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Study: 12-hour night shift can affect a nurse’s performance


Working a 12-hour night shift affects a nurse’s performance more than working a 12-hour day shift does, according to a recent study by Marian Wilson, Ph.D., an assistant professor at the WSU College of Nursing.

Most hospitals in the United States operate on 12-hour nursing shifts now, because they’re easier for administrators to manage and nurses like them, research has shown.

But Wilson’s study, which will appear in the journal “Accident Analysis and Prevention,” shows declines in alertness and performance during a 12-hour night shift that could have implications for both patient and nurse safety.

Strategies to address the discrepancy between day-shift and night-shift performance could include sanctioned napping in the workplace, or a return to 8-hour shifts at night, the paper concludes.

Wilson’s co-investigators on the study were Hans Van Dongen, Ph.D., director of the Sleep and Performance Research Center at the WSU Elson S. Floyd College of Medicine, and Regan Permito, research assistant at the Sleep and Performance Research lab, plus registered nurses Ashley English, Sandra Albritton and Carlana Coogle, of Kootenai Health in Coeur d’Alene. Kootenai Health also supported the research with a grant and their staff donated time to assist with data collection.

The study tracked 22 nurses at Kootenai Health, 11 on the day shift and 11 on the night shift. The nurses took a brief test before, during, and after their shifts to measure behavioral alertness and sleepiness using validated tools. In addition, they wore activity trackers on their wrists to measure sleep duration and kept sleep diaries.

Dr. Marian Wilson
Dr. Marian Wilson

The dayshift nurses’ performance was relatively good and stable across their 12-hour shift. But the performance of nurses working the night shift gradually degraded as their shift wore on, the study found. Both groups slept about the same number of hours per day – 7.1 – and both had roughly the same workload.

“Because 12-hour shifts are becoming the popular norm for nurses, it is critical that organizations consider the potential risks to patients, particularly with regard to night shift employees,” the study concluded. The study also has implications for nurse safety, with nurses whose performance has declined driving home after a night shift, it said.

Added Wilson, “The bottom line – night shift nurses are fighting their natural biological drive for sleep and need more help in maintaining performance and alertness during 12-hour night shifts.”

“Performance and sleepiness in nurses working 12-h day shifts or night shifts in a community hospital” –  Accident Analysis and Prevention. Marian Wilson, Regan Permito, Ashley English, Sandra Albritton, Carlana Coogle, Hans P.A. Van Dongen.

Study: Can an online program help reduce opioid use by patients with chronic pain?

Dr. Marian Wilson

Dr. Marian Wilson

Marian Wilson, an assistant professor at the WSU College of Nursing, is joining a team of scientists who’ll lead a federally funded, $2.5 million study investigating whether an online pain management program can help patients with chronic pain reduce or eliminate the amount of prescription opioids they take.

Wilson, Ph.D., M.P.H., is a co-investigator on the EMPOWER study with lead investigator Theresa Winhusen, Ph.D., director of the Addiction Sciences Division in the University of Cincinnati College of Medicine. The five-year study will involve 400 non-cancer patients who are being treated for chronic pain with long-term opioid therapy at University of Cincinnati Health and Duke Health.

A web-based pain management tool, called Goalistics Chronic Pain Management Program, has been found in small previous trials to decrease patients’ pain and reduce opioid use. The EMPOWER study will expand the sample size and researchers will have access to patients’ clinical records to accurately measure opioid use.

Goalistics teaches relaxation exercises and psychological approaches to managing pain, and encourages goal-setting and physical activity – the kind of comprehensive, holistic pain-management care patients might get through a multidisciplinary pain clinic in an urban area. Wilson, who has used Goalistics in previous research, said many patients with chronic pain don’t have access to that level of care, and instead are treated by primary care providers who have had little training in pain management.

The EMPOWER study hopes to give primary care providers another tool to use in helping patients manage chronic pain, while also responding to soaring opioid addiction rates and overdose deaths. The Centers for Disease Control and Prevention has recommended decreasing the use of opioids for treating pain.

