PRN Shift Tips: Work the Night Shift – the Right Way

Although our circadian rhythms dictate that we should be awake during the day and sleep at night, some fields, such as nursing, require professionals on the job 24 hours per day. No matter what their internal clocks say, all nurses have to brave the night shift at some point in their careers. Although working the night shift is certainly challenging, it also has many advantages, and with the proper preparation and scheduling, nurses might even find themselves choosing to work the night shift regularly throughout their careers.   

Pros of Working at Night

If you’re a night owl, the advantages of working the night shift might seem evident: You get to stay up all night and sleep all day – everything you ever wanted! However, most of the population probably needs some more convincing. Here are some advantages that even non-nocturnal people will appreciate:

• The night shift is slower paced than the day shift is since most patients sleep during the night. You might even have time to read or listen to podcasts at work.
• Night shifts generally pay more than day shifts do. If you’re not a night owl, this is probably the only reason you are contemplating the night shift in the first place.
• Although you must catch up on sleep, you’ll also be able to enjoy free daytime hours to take a class, work in the garden, do exercise outdoors, and all the other activities that are difficult to do when you work during the day. 
• You’ll also have time to run errands and schedule appointments without having to take time off from work.

Cons of Working Night Shifts

Of course, working the night shift also has its challenges. It is simply not in our nature to be awake all night and sleep when the sun is out – at least not for approximately 95% of us. These are some of the negative consequences of forcing ourselves to stay up all night:

• It is hard to get enough sleep. In fact, night shift workers sleep 25% to 33% less, on average, than do day shift workers. In part, this is because everyone else in the household is awake during the day, and the sounds of the vacuum cleaner, the blender, the TV, and so on are not exactly conducive to sleep – not to mention people entering your room looking for things or kids asking you to play with them.
• Desynchronosis, or shift lag, can negatively affect our physical and mental health, resulting in malaise, fatigue, gastrointestinal distress, and poor mood. 
• Lack of sleep can also result in increased incidences of human error at work – everyone makes mistakes, but people are a lot more likely to do so at two AM than they are at 2 PM. 
• Night-shift workers often feel that they miss out on seeing friends and family. Their friends will probably be meeting up for after-work drinks, or their families might be sitting down for dinner as they are clocking in to work. Then, when they are free, most people will be working or at school, which can lead night-shift workers to feel lonely.

Tips for Acing the Night Shift 

The good news is that many of the potential disadvantages of working the night shift can be mitigated with proper information, preparation, commitment, and support. Follow these tips to guarantee a satisfactory night shift: 

• Make sure that your family or roommates understand that you need to sleep during the day. Perhaps, someone can take younger kids to the playground or library in the morning so that you can have absolute quiet. Even if there are no kids at home, the adults you live with need to be on board. You can ask them to avoid using any loud electronic devices while you sleep or to use them with headphones.      
• Make sure you understand that you need to sleep at least 7 hours per day. It might be tempting to tell yourself that you only need four or five hours of sleep, then get up, and try to make the most of your day; however, the lack of sleep will catch up with you sooner or later, and your health will have to pay the price. 
• Set up a sleep schedule – and follow it. 
• Invest in black out curtains.
• Try to have breakfast with family before they start their day and then sleep while they are at school or work. This way you will get to spend time with your family on a regular basis and share at least one meal together.
• Be careful with caffeine intake – too much caffeine during your shift won’t allow you to sleep when you get home.
• Take a nap during a break if possible.
• Stay hydrated. Hydration is very important for your health, but it can also help you avoid drowsiness.
• Eat nutritious food before and during your shift and stay away from too much sugar and simple carbs – these will give you a short surge of energy, but then you will crash and feel even more tired than you did before. 
• Stay active during your shift. If you’re just listening to a podcast, try to do it while pacing the halls. If you need to do paperwork, try standing or walking in place – or even borrow one of those birth balls from labor and delivery and bounce on it while you type or write. 

How to Schedule Night Shifts in a Safe and Healthy Way

Since constancy in circadian patterns is ideal, in theory those who work night shifts should stick to this schedule long term. However, in practice, the issue is not so simple. People who work night shifts often revert to day-time waking hours on days off, which throws the circadian rhythm completely out of whack. Therefore, a clockwise rotational schedule is preferable, transitioning from working mornings to afternoons to nights followed by a period of rest. A good work-schedule transition is working in threes: three mornings, three afternoons, three nights, and three days of rest. 

Of course, clinicians who work PRN shifts through Nursa can choose to work fewer days. However, it is important to take three days off after a maximum of three consecutive night shifts. This is because sleep and alertness are significantly compromised for at least three days following an all-nighter. In fact, there is an association between circadian rhythm and human error during night shifts. The following increases in human error have been found in afternoon and night shifts in relation to morning shifts:

• 18% increase in human error incidents in afternoon shifts 
• 30% increase in human error incidents in night shifts 

Therefore, no matter how well you might be feeling after working a few night shifts, make sure you take a break after every three shifts for your patients’ safety as well as your own.

What if I Simply Cannot Adapt?

If you identify as a morning lark, you most likely will have a very hard time adjusting to the night shift, whereas if you consider yourself a night owl, you will probably adapt very easily. Between 5% to 10% of the population have very rigid chronobiological types, meaning that some of these people find it nearly impossible to be awake at night while others simply cannot wake up early. If you fall in the small percentage of the population that truly struggles to stay awake at night, then skip the night shift – it is not for you. For the rest of you though, with adequate preparation, the night shift could fit your schedule, lifestyle, and income very well. How do you feel about working the night shift?