Nurse. Innovator. Author. Speaker. LinkedIn Top Voice, First Nurse Featured on Ted.com, Forbes Business Council, President Emeritus: SONSIEL, Chief Nursing Officer
Recently I ran a mini #hackathon with #CNOs to tackle their #nursing #workforce #challenges: We bucketed challenges into a few of their biggest turnover and staffing issues: 1. #Retention of #BSN prepared nurses at the bedside. (Acknowledging new 4 year BSN students do not stay at the bedside past 2 years) 2. Staffing of #Medsurg floor (Medsurg floors have an image and a manageable workload problem). 3. #NightShifts: Never enough nurses - and shifts wreak havoc on life and health of night shift employees. I could tell the apprehension of the group of CNOs when I told them we have 45 minutes to solve these problems. They laughed and chuckled - making jokes if they can solve these in 45 minutes they deserve raises for solving problems no one has been able to solve to date for nursing! I told them: “I know this seems impossible - but let’s try it… For success of hackathons it’s really important to establish the baseline clearly….which is: What we are doing today isn’t working - we all know it. So to keep coming at the problems with the same solutions - are not going to change the outcomes. So don’t do what you are doing; do something that could work”. I wish I could document and share with you all the things that happened as we kept pushing to go further towards the root of the problem - but I will share the night nurse: The real issue is for night shifts: People are exhausted on night shifts, they feel ill, don’t function well, their body wants sleep. The traditional idea of: pay more, different start times were floated - until I finally asked them: Why not let night nurses sleep? And boom - the conversation changed. They started sharing: “We allow residents to sleep. The military hospitals allow for “naps” for nurses. Why haven’t we done this? What would be the risks, benefits - potential rhythm and flow?” “This would cost no additional money and no additional tech or resources.” And the energy changed in the room. So what do you all think? Should we let nurses nap on night shifts? Would it help retain the workforce? #NursesOnLinkedIn #HealthcareOnLinkedIn #CNO #Nurses #Nursing #NursingWorkforce
Ulicana Brown
1mo
I was that new graduate RN, BSN 7p-7a nurse on the pulmonary step-down/medsurge unit. I made 3.00 more for working nights and 5.00 more when I worked weekends. I worked 2 years. We would have 8 patients on a good night but good nights didn’t happen often. When we were assigned to the step-down unit we would have 4 vent patients. Many of us new nurses didn’t like the step-down unit but for staffing purposes it was a better nurse:patient ratio and we were provided a respiratory therapist who helped with ADL care. The turnover of staff was probably the highest in the hospital. All of the nurses who started with me were gone within 6 months. That was in 1995. Sadly it hasn’t changed. Even though I don’t feel that sleep was one of the road blocks on the unit I worked, however, I do feel that all things identified should be considered! Patients and things on the nightshift are normally quiet around 1:30ish to maybe 4 am. The physicians were provided quarters to sleep so why not us?
Earlier this year, I completed a 3 year CNO and Hospital Executive role at a greenfield property in Southern China. Night shift naps are the normal shift practice in China. Staff coordinate med passes and treatments so that at least 1.5 hour naps are permitted for all nursing staff at night. While I initially resisted (my “Western” approach at work), our quality audits, unannounced shift rounds, and patient and family satisfaction were equal to or better than our international benchmarks. What actually is riskier…. A nurse bleary-eyed and dazed from lack of sleep, or one refreshed with a mid-shift nap while professional colleagues manned the floor?
I love the idea of allowing night Nurses to nap, at the same time many night Nurses don't have enough staffing coverage to get their meal break. In order to allow naps, we would have e to dig even further to determine appropriate staffing models to cover required breaks and naps. Lastly, it would probably look different based on the floor type, as some units need a nurse to physically replace them for breaks (operating room, labor and delivery, EP/cath labs, ER, PACU, etc.)