“It’s a really difficult situation telling people, ‘Sorry, you can’t have your opioids but we’re not really giving you an alternative,’” Wilson said. An online pain management program could be “a lifeline extended to patients, another tool to help manage pain. It’s something that can give them some hope and show that people understand what they’re going through.”

The research is being funded by the National Institute on Drug Abuse, part of the National Institutes of Health (NIH). Wilson said she’ll function as the study’s pain and online-program expert, while Winhusen, the lead investigator, will oversee the clinical trial.

The study is the third announced in recent weeks involving WSU College of Nursing faculty receiving significant funding from federal agencies:

  • Assistant Professor Roschelle “Shelly” Fritz, of the College of Nursing in Vancouver, is one of three WSU scientists who landed a $1.77 million grant from NIH to research how “smart home” technology can help monitor the health and safety of senior citizens.
  • Associate Professor Janet Purath received a $1.3 million grant from the Health Resources & Services Administration to address a critical shortage of primary-care providers across Eastern Washington through nurse-practitioner training.

Both NIH awards are Research Project Grants (R01), the original grant mechanism used by the agency. R01 and R01-equivalent grants are highly competitive: NIH says that in 2016, for example, just 20 percent of such grant applications were funded, and the average size of the award was about $458,000.

Dr. Celestina Barbosa-Leiker, the College of Nursing’s interim associate dean for research, praised faculty for their success in bringing research dollars to the College of Nursing. “We’re seeing more of the College of Nursing faculty who were successful a couple years ago getting seed grants now writing larger and larger grants,” she said. She also called called the EMPOWER research “a critical study” because of the issue of opioid addiction in the country.

Wilson credited colleagues with valuable help on her work in addiction science, including Drs. John Roll and Matt Layton of the WSU Elson S. Floyd College of Medicine; Barbosa-Leiker; College of Nursing doctoral students Mary Lee Roberts and Teresa Bigand, and Dr. Michele Shaw, associate professor at the College of Nursing.

Said Wilson, “I think we were fortunate that we had the right topic for the times. The nation is focused on the pain and opioid addiction issue.”

News release: College of Nursing faculty part of group landing $1.8 million for “smart home” research

SPOKANE, Wash. – An interprofessional team of scientists from Washington State University has landed a $1.77 million grant to research how “smart home” technology can monitor the health and safety of senior citizens from afar.

The National Institute of Nursing Research, one of the organizations that makes up the National Institutes of Health, awarded the grant to:

Fritz - Cook - Schmitter-Edgecombe l-r
Fritz, Cook, Schmitter-Edgecombe, l-r

— Roschelle “Shelly” Fritz, assistant professor in the College of Nursing in Vancouver;

— Diane Cook, the Huie-Rogers chair professor in the School of Electrical Engineering & Computer Science;

— Maureen Schmitter-Edgecombe, the Herbert L. Eastlick professor in the Department of Psychology

Bringing technology together

The scientists are looking to bring together the analytics produced by smart-home sensors and health monitoring and assessment technology, with the judgment and experience of health-care clinicians for automated health assessment. They will design and pilot test smart-home technology to automatically identify health events for adults with chronic conditions in their own homes.

As sensors record information, a health-care professional will identify data that’s relevant to a person’s health and safety, then engineers will create computer algorithms to recognize meaningful behavioral patterns. For example, a sensor might detect motion in a person’s kitchen around the same time each night as the subject gets a glass of water before bed; the clinician would flag that pattern as important and the engineer would create an algorithm to trigger an automatic alert to caregivers in the absence of that motion.

Living longer at home

The research has the potential to provide dramatic benefits. By extending the ability of older adults to age in place through real-time assessment and intervention, these technologies can extend the functional independence of our aging society, reduce caregiver burden and improve quality of life.

The “clinician-in-the-loop” research project builds on the work of Cook and Schmitter-Edgecombe in developing a health-assistive smart home that uses intelligent algorithms capable of detecting and labeling with over 98 percent accuracy more than 40 normal activities of daily living and behavior patterns for older adults.

