How important is sleep for nurses?

Poor sleep can have profound clinical consequences for nurses and their patients. Media headlines have revealed some of the most tragic events. In 2017, it was reported that a nurse fell asleep and dropped a baby they were feeding¹. Although the baby survived, the child sustained a skull fracture¹. In another heartbreaking instance, a nurse fell asleep while monitoring a patient’s oxygen levels overnight². As the nurse slept, the patient’s oxygen levels fell. The patient suffered significant brain damage and died two weeks later².

Most of us have felt the toll of a terrible night’s sleep — we struggle to stay alert as we battle waves of irritability and poor concentration, avoid social interactions and steer clear of making any important decisions — all reminders that we are far from the best version of ourselves. How we sleep (or don’t sleep) affects how well we perform and feel during the day.

While nurses might recognise the importance of a good night’s sleep, when it comes to their own, it seems that many struggle. Estimates suggest that as many as 61% of nurses experience poor sleep quality, which is substantially higher (almost double) that of other health professionals³. These findings are concerning and raise several questions: ‘how important is sleep for nurses?’, ‘why might nurses be susceptible to poor sleep?’ and ‘what can be done to help?’

The harmful effects of inadequate sleep are well documented^4-6, much like being intoxicated. In fact, a landmark study identified that after about 17-19 hours of being awake, performance on some tasks were equivalent or worse than a blood alcohol concentration (BAC) of 0.05%⁷. Extend this time to 28 hours, performance is similar to a BAC of 0.10%⁷. Chronic sleep deprivation has a similar effect. Sleeping five hours each night for four consecutive nights has been shown to reduce neurobehavioural performance to a level similar to a BAC of 0.4- 0.8%⁸. While it might seem unlikely that anyone would stay awake for such a long time, increasing personal and professional demands might perhaps make it more common than we like to think.

We often hear that nurses “cannot pour from an empty cup” — a reminder that we need to look after our own health and wellbeing to care for others. However, personal and work-related factors can make it difficult to get sufficient quality sleep. As a result, nurses may need to learn and develop strategies and routines to help them get the quality sleep they need.

Sleep may also offer protection against occupation-related injuries and illness. Although not specific to nursing, it has been suggested that workers with sleep problems have a 1.62 times higher risk of being injured at work compared to workers without sleep problems⁹. Similarly, people who sleep less than six hours are four times more likely to develop the common cold¹⁰. With media releases suggesting increasing rates of the flu and staff exhaustion, perhaps efforts that promote and support healthy sleep may be a simple strategy to further protect and promote staff wellbeing? 

In today’s 24-hour society, reports of poor sleep among nurses might simply reflect a broader societal issue. Nurses, like everyone, are trying to juggle a lot (family, work, a social life and increasingly, additional study). They may also take their work home and worry about their patients. All this, combined with rotating shiftwork might just create a perfect recipe for poor sleep. Night and late-early shifts are particularly problematic—I am sure most nurses will testify that our brains seem to think the short time between these shifts is the perfect opportunity to ruminate on the shift just ended and anticipate the one fast approaching, all while watching the clock and seeing opportunities for sleep slip away.

Most nurses do not need to be convinced that sleep is important. They may, however, need guidance on how to achieve enough quality sleep. Unfortunately, many recommendations for the general population, such as advice to ‘maintain a consistent sleep schedule’ are not applicable to nurses and other shift workers. Addressing this issue, recommendations tailored for shift workers have recently been published¹¹. Some helpful tips that might help promote and support healthy sleep among nurses and midwives include:

• Develop a bedtime routine that helps you to wind-down and relax
• Create a comfortable cool, dark, quiet sleep environment
• Consider the timing of food and caffeine as a heavy meal and/or caffeine too close to bedtime may make it difficult to fall asleep
• Plan your transition to days off by scheduling time to sleep that will help you realign your body clock to a typical sleep/wake pattern
• Consider the alerting effects of light exposure when trying to schedule shifts
• Make sleep a priority and schedule enough time to sleep between shifts

In addition to these strategies, it’s helpful for nurses to have a basic understanding of the science of sleep. Since nurses often need to schedule sleep at irregular times around their shifts, it is helpful to know how sleep works and what regulates sleep. This knowledge is often helpful when selecting and applying strategies that promote sleep. Integrating this knowledge with awareness of organisational policies and practices, particularly around roster requests, can also be especially helpful.

By understandings how sleep works, nurses are better positioned to make roster requests and informed decisions about how to best promote and support healthy sleep. However, like efforts to improve diet and fitness, efforts to achieve healthy sleep are probably only going to work if we make it a priority, without placing undue pressure on ourselves.

*It is important to seek professional medical attention is sleep is a problem or concern.

Dr Lisa Matricciani is a Senior Lecturer in Nursing at Adelaide University with a research focus on sleep for health and wellbeing. Lisa has worked clinically as a Registered Nurse for over ten years and has 45 publications with over 2,500 citation.

1. Anderson S. Mum left heartbroken after her premature baby was dropped on his head. https://www.news.com.au/lifestyle/parenting/babies/mum-left-heartbroken-after-her-premature-baby-was-dropped-on-his-head/news-story/2d302052a1cab5ff297d811dafb8d168.
2. Daily Briefing. Nurse sentenced after patient died when she fell asleep. https://www.advisory.com/daily-briefing/2015/03/30/nurse-sentenced-after-patient-died.
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7. Williamson AM, Feyer A-M. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational and environmental medicine. 2000; 57 (10): 649-655.
8. Elmenhorst D, Elmenhorst E-M, Luks N, et al. Performance impairment during four days partial sleep deprivation compared with the acute effects of alcohol and hypoxia. Sleep medicine. 2009; 10 (2): 189-197.
9. Uehli K, Mehta AJ, Miedinger D, et al. Sleep problems and work injuries: a systematic review and meta-analysis. Sleep medicine reviews. 2014; 18 (1): 61-73.
10. Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally assessed sleep and susceptibility to the common cold. Sleep. 2015; 38 (9): 1353-1359.
11. Shriane AE, Rigney G, Ferguson SA, Bin YS, Vincent GE. Healthy sleep practices for shift workers: consensus sleep hygiene guidelines using a Delphi methodology. Sleep. 2023; 46 (12): zsad182.