forced 1 p.m. wake-up call so she can sleep again at night. A light snack, blackout curtains, some easy reading and earplugs are also critical components of her sacred sleep routine.

“You have to be very committed,” says Brunson, who currently works as a night shift supervisor in a CVICU. “It took me a while to learn what works best for me. I learned that I have a window and that if I stay up past 9 a.m., I’ll have trouble falling asleep. It’s almost like my body says, ‘Oh, so we’re staying up.’”

If that happens, the impact to her well-being is immediate. “When I don’t sleep well, I get moody,” she admits. “Everything is annoying to me and I don’t have that level of compassion and patience that I owe everyone around me. I’m just not the same person. I’m not the nurse or the wife or the mother or the friend I want to be.”

Sleep—the unsung health hero

Sleep may be the most basic of essential human functions, and yet, it still lacks the credit it deserves for its role in health and well-being. This is something Terry Cralle, a registered nurse and certified sleep educator, is trying to change.

“The risks associated with sleep deprivation are underrecognized, underappreciated and all too often ignored,” she says. “Sleep deprivation is serious, pervasive and it affects nurses—often in ways they don't realize.”

Settle in, because the list of ways that sleep impacts nurse well-being is long.

For starters, patient safety is at stake. She cites one study that found a 3.4 percent chance of an error when nurses got six or fewer hours of sleep in the prior 24 hours and 12 or fewer hours of sleep in the prior 48 hours. That may not sound like a big risk, but it would actually translate to a probability of 34 events per day in an average teaching hospital with 1,000 nursing shifts per day.

Nurse safety is at risk, too, Cralle says. A sleep-deprived nurse is more likely to experience an on-the-job accident or injury than a well-rested nurse. And don’t even get her started on how dangerous driving while drowsy—like after a grueling overnight shift—can be.

Beyond physical danger, sleep deprivation has been linked to job dissatisfaction, bullying, burnout, communication failures, irritability, pessimism, lack of motivation, depression, substance abuse, obesity, hypertension, diabetes, heart disease, dementia and many other serious health conditions. To add insult to injury is the number sleep deprivation does on the prefrontal cortex. “We don't have any awareness of our performance detriments when we are sleep deprived,” Cralle says. “We think we are doing OK, but we are not.”

Prioritizing sleep in nursing

Despite the myriad benefits of sufficient sleep and the numerous drawbacks of regularly skimping on ZZZs, Cralle says sleep should be a bigger part of the nurse well-being conversation.

“Sleep is a biological necessity, not a luxury,” she says. “But in our culture, many people see the need for sleep as a weakness, a character flaw, lack of a work ethic, or being self-indulgent or lazy. Unfortunately, I think this is especially true among nurses.”

Cralle recalls a meeting with nurse executives that helped cue her in to this pervasive problem. “When I asked about sufficient sleep, there was a bit of laughter and a lot of ‘Who has time for that?’ It was quite alarming. We simply can't afford to glorify sleeplessness—as a society, as an organization or personally. No one, regardless of profession, is effective, productive, accurate, compassionate, focused or happy without sufficient sleep.”

Brunson shares Cralle’s concern for the demonization of sleep in modern culture. As a nurse leader, she makes sure the nurses she oversees understand how important sleep is. “I’m pretty vocal about it,” she says. “They know that my sleep is important to me. And they know their sleep is also important to me.”

When making the schedule, Brunson will take note of shift requests that might not be conducive to quality sleep and make a point to check in with the nurse making the request. She also offers the couch in her shared office for anyone who needs a quick power nap. If she sees a nurse having a “microsleep,” a brief, uncontrollable moment of sleep that occurs when you’re normally awake, she’ll check in then, too. “‘Are you OK?’ and ‘What do you need?’ can be powerful questions,” she says.

Unfortunately, as the pandemic has nurses working overtime and dealing with incredible amounts of stress, both Brunson and Cralle fear that sleep is taking a backseat at a time when it should be front and center.

“I would urge nurses to rethink sleep entirely,” Cralle says. “Schedule sleep. Make it a non-negotiable item in your daily schedule. Be completely unapologetic for your need for sleep. Treat it as the vital sign it is.”

Terry Cralle, MS, RN
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