The research also builds on Fritz’s innovative pilot work conducted at Touchmark on South Hill,, a retirement community in Spokane, Wash. There, she has deployed five health-assistive smart homes, with support from the Touchmark Foundation. Fritz is evaluating the clinical relevance of raw sensor data, so the intelligent algorithms can be trained to detect health changes in older adults with multiple chronic conditions. Research under the new grant will again be conducted at Touchmark on South Hill.

The five-year grant started on Aug. 1. It includes funding for a nursing Ph.D. student to work as a research assistant with a nine-month tuition waiver and stipend. Interested students can email Fritz for an application at

WSU researchers recently presented at nursing conference in Dublin

Nightime shot of a bridge over the River Liffey in Dublin.
Nightime shot of a bridge over the River Liffey in Dublin.
The River Liffey near the Convention Centre Dublin in Ireland. Photo by Connie Nguyen-Truong.

WSU College of Nursing faculty and a doctoral student recently presented their research at the International Nursing Research Congress in Dublin, Ireland.

The 28th annual event was sponsored by Sigma Theta Tau International, the Honor Society of Nursing, and drew nearly 1,400 nurse researchers, students, clinicians and leaders.

The presentations of work by WSU College of Nursing faculty and student were:

Research Session: Transitions in the Care of the Older Adult
“Participatory Approach to Build Capacity: Nurse-led Research to Overcome Insufficient Mobility in Hospitalized Older Adults” by Clinical Assistant Professor Dr. Gordana Dermody and Instructor Dr. Ruth A. Bryant

Research Session: Patient Education in Oncology Patients
“Feasibility of a Breast Health Education Intervention for Vietnamese-American Immigrant Women,” by Assistant Professor at WSU Vancouver Dr. Connie Kim Yen Nguyen-Truong and others.

Dr. Connie Nguyen-Truong standing in front of a Welcome to Dublin sign at the International Nursing Research Conference
Dr. Connie Nguyen-Truong, Assistant Professor in the WSU College of Nursing in Vancouver, presented research at the International Nursing Research Congress in Dublin in July.


Research Session: Smoking Cessation Interventions
“Tribal College Students’ Access to and Use of Mobile Communication and Technology for Health Information,” by Assistant Professor and Pre-licensure Program Director Dr. Jo Ann Walsh Dotson and and Assistant Professor IREACH Dr. Lonnie A. Nelson

Poster Presentation
“Professional Identity in the Lived Experience of Hospital Nurses,” by PhD candidate and Graduate Teaching Assistant Tullamora T. Diede

Sigma Theta Tau International is a nonprofit whose mission is advancing population health and promoting the nursing profession. The honor society has more than 135,000 active members in more than 90 countries.
Dr. Nguyen-Truong said researchers who attended the International Nursing Research Congress made valuable connections for possible collaborations in research, and that personally, she forged stronger ties with her colleagues from the College of Nursing in Spokane.

WSU College of Nursing faculty present at major gerontology conference

Portrait of Dr. Roschelle "Shelly" Fritz gesturing to a wall-mounted sensor

The work of several WSU College of Nursing faculty was presented at a major gerontology conference in San Francisco this week.

Dr. Roschelle “Shelly” Fritz, an assistant professor at the WSU College of Nursing in Vancouver, Wash., co-chaired a symposium with Dr. Cory Bolkan, an associate professor in the College of Agricultural, Human, and Natural Resources Sciences (CAHNRS), also in Vancouver. They presented at IAGG World Congress of Gerontology & Geriatrics, a conference that drew more than 6,000 attendees.

Portrait of Dr. Roschelle "Shelly" Fritz gesturing to a wall-mounted sensor
Dr. Roschelle “Shelly” Fritz displays one of the sensors being used in a research project to monitor senior citizens’ health and safety from afar, installed at Touchmark on South Hill in Spokane.

Their symposium, “Gerontology Across the Continuum: From Independent to Assisted Living,” included a presentation on Fritz’s research into health-assistive smart homes; Bolkan’s research into technology to support aging in place, with College of Nursing Executive Assistant Dean Renee Hoeksel as a co-investigator; and a presentation on provider knowledge of assistive technologies, with Associate Professor Catherine Van Son of the College of Nursing as the lead researcher.

