Working nights is a challenge for most nursing staff especially when one has to work for 4-5 nights in a row. Some nights are easy and some nights are chaotic. The nursing activities at night are slightly different in some areas such as in Mother-Baby Unit because most new mothers are healthy and they need more rest period. However, think about the trauma that comes in the emergency room every night and face non- stop excitement, drama, and stress. Or in the intensive care unit where one has to deal with codes after codes or ventilator intermittently beeping one patient after the other. All these situations can cause physical and emotional stress especially when working on the night shift.

Impact on health and safety
For the night staff, there is a great effort made to balance ones personal needs, work, and a good sleep. According to most studies, night staff faces more health and safety risks than any other shifts. Lack of quality sleep and chronic sleep loss often time leads to serious health problems and fatigue. The night shift work disrupts the circadian rhythm and causes change in sleep patterns. At sundown, the human body is automatically preparing for sleep producing high level of melatonin and lowering the body temperature thus inducing sleep. However, when one works after sundown, this forces the body to stay awake the whole night and causes loss of sleep. If one does it every day for the next 3-5 days, this will lead to chronic sleep loss. According to the 2001 study written by Davis, Mirick, & Stevens published in the Journal of National Cancer Institute that night staff are at risk for infertility, breast cancer, colorectal cancer, diabetes, cardiovascular disease and gastrointestinal disorders. Other study has shown that lack of sleep affects alertness thus causing more errors or accident and poor performance. Fatigue is common among night staff and decreases work productivity. Fatigue and chronic sleep loss alters memory, communication, attention, reaction time and agility.

Night staff greatest achievement
However, in spite of these challenges, the night staff greatest achievement is their strategies to combat fatigue and sleeplessness. Autonomy and creativity is second nature for the staff since they learn to work with very limited resources most of the time. Staff cohesiveness and teamwork is also much better at night than any other shift because most night staff value each other, they have good bonding, and they remain loyal to one another. The staff also utilizes their time effectively to get the job done.

Overcoming staff dissatisfaction
Other issues that contributes to night staff dissatisfaction and poor performance are lack of staff, less leadership or administrative support, less communication or engagement from the rest of the nursing staff, lack of equipment and supplies, fatigue, lack of decent place to take a break, and lack of open cafeteria or coffee shop. Poor staffing and constant floating of staff to other units during the night always leads to disgruntled and disheartened staff.

Strategies to maintain a healthy environment
Creative management is one of the strategies to overcome the issues faced by the night staff.

• Nursing leadership must be visible and available to assist the night staff. Studies have shown that the night staff responds differently to different leadership style and influences the satisfaction of the night staff more than the day staff.
  
• Acknowledge that there are work differences between day and night shift and that the night staff are valued for their contributions and sacrifices.
  
• Unit managers or leaders must meet frequently with the night staff and listen to their opinion and grievance thus narrowing the gap of social isolation and disconnection.
  
• Create programs to disseminate information about fatigue, sleep deprivation, importance of exercising, eating well, and the health risks.
  
• Allow and encourage multiple small breaks throughout the night.
  
• Provide comfortable and safe areas where staff can rest. Studies have shown that napping at work during the night shift is an effective way to maintain alertness, improve reaction time, and decision-making.
  
• Coffee shop and cafeteria should remain open at night. Make available other healthy food choices stored in the vending machines and include food that can be heated easily.
  
• Educational offerings such as mandatory classes or competency/specialty-based classes must be available and given at night. Offer the same opportunity and privilege given to day staff.

Creative strategies to make the night shift interesting are important to reduce chronic sleep loss, stress, fatigue, and social isolation. Respect, recognition, and rewards given to the staff will surely increase staff satisfaction and morale. The most important of all is to put these strategies in action to improve staff satisfaction and customer service and raise the bar for patient care standards.