I stopped doing shift work involving swing and overnight shifts a few years ago, but I know plenty of veterinary technicians and nurses (and veterinarians) who continue to do so. Regrettably, there is no way around this when it comes to veterinary emergency and critical care, since emergencies and intensive care extend outside of the regular 9am-5pm work day! Unfortunately, the consequences of doing shift work are well-documented among human nurses, residents, and physicians and warrant discussion and further investigation in veterinary medicine.
A recent study published in the Journal of Advanced Nursing surveyed more than 300 human nurses working rotating shifts in seven hospitals in Italy. Nurses worked an average of 36 hours per week with at least one shift starting in the morning, afternoon, and evening. Not surprisingly, more than half of the nurses reported sleep difficulties and almost one-third reported feeling burnt out. It seemed that those nurses reporting sleep issues described as poor sleep quality, disturbed sleep, reliance on sleep medications, or daytime impairment related to sleep loss, were twice as likely to report burnout compared to those who did not report sleep issues.
The association between shift work and burnout is disturbing given that burnout in nurses is associated with decreased patient satisfaction, reduced quality of care, increased medical errors, and higher mortality rates. While it is difficult to measure patient satisfaction in veterinary medicine, it is likely that technicians that work rotating shifts also experience burnout that affects patient care and pet owner satisfaction.
Burnout is described as the physical and emotional exhaustion that occurs when veterinary care providers have low job satisfaction and feel powerless and overwhelmed at work. This results from a combination of exposure to environmental and internal stressors, as well as inadequate coping skills. Feeling as though there is little to no control over work, lack of recognition or rewards for good work, unclear or overly demanding job expectations, or working in a chaotic or high-pressure environment all can lead to burnout. Working long hours, feeling over-extended or overwhelmed, and not getting enough sleep also contribute to burnout. If this does not describe shift work, I don’t know what does!
The association between shift work and sleep deprivation is understandable – working rotating or night shifts alters the body’s normal circadian rhythm (i.e., sleep-wake cycle) thus disrupting sleep patterns, which can lead to medical problems that include weight gain, psychological distress, and cardiovascular disease. Not having the opportunity to mitigate these issues leads to a vicious cycle whereby burnout and sleep deprivation go hand in hand.
So, what can be done to help? Sleep hygiene is of the utmost importance to help mitigate sleep patterns in those working shifts. This means engaging in activities to help fall asleep (and stay asleep) regardless of the shifts being worked. Here are some pointers for those doing shift work in practice:
· In the days leading up to your swing/overnight shift: Prepare to wake up at least 3-4 hours after the end of your night shift (e.g., if the overnight shift is 6 PM – 6 AM, shift your 8-hour sleep schedule to 2 AM – 10 AM (or later)).
· Before or during the shift:aim to get 30-60 minutes of daylight exposure as early in the shift as possible (even if in the form of a phototherapy light); exercise for 30 minutes (ideally before the shift, not after); take moments to relax (pause, breathe, stretch); make lists of things to do or that you need to remember later; avoid caffeine within 6 hours of bedtime; avoid alcohol within 4 hours of bedtime; eat healthfully by avoiding sugary or processed foods; avoid large meals or spicy food close to bedtime.
· When going to sleep: aim for 7-9 hours of sleep daily (including naps); avoid using electronic devices within 1-2 hours of bedtime; keep electronics out of the bedroom; ensure you have a comfortable mattress; consider Ca++ or Mg++ as a natural sleep aid; use the bed only for sleep or intimacy; ensure the bedroom is sound- and light-proof.
· Consider natural sleep aids: take 0.5 – 3 mg of melatonin approximately 30-45 minutes before your desired bedtime to facilitate falling (and staying) asleep.
· Enlist the support of family and friends: ensure that others know not to call when you are sleeping and to be considerate in scheduling gatherings or events that accommodate your irregular schedule.
Although shift-work is not ideal, these pointers can help to ameliorate the side effects and cope effectively. If you have any other thoughts or suggestions, please feel welcome to share them with others in the comments section below!
Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals. She facilitates wellness workshops, boot camps, and retreats for veterinarians, technicians, students, and other veterinary care providers. To sign up for newsletters containing information regarding these events and veterinary wellness topics, please click here. More information can be found at www.criticalcarevet.ca.