Nurse, Heal Thyself!

By Julia Worrall RN

I have been a nurse for over 20 years. And I’ve been exhausted just as long.

Unfortunately I am not alone. Nurses are called upon  to be superheroes…impervious to niggly details like hunger, pain, sadness and fatigue. 

We keep going. I mean what choice do we have? As the years go by we become crusty and curt, a ‘Nurse Ratched’ if you will.  But we keep showing up. Putting aside our fatigue to care for you because, for the most part, in our profession the need for sleep is considered a character flaw…only for the weak. A ‘good’  nurse can churn out shift after shift, even on minimal sleep, because we will never abandon you, our patient. 

Patience with our Patients

We know that hospitalization can be one of the most physically and psychologically stressful events in one’s life, and that this stress has the potential to reduce our patients’ sleep quality, impair recovery and delay discharge. Because patients notoriously complain about the noise we make at the nursing station, their roommates’ snoring, and about how hard it is to get a good night’s sleep, we hand out sleep aids like candy. 

Understandably then, this legitimate concern has made nurses experts at teaching their patients about sleep, sleep hygiene and sleep disorders. 

Right?

Wrong! How I wish this were true, but in general nurses consider sleep promotion a very low priority in their busy practice. Might the shocking fact that the typical nursing student receives just an average of 60 minutes of education about sleep during their entire 4-year program have anything to do with it?

Yes, SIXTY MINUTES. Think about that…. We spend a grand total of one hour discussing what occurs during ONE-THIRD of our patients’ lives! 

No wonder nurses do not place a high priority on sleep! Nurses consider insufficient sleep knowledge as a major barrier to effective sleep management in the clinical setting. In addition, they view discussions about sleep with their patients to be impractical due to a perceived lack of time.

Since nursing is considered to be the most trusted profession, and nurses are the largest group of healthcare professionals, are we not perfectly positioned to effect change for both our patients and ourselves?

Nurses who adopt healthy behaviours themselves act as positive role models. In fact, nurses who enjoy higher quality sleep are more knowledgeable about sleep in general, have a positive attitude toward sleep hygiene, and are much more likely to broach this important subject with their patients.

So before we can address the sleep health of our patients, we need to address our own sleep. 

Nurse, Heal Thyself! 

Many times I have reported for a shift only to hear the nurses lamenting their extreme sleep deficits. We wear our sleep deprivation as a badge of honor. This is foolhardy and explains the lack of resiliency that is creeping into our profession. It is hard to be compassionate toward our patients while we are exhausted, yet managing a never-ceasing flow of patients through our department. Sadly, it is our own lackadaisical attitudes about sleep, our own habits, that are harming our patients. 

It is true that we are pressed in every way for time, but how fantastic would it be if we could have a dedicated Sleep Technologist/Educator to provide inservice training for nurses and to be a resource for the inevitable sleep issues our patients face once admitted? Those issues, in fact, often the root cause of why they are admitted. 

My dream for the future is that sleep education be extensively taught to nurses and that Sleep Techs/Educators be an integral part of the in-hospital multidisciplinary team.  

As the world’s attention turns to consider that occult one-third of our lives, I call upon nurses to collaborate with the sleep educators to discuss strategies for helping  patients’ achieve a solid eight or so hours of restful life-enhancing sleep. 

The Tragic Toll of Sleeplessness on First Responders

Sleep, or lack thereof, has also been found to be a critical factor in the ability of our First Responders to do their jobs. We rely on them to respond in emergencies of the highest severity: to be on top form, able to save lives, and fight through the trauma. But first responders too, are only human. Firefighters, police officers, correctional officers, paramedics, and nurses are all susceptible to sleep-related disorders just like the rest of us. With unhealthy long and irregular shift patterns, these life-saving professions have been shown to have detrimental effects on the lives of heroic individuals.

