Shining a Light on the Challenges of Night Shift Nursing: A Mixed-Methods Study

BACKGROUND: Night shift work is known to disrupt circadian rhythms, leading to significant physical and mental health challenges, including fatigue, sleep deprivation, and long-term health risks. For nurses working the night shift, these factors compromise both their own well-being and patient safety. Addressing these challenges is critical to improving outcomes for both staff and patients. PURPOSE: This study aimed to explore nurses' perspectives on night shift work, identify fatigue countermeasures, and elicit nurses' recommendations for improving working conditions. METHODS: This mixed-methods study was conducted in two phases. In Phase One, night shift nurses at 12 hospitals within a northeastern U.S. health care system were surveyed to assess their night shift experiences. Phase Two employed focus groups at six of those hospitals to gain insight into night shift nurses' perspectives on the challenges they face and suggestions for improvement. Descriptive statistics were used to analyze the survey data. Thematic analysis of focus group transcripts was conducted to identify themes. RESULTS: The survey results identified gaps in night shift support, including limited access to in-person education and hot, nourishing food. Recognition of night shift nurses' unique needs was the overarching theme from the focus groups. Seven additional themes further described those needs and indicated areas for improvement: safety at night--from feeling safe to being terrified; drowsy driving; need for a break; "we're tired"--napping; nourishment at night; self-care; and night work is undervalued. CONCLUSIONS: The results support findings from prior research and underscore the persistent challenges night shift nurses face. While these challenges are well documented, changes to address them have been limited. Health care organizations must move beyond acknowledging the issues to implementing evidence-based interventions and structured programs. Addressing the concerns of night shift nurses is imperative and necessary to safeguard nurses' health and well-being; reduce turnover; and ensure safer, high-quality patient care.