Allowing Nurses to have 𝑺𝘶𝘧𝘧𝘪𝘤𝘪𝘦𝘯𝘵 𝑹𝘦𝘴𝘵 – be that a nap or otherwise, is necessary for the Human Body and >>> Respectful. But, as many others have noted, Heidi E. Morin, >>> who cares for the other Nurse’s patients when on break? Often on night shift there is One Nurse for the entire unit of patients. Many, many times we have all worked 8/10/12 hour shifts without a break or sufficient break. Will “𝒂 𝑵𝒂𝒑” help with Nurse retention ??? Not so sure that one entity will “fix” all the issues facing Nurses. It is a concept that we need to add to the discussion that has led to: Nurse Burnout / Departure. Agree, Rebecca Love RN, we need to ask the question “𝒘𝒉𝒂𝒕 𝒊𝒇”? ___________ ~ Famey
Jennifer Rivera
1mo
I am cheering out loud for this idea. I’m my previous experience, the biggest break I got a night was to walk to get a coffee. Eat at my desk and muscle through. I always felt a little jealousy toward the residents. With the technology that I now work with, the nurse could be alerted to any critical events that pertain the their patients only, much like a resident and a pager.
Having worked night shift most of my nursing career before going into management, I understood the challenges of the graveyard shift. As a DON of over 17 years, our night shift employees were allowed to combine their night shift break and take a nap which equated to 30-45 minutes where the staff were able to cover each other and take turns including holding each other accountable with a designated area just made for napping and not anywhere else in the building. I never had issues with night shift call outs or falls when it comes to residents and a great team that worked together. Talk of Millenials, we had challenges when they worked full 8 hours shift, so they were allowed to buddy with each other and allow them. Once morning shift or rush hour with residents was over, they would take several mini breaks rotating and came up with special schedules such as 6am -2pm to allow day shift staff get to pick up their kids from the business not pay after care and allow night shift to leave one hour early to get their kids ready for school and avoid extra expenses and as for the 2pm-10pm shift the staff would pick up another shift if they had 2 jobs and make it on time hence not have staff either coming late or calling out.
Keisha M.
1mo
Rebecca Love RN, MSN, FIEL seems common sense is not so common any more. There is an alternative cure for everything but there is no cure for sleep but sleep. I cannot tell you how many times I have fallen asleep at the stop light after leaving work!! It happens fast and there is nothing you can do. Not being able to take your break (especially on night shift) is a crime and nothing to boast about. Even if its 15 minutes power nap they need it. Where is the care for the caregiver?
I’m a bit confused, we have an hour break on a typical 12.5 hour shift; many of us choose to nap then. It’s part of our regular break though, not a special time. Although unlike docs we have to sleep in chairs or on the floor. I usually bring a pillow from home.
Rebecca Love RN, MSN, FIEL was this the session in Orlando? Nice! I never napped on night shifts during my years in ICU. My entire schedule switched and I slept during the day. This might be something to consider for those covering a night shift that normally works days or a double shift. I can tell you I was tired when asked to stay late in the mornings though! I think it’s important to have the conversation for consistency, safety and overall awareness. 🤔I would look to current practices of residents, and workers in other industries who have a variation of this- like drivers.
Mother. Entrepreneur. Nurse. Humanitarian.
1moRebecca Love RN, MSN, FIEL I worked night shift in the ICU for several months and I worked night shift in a cardiac stepdown unit for almost a year. I was not allowed to nap at the cardiac stepdown unit but I did in the ICU. Naps were just something nurses did to take care of each other. Management didn’t get involved. Years later management said no one on nights was allowed to sleep nurses suffered. Patients didn’t suffer if a nurse napped because adequate coverage was available. When it was a busy night and many patients were unstable no one napped. Allowing naps at night is a no brainer, common sense solution. Perhaps we can mirror what scandanivan nurses who work night shift do…nap. CNO’s should look outside the US for solutions other countries have tried. If the central goal is to help nurses rest then all other issues such as staffing models, etc will be built around the central goal.