An enterprise piece on Shift Work Disorder and the dangers of exhaustion amongst nurses.
“A nurse I know fell asleep while driving home. She ran someone off the road.”
Erin Geller, an R.N. at Mercy Hospital Northwest Arkansas relays this story to me. She won’t give up the name of the nurse and said she no longer works at Mercy, the shorthand name of the hospital.
“It freaked her out,” she said. “She works somewhere closer to her house now.”
It is 7 p.m. on Monday, March 12. Most people are preparing supper or getting their kids cleaned up for bed. The nurses at Mercy, however, are preparing for a shift change.
It is hard to identify who is leaving for the day and who is just clocking in as both groups look exhausted.
Erin Geller rubs her eyes and yawns. “I forgot to wash my scrubs last night,” she says. “So, this is last night’s blood.” Her black scrubs have the faintest trace of a stain near her shoe which is also coated with hospital sludge.
“This is from last week’s anal fistula,” she said, pointing to her heel. I ask her what that is. She laughs. “You don’t want to know.”
Erin Geller, “charting” for her hospital floor. This involves writing reports and details of the evening’s activities.
Erin is taking a shift report from another nurse. I pretend I’m not paying attention. “Good luck,” the day nurse says to Erin. “He’s been ringing the call button all night.” She rolls her eyes. “Addict.”
She hands over paperwork for Erin to file. “I just gave him morphine so that should shut him up for a bit.” Erin looks relieved.
“A pushy drug addict is the last person you want to deal with at the beginning of your shift,” she tells me. “They can ruin your whole night.”
Mercy Hospital Northwest Arkansas is a Catholic-based, not-for-profit hospital in Rogers, Arkansas. This hospital was recently ranked within the top 100 hospitals by IBM Research, a huge honor considering there are over 6,000 hospitals in the United States.
Mercy provides healthcare to full-time employees and offers two individual counseling sessions a year. Modern Healthcare Magazine rated Mercy within the “top 100 places to work” due to their healthcare benefits and generous PTO. This time off is essential for nurses, according to an article by Minority Nurse.
Vacation and mental health days are essential for any career, but they are especially important for nurses. According to the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Objective, nurses are twice as likely as the general public to experience symptoms of depression. These symptoms can be exacerbated by fatigue and anxiety, especially when nurses are under significant pressure at work.
Nurses at Mercy manage a 10+ patient workload, meaning they are in charge of distributing medication, running tests and checking on over ten patients at least once every two hours. A particularly tricky patient, like the addict Geller inherited from the day shift, can consume their entire shift.
To combat this issue, Mercy hospitals employ nurses’ aides and assistants to help run the floor.
“Noah’s my aide tonight,” Geller tells me. “Love the kid, but he’s like a bad luck charm. Whenever I work with him there’s always some lady on laxatives that doesn’t want to be cleaned up by a guy.” I ask her how often she runs into that problem. “Nightly,” she laughs.
“Some nurses have never seen an anal fistula. I’ve been here less than a year and I’ve had three. All with Noah.”
Geller and joins Noah Hinchcliffe to make their rounds, introducing themselves to their patients and running vital signs.
Noah Hinchcliffe, demonstrating how he uses a thermometer to take temperatures. At only 19, Hinchcliffe is a nurse’s aide, taking classes to become a registered nurse.
I can’t participate in this, so I hover by the nurse’s station as the day nurses finish up. I direct my attention to Andi Cullwell, a blonde nurse adding cream to a giant cup of coffee.
“This is my fourth night in a row,” she tells me with an eye roll. “I think I’m still asleep.” Cullwell just turned 30 and she’s been a nurse for two years. She has two kids at home, ages five and three.
“They’re more exhausting than work,” she laughed. “Crazy bastards.”
After finishing their rounds, Geller and Hinchcliffe come back to the nursing station to fill in Cullwell on the weekend’s activities. The three of them have coordinated their schedules so they can have the same weekends off, but Cullwell chose to spend time with her kids this weekend.
“They needed a break from grandpa,” she says to me. Cullwell’s dad lives on social security and babysits for her while she sleeps during the day. “He’s much cheaper than daycare,” she tells me.
Cullwell is very candid about what it’s like to raise kids on a nursing schedule. “I feel bad because I’m always tired when they’re awake. It’s hard to tolerate all their questions and weird stories.”
She said that last week her oldest told her he believes more in aliens than in God. “That’s just not a conversation I have the energy for,” she laughs. “I’ll let my dad deal with that one.”
