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Lois James, PhD, assistant professor at the WSU College of Nursing

A researcher at the Washington State University College of Nursing will lead a $1 million, federally-funded study on nurses’ work shifts that could influence policy nationally.

Lois James, PhD, and a team from the College of Nursing, the Elson S. Floyd College of Medicine, and the WSU Sleep and Performance Research Center plan to pursue three lines of inquiry in the study:

  1. Whether working consecutive 12-hour shifts impairs patient-care skills or increases fatigue and sleepiness among nurses;
  2. Whether nurses working consecutive 12-hour night shifts are more impaired by fatigue than nurses working day shifts;
  3. And whether working 12-hour night shifts puts nurses at greater risk during their drive home than working the same length day shift.

“Although evidence exists that shift work is dangerous for patients and nurses, very little is known about optimal shift scheduling,” James wrote in her funding proposal to the Agency for Healthcare Research and Quality. “Given that doctors have had regulations on work hours since 1987 it is unacceptable that nurses still do not have set policies protecting them against safety risks and protecting their patients against preventable medical errors.”

The study will involve 50 nurses working day shift and 50 nurses working night shift, all at Providence Sacred Heart Medical Center in Spokane. Participants will report to the WSU Health Sciences campus for testing immediately following three consecutive, 12-hour day or night shifts. They’ll also be tested following three consecutive days off.

Scientists will use various methods to test reaction times and cognitive capacity, and outfit the subjects with wrist-worn sensors to monitor sleep cycles. They’ll be tested in the College of Nursing’s Simulation Laboratory to see how well they perform a range of nursing skills like inserting an IV or monitoring vital signs. They’ll be asked to mentally calculate medication dosages. And finally, they’ll use simulators in the WSU Sleep and Performance Research Center to test their driving skills.

The research could lead to national regulations on nurses’ work hours, James said. “Should we find that shift-accumulated fatigue and 12-hour night shifts are detrimental to nurses’ ability to care for their patients and drive home safely, then we will provide ammunition against consecutive 12-hour shifts,” she wrote in the research proposal. “Should, however, we find no differences between work and rest conditions, or day versus night shifts, then we will provide equally valuable information supporting what has become a very popular shift schedule.”

Most hospitals in the United States operate on 12-hour nursing shifts because they’re easier for administrators to manage and nurses like them, research has shown. But a small study conducted by WSU researchers at Kootenai Health in Coeur d’Alene showed that working a 12-hour night shift affects a nurse’s performance more than working a 12-hour day shift does.

Marian Wilson, PhD, an assistant professor in the College of Nursing, worked on the previous study and is co-investigator on the new research in Spokane. Other co-investigators are Kevin Stevens, MSN, director of the College of Nursing’s Center for Clinical Performance and Simulation, Stephen James, PhD, assistant research professor in the WSU Elson S. Floyd College of Medicine, and Patricia Butterfield, PhD, professor and associate dean of research at the College of Medicine.

The three-year study will begin this year. Participants will be paid to take part, and those who report to WSU for testing after working consecutive night shifts will be given transportation home.

Reviewers at the Agency for Healthcare Research and Quality said in awarding the research grant that the study will provide objective evidence of the impact of shift-work-related fatigue. “This will result in concrete recommendations regarding safe shift-scheduling for day and nightshift nurses – information that may help keep nurses safe, reduce preventable medical errors, and improve patient care.”