Sleep Deprivation and the Potential Impact on Nursing Students Practice and Health

Nursing students are an important part of the overall healthcare team.   In addition to the didactic aspect of nursing student education, students also complete required clinical experiences in a variety of healthcare organizations. Today’s nursing students are often engaged in full or part time employment, sometimes working 12-hour shifts (Robinson, 2011). Obtaining nursing clinical sites has become more difficult due to increased competition because Schools of Nursing are jockeying for the same sites which leads to decreased clinical day availability.  This problem has often led faculty to place students in the clinical site for 12-hour experiences thus reducing the number of clinical days in the organization.  An additional rationale for 12-hour clinical experiences is that 12-hour clinical experiences better prepares the students for the real impact of the work environment.  However, there is a concern that 12-hour work commitments and 12-hour school clinical experiences may lead to safety issues, increased errors, sleep dysfunction, and acute and chronic health issues for students.  

Additionally, there is concern that student sleep dysfunction may lead to increased automobile accidents and work related error rates when working 12-hour shifts (Eanes, 2015). Some research has indicated that sleep deprivation resulting from poor habits, stress, increased work and clinical experience commitments could lead to safety concerns for students and patients (Abdalkader & Hayajneh, 2008; Eanes, 2015; Kurebayashi, Miyuki, & Paes da Silva, 2012). The results of sleep deprivation may also contribute to a decline in student course performance, early burnout, acute and chronic health issues, and substance abuse (Eanes, 2015). 

There were 328 undergraduate nursing students invited to participate in the study.  One hundred eighty-two students responded and 179 students completed the study, resulting in a 54% response rate.  Demographically, (n=157) were 19-24 years old, (n=169) females and (n=163) were single.  There were 21 (4-point Likert type) questions, including demographic, personal sleep habits, motor vehicle use after working and program clinical experiences, student spare time activities, and work safety and program clinical experiences. An online Qualtrics survey method was used to distribute the study questionnaire.

The results of the study found that (n=120) participants needed 7-8 hours of sleep daily to feel rested, and (n=35) needed 8 or more hours of sleep to feel rested for a total of (87%).  However, (n=107) students were actually receiving 5-6 hours of sleep daily and (n=35) slept 7-8 hours daily.   Sixty-two percent of the students reported 6 hours of sleep or less prior to attending class and 83% received 6 hours or less sleep prior to a nursing clinical experience. Ninety-eight percent of the student participants believed they would perform better academically of they had more sleep. To combat sleep 85% admitted to consuming caffeine, and 31% took sleeping pills to fall asleep, while 20% took stimulants to stay awake.  Bootzin and Stevens’ (2005) study indicated that 90% of college age people entering drug rehabilitation programs admitted to self-medicating to stay awake and then to obtain sleep. The majority of students were awake 18-19 hours per day.

Participants reported employment of 8-12 hour shifts, and 12-hour nursing clinical experiences, while often combining employment and clinical consecutive days of 12 of more. Student participants (99%) believed they could provide safe care and were safe to work and practice in a clinical setting when obtaining very little sleep.  Eighty-five percent of student participants believed that work and school clinical experiences of 12 hours or more did not impact safety. Schools of nursing may need to develop policies and promote strategies that encourage adequate sleep.  There is a lack of research on the impact of nursing student’s performance and safety when working 12-hour shifts during employment and required program clinical experiences.  Study results may help nurse leaders to teach and inform nursing students about the negative consequences of sleep deprivation possibly leading to sleep dysfunction.  Nursing leaders have a responsibility to cultivate strategies in order to help students improve sleep and improve personal and patient safety.

References

Abdalkader, R. H.,  & Hayajneh, F. A. (2008). Effects of night shift on nurses working

in intensive care units at Jordan University Hospital.  European Journal of Scientific Research, 23(1), 70-86.

Bootzin, R. & Stevens, S. (2005). Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clinical Psychology Review, 25, 629-44.

Eanes, L. (2015).  The potential effects of sleep loss on a nurse’s health.  American

 Journal of Nursing, 115(4): 34-40.

Kurebayashi, L. Miyuki, do Prado,. & Paes da Silva, M. (2012). Correlations between

stress and anxiety levels in nursing students.  Journal of Nursing Education and Practice, 2(3): 128-134.

Robinson, M. (2011). Supportive attitudes and working nursing students.  Oklahoma

 Nurse, 56 (1): 21.