While rotating shifts are the norm for many nursing staff, they can have a significant impact on your physical and psychological health, emotional wellbeing and work-life balance.
“Shift working varies by setting, but for those working with inpatients in the NHS, it’s probably around 70% of nursing staff,” says Dr Chiara Dall’Ora, associate professor in health workforce at the University of Southampton. A registered nurse herself, shift working was the primary focus of her doctorate and she’s currently researching how modifying shift patterns for nursing staff might improve patient safety, workforce wellbeing and NHS efficiency.
For staff working shifts, most will be rotating, with a combination of days and nights. “There are lots of issues that come with this kind of shiftwork,” says Chiara. “The internal body clock we have, that regulates all our functions, is constantly asked to move to different time zones.”
As a result, digestion, reproduction, cardiovascular and metabolic functions can all be adversely affected. Risks include weight gain, digestive and sleep disorders, mental health issues and even cancer. “There are also disturbances to family and social life too,” says Chiara.
Time off can be impacted by the need to recover properly, especially if completing a set of 12-hour night shifts. “It’s ingrained in nursing staff to be superheroes who don’t have human needs,” says Chiara. “But it’s not true.”
I’d love to see a culture change where nursing staff can say they’re fatigued and managers will listen
While some nursing staff feel shift working improves their work-life balance, it’s not for everyone, says Leona Cameron, Joint Head of Health, Safety and Wellbeing at the RCN. “As you get older, 12-hour shifts can be more challenging,” she says. Employees have a legal right to request flexible working from the first day of their employment. See the RCN’s guidance for more details.
Looking after yourself
There are a few areas nursing staff can look at to help mitigate the impacts of shift work.
Sleep hygiene
- Sleep is key, says Chiara: “Make sure the room is as dark as possible. Light is one of the factors that regulates our circadian rhythm. Blocking out light will help trick your body clock.” Consider blackout blinds or heavy curtains for your bedroom, or an eye mask to wear in bed.
- Go to bed, rather than falling asleep on the sofa, says Leona: “Daytime sleep tends to be lighter, so try and induce heavier sleep where you can. You won’t get deep sleep napping on the sofa.” Ear plugs could help if daytime noises break through your light sleep.
- Be aware of the symptoms of a sleep disorder, says Chiara. These include regularly taking longer than 30 minutes to fall asleep; waking frequently and struggling to go back to sleep; waking too early; heavy snoring; being restless during sleep; and feeling unrested even after sleeping. Seek support via your GP, if needed.
- Read more about how to wind down to sleep and what it means to sleep well here.
Technology use
- Avoid TV and switch off your phone when you’re at home, Leona advises. “A lot of nursing staff are part of messaging groups, so it can be tempting to try and keep up,” she says.
Food and drink
- Avoid caffeine for as many hours as possible before you want to sleep, says Chiara. “During a night shift, it’s typical to have a coffee or a caffeinated drink to keep yourself alert. But first think about when you’ll need to rest,” she says.
- Snacking can be useful during shifts, but be careful about your choices, Chiara advises. “Dried fruit and nuts are nutritious healthy options that won’t overburden your gastrointestinal system,” she says. “Sugary foods, such as chocolate, may provide a short-term energy boost, but this will be followed by a dip in energy levels,” says . Read more about eating for endurance and keeping your energy up here.
- Don’t try to sleep or go to work immediately after eating a larger meal, suggests Chiara. “Give your body time to digest food,” she says. Meal planning and prepping can be useful too.
Leisure time
- Be proactive about your social life, even if it’s challenging. “Make your friends aware you’re working nights – you can even give them your rota,” Chiara advises. “Then try and find times that are mutually convenient to meet up.”
- Fit exercise into your schedule. “It can take various shapes and forms, and you don’t need to go to the gym,” says Chiara. “Stretch for 10 minutes or go for a walk. Try to do something every day.” But be careful not to do strenuous exercise just before you go to bed, as it can delay sleep, says Leona. Try these five simple exercises tailored especially for nursing staff.
How can managers and employers help?
If you’re responsible for the wellbeing of others, you can take a variety of steps to support staff who are on rotating shifts.
- Managers should encourage staff to take their breaks. Legally, anyone working more than six hours should be given a 20-minute uninterrupted break. Plan when everyone can take their breaks at the shift’s start. “We’re still hearing of staff who struggle to get access to drinking water or visit the loo during their shift. That should not be happening,” says Leona.
- Learn to spot the signs of fatigue in staff. “It’s especially important to notice any changes in behaviour or mood and ask if everything is okay,” says Chiara. “I’d love to see a culture change where nursing staff can say they’re fatigued and managers will listen.”
- Shifts should be designed to allow two nights’ full sleep when switching from day to night and vice versa, . Meanwhile a minimum of 11 hours' rest between shifts.
- Managers can also consider e-rostering, which allows staff to choose their own shifts, within some parameters, says Leona. .
