By Gary Evans, Medical Writer

There is a general consensus that healthcare workers on 12-hour night shifts may struggle with fatigue, even to the point of being at risk of an accident on their way home. In that sense, sleep deprivation goes beyond the risk of personal injury or patient errors.

“It’s a public health problem,” says Marian Wilson, PhD, of the Sleep and Performance Research Center at Washington State University in Pullman.

But the solution is complicated, as a study by Wilson and colleagues found that simply establishing a fatigue mitigation policy may not solve the problem if the work culture does not support breaks and napping.

The researchers assessed sleep quality, sleepiness, and use of workplace break opportunities in 1,285 healthcare workers via an online questionnaire. Two hospitals were surveyed, including one with a fatigue mitigation policy. Overall, 68.9% of respondents reported generally taking breaks of at least 30 minutes and 21.7% had access to a quiet place to rest.

“The presence of a fatigue mitigation policy was not associated with reduced sleepiness,” they concluded.1 “However, accounting for hospital and shift characteristics, employees with access to a quiet place to rest while on break had significantly lower self-reported sleepiness scores.”

Paradoxically, workers taking breaks of at least 30 minutes reported greater sleepiness than those not taking breaks — a finding that may be associated with “sleep inertia.”

“Part of the problem is we don’t know exactly what kind of a break you need to be both refreshed and safe,” Wilson says. “Another problem is that if you take a nap break on the night shift, initially when you wake up you can be a little groggy. You may suffer some greater performance deficits due to sleep inertia.”

In addition, tired healthcare workers may not take breaks if there are not adequate relief staff or clear support for the practice in the work culture.

“Even if you have this in policy, that may not be enough to change the culture or the behaviors of the staff,” she says. “This was a relatively new policy when we did the study. We believe, based on other information and research, that you would have better results if you also focused on the culture of nurses’ and healthcare employees’ willingness and ability to take breaks.”

Policies, rather than stating that there is “permission” to take a break, may need to be worded as “we expect you to,” she says.

“The culture needs to be changed just as it has in the trucking industry and with airline pilots,” Wilson says. “We recognize that performance fails when you are too fatigued. It is not normal to the human body to be working night shifts. Biology is against staying awake all night.”

With 12-hour shifts increasingly common, Wilson reminds that performance deficits tend to occur at about the six-hour mark.

Beyond the work culture issues, there is little standardization of what type of rest space is needed to provide relief.

“One question we want to explore in future research is what these break rooms really look like,” she says. “In many hospitals there is a lot of variation in those rooms depending on what unit you are working on. What should be the standard for a rest break room? What should facilities offer, and what should they look like?”


1. Wilson M, Riedy SM., Himmel M, et al. Sleep quality, sleepiness and the influence of workplace breaks: A cross-sectional survey of health-care workers in two US hospitals. Chronobiology International 2018: