Sleep Problems Threaten Nurses’ Mental Health

Sleep problems are nothing new to nurses and other frontline healthcare workers, but the pandemic has made them even worse. Find out how this impacts nurses’ mental health and what employers can do about it.

This past weekend, our nation’s capital here in Canada was inundated with truck drivers. No, they weren’t pooling their resources to to try to put an end to our supply chain problems, although that would have been a noble gesture.

Instead, they were protesting the ongoing vaccine and mask mandates our provincial governments have been enacting. One wonders why they converged on our federal parliament when these fall exclusively under provincial jurisdiction, but that’s a separate issue.

Underlying the protests was a general sense of feeling fed up with the ongoing pandemic measures.  Jay Hill, interim leader of Alberta’s Maverick Party told the the New York Times that the protestors, “have just reached a point of frustration and exasperation with these lockdowns and continuation of restrictions that they want someone to speak up and say ‘enough.’”

“I Believe in Public Health. Thank you Nurses.”

The Canadian Broadcasting Corporation (CBC) reported that counter-protestors turned out carrying signs with slogans such as, “I believe in public health. Thank you nurses.” Polls suggest that this latter sentiment is much more widely shared by the vast majority of Canadians.

The pandemic has certainly taken a tool on the nursing profession. For example, a study published in the Journal of Occupational and Environmental Medicine has found that a majority of nurses reported having sleep problems during the first six months of the COVID-19 pandemic.

Sleep deprivation is nothing new to the nursing profession. Patient care is stressful in any clinical setting, and the demands of shift work often disrupt healthcare workers’ sleep cycles.

Pandemic Makes Occupational Hazard Even Worse

Even so, the study reveals that the pandemic is making this occupational hazard even worse. The lead author of the study is Associate Professor Amy Witkoski Simple of New York University’s Rory Meyers College of Nursing, a world leader in nursing and health education since 1932.

In a press release, she explained her team’s findings this way. “Nurses are already at risk for higher rates of depression and insufficient sleep compared to other professions, thanks to the stress of patient care and the nature of shift work. The pandemic seems to have further exacerbated these issues to the detriment of nurses’ well-being.”

Nurses have borne the brunt of the global coronavirus outbreak. In its early phases, circumstances forced them to cope with staff shortages and a lack of personal protective equipment (PPE).

Witness Even More Suffering and Death than Usual

Making matters worse, the pandemic forced nurses to witness even more than their usual share of suffering and death. In many cases, loved ones of terminally ill patients were unable to be with them in person as they faced the end of life process, and nurses found themselves explaining this policy to grieving families.

Between June and August, 2020, the researchers conducted 39 in-person interviews with frontline nurses and surveyed an additional 629 online. The sample included staff from healthcare facilities in eighteen states.

Fifty-five percent of the respondents reported experiencing sleep problems. A further 52% reported feelings of anxiety, and 22% had suffered from depression.

Working Conditions Nurses Endure Create a Vicious Cycle

The team determined that the working conditions nurses were enduring created a vicious cycle. The insomnia triggered other mental health concerns, which then aggravated the sleep problems, and so on.

The biggest risk factor triggering this syndrome was trying to function on five hours of sleep or less before working a regular shift. This wasn’t always something over which nurses had any control.

The sleep problems often came from thoughts about their stressful working conditions. Stress factors might include understaffing, being abruptly assigned to a COVID unit, not having adequate PPE, and witnessing unusually high mortality rates.

Trouble Falling Asleep, Waking Up During the Night

Ruminating about these high risk working conditions caused many respondents to have trouble falling asleep. Others found that they would wake up in the middle of the night and be unable to go back to sleep.

Respondents also reported that the unexpected shift changes needed to cope with pandemic workloads also caused sleep problems. These results didn’t come as a surprise to Professor Witkoski Simple.

“We know that getting sufficient sleep fosters mental and emotional resilience, while not getting enough sleep predisposes the brain to negative thinking and emotional vulnerability.” Nurses have been taking on these risks to their psychological well being out of a sense of duty to patient care.

Calls for Employers to Take Direct Measures on Issues

The study calls for employers to take direct measures to address the issues their survey uncovered. Specifically, administrators need to respond proactively to make sure teams have the resources they need in terms of staffing, PPE, and beds.

On an individual level, the researchers call for management to provide stress management training and access to counselling when needed. The study also encourages supervisors to take mental health issues into account when planning staff schedules. This includes avoiding excessive overtime, abrupt shift changes, and inflexible hours of work when feasible.

We’re all growing increasingly weary of the pandemic. The disruption, isolation, and loss of freedom are tough on every one of us.

Last Weekend’s Protests Strike the Wrong Chord

Even so, I can’t help thinking that last weekend’s protests strike the wrong chord when we consider the sacrifices our nurses and other frontline healthcare workers are dutifully accepting. It seems to me that if they can manage under these conditions, the rest of us can put up with staying home, putting on a mask, and getting our shots.

Professor Witkoski Simple concluded by saying, “Our findings help us better understand the difficulty nurses are facing—and why some nurses are leaving their jobs or the field altogether—but also reveal opportunities for hospitals and other employers to support this critical workforce.” 

We always have more to learn if we dare to know.
Learn more:
Another Pandemic Challenge for Nurses: Sleep Problems
Individual and Work Factors Associated with Psychosocial Health of Registered Nurses During the Covid-19 Pandemic
Benefits of Nature Confirmed by Science
We All Need to “Sleep and Dream of Sheep”
Social Media Distancing: Flattening the Infodemic Curve

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