In addition to that, first responders’ job roles result in physical and mental strain on the body–even when functioning at a level of optimum sleep–so the knock-on effect of poor performance can lead to a multitude of mental health concerns. Many workers in first responder positions are, at some point in their career, likely to be involved in some form of event which could lead to PTSD: a harrowing condition that could ultimately lead to a higher risk of suicide.

Dangerous Livelihood

Those working in potentially life-threatening environments are often exposed to harmful fumes, chemicals, and dangerous scenarios, and are trained to protect themselves against these elements. For the first responder, the one area of their professional lifestyle that is often overlooked for needing care is the access to a good night’s sleep. A study by the Journal of Clinical Medicine found that nearly 40% of 7,000 firefighters tested were found to suffer from insomnia, work-shift disorder, sleep apnea, or a combination thereof. Although most of these individuals were likely all too aware that their sleeping life was less than ideal, nearly 80% of these firefighters didn’t know that their lack of shuteye time had resulted in a medical disorder. 

Around 103 firefighters and 140 police officers in the U.S. tragically took their own lives in 2017. These figures far exceed the death tolls relating to incidents actually occurring on the front line. And with suicide figures notoriously underreported, it’s likely that these figures are actually much higher. With such common exposure to gun crime, it’s unsurprising that 90% of police suicides are by firearm. Figures relating to suicide in firefighters are also incredibly shocking: 44% of full-time firefighters and over 50% of volunteer firefighters had experienced suicidal ideation, nearly 17% and 31%, respectively, had made suicide plans, while more than 15% and almost 27%, respectively, had made suicidal attempts.

You give so much of yourself to keep us safe, now let us return the favor.

Killer Fatigue

Many emergency responders, including those in the police force and medical services, work between 16- and 24-hour shifts, and even when rest time is encouraged, it is likely that these individuals will be disrupted and called out at unsociable hours. In 2015, a study referenced by the National Highway Traffic Safety Administration reported that around 50% of emergency medical service workers surveyed were suffering from fatigue. This inadequate state of awareness can lead to fatal errors in medical operations, poor driving quality, and slow reactions which could lead to injuries or death. Having very little sleep can also impair judgment and memory retention, making even the most experienced workers likely to face difficulties in high-pressure and fatal scenarios. When the body suffers from prolonged periods of sleep deprivation, cognitive functionality decreases and results in impairment similar to an ‘over-the-limit’ blood alcohol level of 0.1%. And with the amount of emergency calls increasing year on year, first responders continue to live under crushing amounts of pressure, which leads to even less chances of quality sleeping time.

Just because you have time to sleep doesn’t mean you’ll be able to!

Shift Workers and The Circadian Rhythm

The Circadian rhythm is the natural physical, mental, and behavioral changes in the body that take place in most living things on a daily basis. Natural circadian rhythm in humans makes us sleep at night and stay awake during the day. Understandably, shift work disrupts the circadian rhythm, and we are just beginning to understand the vast significance of the health consequences this can have on the body. Circadian misalignment, as it’s called when someone isn’t able to follow the natural circadian rhythm of sleeping at night and staying awake during the day, affects cardiovascular and mental health, and increases one’s risk of cancer, as well as a host of other potential problems. Furthermore, it increases the risk of workplace accidents and injuries, and increased errors in the workplace. Addressing and treating the sleep issues that shift workers face will have tremendous positive consequences for the health of these workers, while improving the efficacy and efficiency of their work output.

The Sleep RN: It’s Time to Help our First Responders

With the nation facing these major issues, many of which can be traced back to improper sleep, there is no one better positioned to step in than Julia Worrall, The Sleep RN. With her innovative and cutting-edge research tools and methods, combined with a team of world-renowned professionals who are all leaders in their fields, she’ll work with medical professionals, first responders, corrections officers, veterans, and inmates to heal the nation by implementing inventive approaches to correcting unhealthy sleep patterns. With The Sleep RN at the helm, those who want to see real change and results can, in every sense of the word, rest easy.