There were about 20 symposiums including about 100 presentations being held concurrently every two hours, but Fritz and Bolkan’s session drew the attention of the official conference Twitter feed. One tweet, for example: “Nurses are often the go between with smart technology and the person. These health prof need to be knowledgeable & adaptable.”

Fritz, who is investigating whether smart-home technology can enhance the health and safety of senior citizens from afar, said via Twitter as she was leaving the conference:

“Main takeaway from #IAGG2017 – my older adult years will be full of cool tech! Hope to be independent forever #gerontechnology.”

CBTSim certified by international police training organization

Portrait of Lois James in front of her CBTSim simulator
Portrait of Dr. Lois James, the researcher who developed CBTSim
Dr. Lois James of the WSU College of Nursing

A simulator developed by a WSU College of Nursing researcher to help police officers recognize their biases has been certified by an international law enforcement training organization.

It’s only the second “implicit bias training” class to receive the Seal of Excellence from the International Association of Directors of Law Enforcement Standards and Training (IADLEST). The association sets standards for police training programs to ensure consistency across the country.

CBTSim, or Counter Bias Training Simulation, was developed by Dr. Lois James, an Assistant Professor at the WSU College of Nursing. Her co-investigator is Dr. Stephen James, Assistant Research Professor at the Elson S. Floyd College of Medicine at WSU.

CBTSim is a portable unit that uses full-sized video screens to present police officers with realistic scenarios where they’re required to make deadly-force decisions. The scenarios are based on 30 years of data, and “may elicit a response from the student based on their inherent biases and not from an actual threat presented,” noted the evaluators who awarded the Seal of Excellence to CBTSim. The simulation is followed by discussion and debriefing among the trainer and the participants.

“Receiving the IADLEST National Certification Program™ seal of excellence is a significant achievement for CBTsim,” Dr. Lois James said. “Requirements for certification are a firm grounding in scientific evidence on the training topic, as well as a rigorous plan for evaluating trainee progress. For an implicit bias training class to be stamped with this seal of approval is rare, and I hope will speak to the value of CBTsim for police departments nationwide.”

With the certification from the national training organization, CBTSim will be listed on a roster of approved training programs for police and sheriff’s departments across the country.

James developed CBTSim with support from the WSU College of Nursing and a grant from the university’s Office of Commercialization. She is currently marketing the training to law enforcement agencies nationwide.

Lois James, WSU Spokane College of Nursing, 509-324-7442, cell 509-385-9386,

Federal grant will help WSU-trained nurse practitioners address primary care shortage

Portrait of a nurse practitioner using a stethoscope on a patient.

A new federal grant received by the WSU College of Nursing will help train nurse practitioners to address a critical shortage of primary-care providers in rural areas across Eastern Washington.

Called WSU-ANEW, the two-year, $1.3 million grant from the Health Resources & Services Administration promotes nurse practitioner education in several ways. Dr. Janet Purath, project director and an Associate Professor at the WSU College of Nursing, noted in her grant application that 19 of 20 Eastern Washington counties are considered primary care shortage areas, and 18 of 20 counties are designated rural.

WSU-ANEW creates a formal partnership between the WSU College of Nursing and CHAS Health, the Community Health Association of Spokane. That partnership includes a joint appointment of a Nurse Practitioner Faculty in Residence, who will use the real-world clinical and organizational challenges faced by CHAS providers to help enhance curriculum at the College of Nursing.

The WSU College of Nursing’s clinical doctorate, the Doctor of Nursing Practice, qualifies students to take a national exam to become licensed as an Advanced Practice Registered Nurse (APRN) with specialization as a Family Nurse Practitioner or as a Psychiatric Mental Health Nurse Practitioner. The degree is offered on WSU campuses in Spokane, the Tri-Cities and Vancouver. CHAS is a nonprofit that provides medical, dental, pharmacy and behavioral health services to patients regardless of their ability to pay.