The night-shift nursing staff on the sixth floor of Mercy Hospital Northwest Arkansas (Hinchcliffe and Cullwell are in the back row on the far left). Not everyone is pictured.
Hinchcliffe has more energy than both the girls combined. He’s 19-years-old and taking nurses classes at NWACC to be an RN (registered nurse).
Right now he’s a nurse’s aide, which mean he does all the nurse’s dirty work, changing bed pans and bathing patients. “It’s fun because I work with Erin and Andi,” he gushes. “Last week Erin brought me Chick Fil A.”
Hinchcliffe says that he likes working nights because it’s easier. “The patients are asleep so they can’t complain as much,” he said. “And there aren’t any families or doctors, so it’s calmer than days.”
The calm atmosphere of night shifts can contribute lackadaisical or improper nursing practices. Ann E. Rogers, an associate professor of Pennsylvania School of Nursing and the Center for Sleep and Respiratory Neurobiology, said that nurses who have not obtained adequate amounts of sleep put their patients in significant danger.
She reports that accidents at the hospital are more likely to occur on a night shift, and the risk goes up significantly if the nurse is working consecutive nights.
By the fourth night shift, an average nurse is 36 percent more likely to make a mistake.
I asked Geller if she’s ever taken one of the counseling sessions offered by the hospital. Mental health days, when combined with counseling, can be essential to improving work conditions and sleep patterns. She says she has not utilized the company’s free counseling services or mental health days.
“I’m just busy,” she shrugged.
Geller is the newest of the three and seems to be having the hardest time adjusting her sleeping schedule. I asked if she planned on working nights for a while. “Absolutely not,” she answered without hesitation. “I’m asking for days as soon as I move.”
I told the trio about Shift Work Disorder, the mood disorder associated with working at night. Long-term sleep deprivation and abnormal circadian rhythms can contribute to depression and anxiety, worsening any pre-existing health issues.
“Well that’s great,” Geller laughs. “No wonder I’m so depressed.”
When I first read about Shift Work Disorder, she immediately came into my mind. Geller had suffered with severe anxiety during nursing school and was prone to seasonal depression, even when she was getting regular sleep. I wanted to see how her hospital schedule contributed to her already existing mental health conditions.
Many people who work at night complain that they miss out on spending time with their families and friends outside of work. Geller agrees with this. “It’s hard because all I want to do during the day is sleep. And when I’m at work, I just want to go home and sleep.”
Working at night makes you more likely to experience long-term sleep deprivation as the light exposure suppresses melatonin that is normally secreted at night, when other people are asleep. Additionally, people who work at night have unusual circadian rhythms, contributing to depression and “sleep debt,” over time.
When I asked if she ever experienced depression from her schedule, she replied, “This was my first winter working night shifts. I’m not doing that shit again. Ever.”
This Christmas, Geller didn’t have time to go home and see her family in Dallas. “I know I don’t want to do Christmas alone again,” Geller said.”
Because she just started at Mercy, she works the shifts no one else wants. That means working on Thanksgiving, Christmas Eve and New Year’s. She laughs, “I even worked on St. Patrick’s Day.”
A variety of solutions to Shift Work Disorder have been proposed, including designated nap times and brighter lights. Rogers recommends both of these concepts, and also believes stimulants like caffeine and exercise can help keep nurses on their toes.
Illinois nurses rallied together in March 2019 to introduce the Safe Patient Limits Act (House Bill 2604), a bill that would require limits on how many patients each nurse can treat in a shift. Currently, there is no federally designated limit.
Many nurses who leave the profession report they were overworked and exhausted, with over 15.6 of nurses reporting they feel, “burnt out.” Doctors Cynthia King and Leigh Ann Bradley believe hospitals are, “asking nurses to do more with fewer resources.”
Feelings of anxiety and stress are typically accompanied with the profession as nurses are expected to be alert at all times, expecting the unexpected.
By the end of our interview, Geller said she is “totally over,” the night shift. “You get paid more to work at night, but I don’t care about that anymore. My mental health is worth so much more.”
Her friend, Nicole Melson, transferred to a Mercy clinic last week because she didn’t like the hospital’s grueling schedule. I asked her if she’d consider doing the same. “I mean, I like working at the hospital,” Geller said. “It’s fast and I learn a lot. But it is hard. It’s really hard.”
I reached out to Melson and asked why she transferred to the clinic. “I just thought you had to work at a hospital right out of school. I hated it. I didn’t know any of the doctors and I never got any weekends off,”
I asked if she liked her new schedule. “I also thought I’d hate working a nine to five, but I love it. I’m just getting my sleeping schedule back.”