Healthcare workers who work long hours and night shifts can be prone to sleep deprivation that endangers themselves and their patients, the National Institute for Occupational Safety and Health (NIOSH) reports.

To address this issue, NIOSH makes available a free online training program that can be used to educate nurses and other healthcare workers. The training takes about 3.5 hours to complete and covers the risks of sleep deprivation, providing strategies for nurses and managers, says Claire C. Caruso, PhD, RN, FAAN, a research health scientist at NIOSH.

“It is comprehensive and covers the issues associated with shift work, long work hours, and sleep,” she says. “It talks about individual differences in people’s ability to cope with these demands. It covers the theory of why this occurs in terms of sleep physiology, so people can understand why they are having these problems.”

The NIOSH training explains circadian rhythms, the internal body clock that prompts sleep and awakening. The day/night cycle of the sun is the strongest cue, meaning night shift workers are fighting against their own biologic forces to stay awake on the job.

Some hospitals are creating nap rooms to help restore exhausted workers, but they must be aware and plan for “a period of grogginess” as staff awake and prepare to return to work, she says.

“Some hospitals don’t allow people to sleep on the job,” Caruso says. “But as managers become more familiar with the usefulness of this, they may decide that it makes sense to allow short naps during the work shift.”

Indeed, some hospitals have embraced the concept, setting up designated quiet rooms for workers to relax and nap.

“It can be like a meditation room,” she says. “Some facilities have sleep coaches for night shift workers, who are associated with the most risk of sleep problems.”

Make Sure Sleep Message Isn’t Lost

Sleep deprivation plans also can be implemented during emergency events and natural disasters, she adds.

“A new shift, for example, can’t come in because there is a snowstorm limiting the ability to drive,” Caruso says. “In those cases, naps can be really helpful to restore people so they can continue working for a few hours.”

The NIOSH training also includes a section on “drowsy driving,” as getting home safely after a long shift is an underappreciated risk for nurses and other staff. NIOSH cites studies and surveys that found that 10% of nurses say they have been in a traffic accident related to work fatigue.

Sleep deprivation may get lost in the many issues and occupational threats of healthcare work, but it is important to keep it on the radar.

“Periodic messages from management are important, underscoring that they respect staff need to be off from work so they can sleep and recharge,” Caruso says. “For example, during flu season it is really important to get enough sleep after you get the flu shot because [it boosts] antibody levels.”

Daylight Saving Time changes do not faze many people, but employee health should be aware that some workers have difficulty adjusting.

“New employee orientation is a good time to communicate these messages,” Caruso says. “Also, during vacation season, remind them that there is higher risk of drowsy driving because people tend to push themselves to drive longer to get to their destination.”

Address Sleep Disorders, ‘Healthy Sleep’

In addition to education, some healthcare programs are addressing sleep disorders in workers.

“Sleep disorders are pretty common, but they are often not treated and diagnosed,” she says. “Some have a system in place to help people who seem to be having more trouble on night shift or falling asleep on the job. Try to get the assessment done by a certified sleep clinic.”

In incident investigations, consider whether sleep deprivation could have played a role. For example, one study found that mandatory overtime for healthcare workers increased the risk for needlesticks and other work-related injuries, NIOSH notes.1

“The other thing [facilities] can do is set up an anonymous, no-blame self-reporting system for workers to report their near-misses and incidents,” Caruso says.

Other contributing factors to healthy sleep include making healthy, nutritious food available on all shifts to decrease consumption of vending machine snacks. Onsite laundry and childcare also can really help night shift workers, she says.

“Build a culture of safety that, for example, shares messages on sleep wellness at every meeting,” Caruso says. “There is a lot that can be done. Organizations that address this reap a lot of benefits in improving patient care, retention of nurses, and reduced stress and burnout.”

The NIOSH training is available at:


  1. de Castro AB, Fujishiro K, Rue T, Tagalog EA, et al. Associations between work schedule characteristics and occupational injury and illness. Int Nurs Rev 2010;57(2):188-194.