Portrait of a nurse practitioner using a stethoscope on a patient.
In many states, nurse practitioners can operate independent practices including the ability to diagnose and treat illness, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications.

In addition, the WSU-ANEW project will provide traineeships to 15 to 30 nurse practitioner students at the WSU College of Nursing. Eligible students will receive tuition reimbursement and stipends if they agree to be trained primarily in rural health clinics or clinics providing care to underserved populations. The grant project also will create a marketing program to connect nurse practitioner graduates to jobs in primary care in rural and underserved areas.

Said Dr. Purath, “We know from educational research that students trained in clinics that provide care to underserved people are more likely to practice in those clinics after graduation,” and this project supports that notion.

Many states, including Washington, Oregon and Idaho, allow nurse practitioners to operate independent practices with the ability to diagnose and treat illness, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications.

Anita Hunter’s passion to help others took her around the world

A sign for Holy Innocents Children's Hospital in Mbarara, Uganda
Dr. Anita Hunter feeds a giraffe at an animal sanctuary in Uganda, Africa.
Dr. Anita Hunter with a giraffe at an animal sanctuary in Uganda.

By Addy Hatch

Anita Hunter has traveled the globe, but the pediatric nurse practitioner, professor and academic leader didn’t hit the tourist spots. Instead, she chose destinations where people were suffering and she believed she could help: Ghana, Belfast, Tijuana, Uganda.

But that traveling is over for WSU College of Nursing’s Associate Dean for Academic Affairs and Accreditation. Hunter, PhD, MSN, RN, FAAN, said a recent trip to Uganda was her last.

“After 22 years I’ve got to call a stop,” said the 71-year-old. “I can’t physically sustain the stress of those trips.” Getting to Mbarara, Uganda, for example, takes 24 to 36 hours each way, including multiple flights and a 6-hour drive once she lands in the East African country.

She made the decision that her recent trip to Uganda would be her last several days before she left the country. “It was a very emotional time,” Hunter said. Bringing health care and improved public health to communities internationally “has been a passion of mine for a very long time.”  » More …

Community fitness program helped overweight teens in Coeur d’Alene

Image of two feet in running shoes.

Image of two feet in running shoes.

By Addy Hatch, College of Nursing

Five years ago, researchers in Coeur d’Alene, Idaho, wanted to test whether overweight teenagers would be receptive to a community-based fitness program that included exercise, goal-setting, and nutrition coaching.

As it turned out, finding 20 overweight teens who wanted to take part “was the easiest recruitment I ever had for a study,” said Dr. Marian Wilson, an assistant professor at the WSU College of Nursing. “We had kids lining up to get their BMI measured.”

And it worked – at the end of the 12-week study, the teens showed improvement in blood pressure, they could do more push-ups and sit-ups, they could walk faster on a treadmill, their “screen time” was down and they expressed greater confidence. The results of the study have just been published in the Journal of Pediatric Health Care.

Shawn Burke brought the idea for the community-based fitness program to Wilson when she was clinical research coordinator at Kootenai Health in Coeur d’Alene. Burke worked as a personal trainer and saw a need, he said.  » More …

Recent PhD grad Ruth Bryant recognized for research on pressure ulcers

A portrait of Ruth Bryant in her commencement robes.
A portrait of Ruth Bryant in her commencement robes.
Ruth Bryant at WSU College of Nursing commencement, May 5, 2017.


Ruth Bryant, who received her PhD from the WSU College of Nursing earlier this month, is the first person to receive a new award from the Western Institute of Nursing Gerontological Special Interest Group.

Bryant was recognized for Best Student Presentation at the recent WIN conference in Denver for her research abstract, “Comorbid Conditions Associated with Adverse Outcomes in Patients with Pressure Ulcers.”

“Getting an award at WIN was really a surprise,” Bryant said recently.

The longtime nurse has devoted much of her career to wound healing and wound care, co-founding an accredited online program for nurses seeking advanced certification in wound, ostomy and continence care.

She wanted to pursue her doctorate and chose WSU College of Nursing because of its hybrid model, combining four weeks of in-person course work with online and distance-learning.   » More …