Changing clocks: night shift nurses can ‘fall back’ with deadly consequences

By Dr Pushpa Chandra

Nov 07

It’s autumn, and most of us are looking forward to an extra hour in bed the night the clocks ‘fall back’. For night shift workers, however, it’s not such a welcome event. For nurses on a ‘normal’ 12.5-hour night shift, that extra hour of work can not only be extremely tiring, but can also potentially lead to more mistakes, accidents and personal injury.

Welcome to the 17-hour night shift

For any nurse on night shift, this is the way it works. You get up and have a meal the evening before you start your shift. You drive to work. So, you’ve already been on the go for a couple of hours before you start your actual shift. (By the time you get back to your bed, you will most likely have been up for about 17 hours.)

You’re up all night, mostly on your feet with just a few short coffee breaks and snacks to keep you going. All the time, you are fighting nature. Your body tells you that you should be fast asleep in bed. Your cortisol levels are out of balance, and your melatonin (sleep hormone) is tugging at you to sleep. At around 2am, you would normally be in your deepest sleep and you feel so fatigued you’d give anything for a five-minute nap. The coffee didn’t help and you're probably a bit constipated since bowel movements are naturally suppressed at night.

You became a nurse because you care—and you still do. But night shift is testing your commitment

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But you carry on. You don’t want to let anyone know that you're dying on your feet. You want to do your job. You became a nurse because you care—and you still do. But the night shift is really testing your commitment, especially after a few years of it wrecking your natural rhythms and interfering with your family, your social life and your health.

Let’s keep this between us. No-one else needs to know…

All the other nurses and doctors know that this is when mistakes happen—when you’re feeling so fatigued. No one can blame you if you slip, and there is tacit agreement among your colleagues to cover for each other, if necessary. Consequently, only some mistakes get reported. It's estimated that there are up to ten times more mistakes made than the number reported. And no one reports the mistakes of others—particularly doctors—for fear of repercussions. If you’re a nurse in your 30s, you have your career to think about, so you don’t want to rock the boat (even if your health is suffering and you know that all kinds of serious conditions—even breast cancer—could develop due to cortisol dysregulation and a battered immune system).

It's estimated that there are up to ten times more medical mistakes made than the number reported

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Somehow, you’ve made it through the night and, normally, you'd be looking forward to driving home, although you probably won’t remember it, as you'll be driving on autopilot. But then you realize that the clocks have changed and you have another hour to go. By the time you finally get home, you will have been on the go for about 17 hours.

You're now in your danger zone—so deeply fatigued that you can barely think or even walk straight. But, before you leave, a patient requires a critical blood transfusion and another must get a morphine infusion. You and your colleagues do all the right checks. You're certain that you're reading the details right, but all of you are in the same exhausted state and you know that errors can still be made. Was that a 6 or an 8, was it 0.1 or 1.0, or even 10? Did you just give a child 10 times or even 100 times the amount of morphine than she actually needed? You know that could be fatal, especially if she is not ventilated. Yet all the checking in the world won’t necessarily be enough when you're feeling like this—and the wrong transfusion could be deadly.

2am on night shift: you're in your danger zone—deeply fatigued, you can barely think straight.

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Uppers and downers

You know you're not fit to be making such vitally important decisions, but you don’t want to let the team or the patient down. You keep going but, beneath all the bravado, you're feeling deeply depressed. This isn’t what you signed up for and this certainly isn’t the best way to administer healthcare to trusting patients. So it's a relief to know that, as a nurse in Canada, you have access to an endless supply of free antidepressants. You know that these drugs can have serious side effects—such as depression and suicidal tendencies—but you take them anyway, so you can do your job.

What’s wrong with this picture?

The short answer is: everything. Not only is the healthcare system failing its own staff, but it's also putting at risk the patients they're meant to be serving. To make matters worse, the system is plying its staff with drugs that often don't work and can further damage their already depleted health.

Not only is the healthcare system failing its own staff, it's putting at risk the patients it's meant to be serving

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How can you make it better?

There are other ways—healthy, natural ways—to mitigate the effects of night shift work. Education, nutrition, natural supplements and proper exercise go a long way towards countering the effects of circadian rhythm disruption. As a shift-working nurse for 27 years, Dr Pushpa Chandra discovered her own ways of overcoming these problems and remaining supremely healthy during her time in ICU at a children’s hospital. She did shift work while also attending college and she regularly ran ultra-marathons all over the world. Having finished her career as a nurse, she then became a naturopathic doctor and has devoted her life to developing ways to help shift workers live longer, healthier lives. She now offers a unique natural formula to help nurses and other shift workers function more effectively, while supporting their health and longevity.

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About the Author

Dr. Pushpa Chandra is a Vancouver based Naturopathic Physician with an integrative approach to healthcare. Her background includes over 27 years of acute care hospital experience as a registered nurse and 22 years at BC Children's Hospital in critical care, working with the province's sickest children. Her special interests include research in circadian rhythm disruption, sports medicine and pediatrics. As a competitive sports enthusiast, Dr Pushpa completed ultramarathons and marathons in all 7 continents including North Pole, Antarctica and Mt Everest. As a shift worker she has been using the ingredients of AWAKE and ASLEEP to boost her performance, endurance and overall health.

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