Health workers explore night life


If you’re considering health care as a career, count on working the graveyard shift at some point.

“Health care is a 24/7 operation, so it’s tough for anyone in this field to avoid the night shift – at least until you have some seniority in an institution to move to a day job,” said Susan Smeltz, interim chief nursing officer at Centennial Medical Center in Frisco, Texas.

The night shift is a necessary evil for hospitals, nursing homes and 24-hour pharmacies. Employers and employees have to work hard to minimize the negative effects.

Up to 20 percent of workers in industrialized nations maintain night jobs or rotating schedules. As many as 10 percent of them have been diagnosed with shift-work sleep disorders. Their chief complaint: insomnia or excessive sleepiness.

A new study highlights this often under-recognized condition. The results appear in an Aug. 4 New England Journal of Medicine report titled “Shift-Work Sleep Disorder – The Glass Is More Than Half-empty.” Several hundred workers participated in the national clinical trial from different industries, not just health care.

Regardless of their vocations, shift workers have a higher risk for developing gastrointestinal ulcers, heart disease, depression and a host of other ailments, the study found.

Not surprisingly, their sleep patterns also tend to be disrupted.

“Shift-work sleep disorder is a significant problem for a lot of people in our society,” said Gary Richardson, one of the study’s investigators and a senior research scientist at Henry Ford Hospital in Detroit.

Richardson said many night-shift workers devote too little time to sleep during the day.

“We can do something about it,” he said. “These are practical problems that have practical solutions.”

Researchers said prescription drugs approved for excessive sleepiness may promote wakefulness and alertness among nocturnal employees more effectively than a constant cup of coffee.

Caffeine ranks as the most widely used stimulant for those with shift-work sleep disorder, Richardson said.

“They prescribe it for themselves in the form of Starbucks,” he quipped.

One benefit for night-shift workers: Health employers generally have to offer incentives for hard-to-fill time slots.

“In very large hospitals with trauma centers, the surgical suites and radiology departments are also staffed around the clock, while in some smaller hospitals, they are staffed by on-call personnel during the night,” Smeltz said. “Working 12 hours a day three days a week and having four days off is a nice incentive.”

At Walgreens, overnight pharmacists get seven days off after working seven consecutive shifts.

“A lot of them choose the overnight shift because they enjoy the seven-on, seven-off schedule,” said Michael Polzin, spokesman in the chain’s suburban Chicago headquarters.

Many employers also pay a bonus to night-shift workers. Among them is Medco Health Solutions Inc., a pharmacy benefits manager serving health plans, major corporations and government agencies.

“Call centers are operated by reps and pharmacists, and they’re there to answer questions from our members,” said Jennifer Leone, spokeswoman in the Franklin Lakes, N.J., national office. “We’ve been a 24-hour pharmacy for a long time.”

Texas Health Resources, which owns 13 hospitals, rewards its night staff with an hourly differential ranging from 75 cents to $10, said Deborah Ellison, director of compensation.

“Some people actually prefer to work these shifts,” said Michelle Kirby, THR’s vice president of people and culture. “If families are trying to avoid child care or day care expenses, sometimes it works very well if the spouse is working the day shift and the employee can be home with the children at that time.”

Some employees “have a body clock that makes them more attuned to working these hours,” said Beth Mancini, a professor and associate dean for undergraduate nursing programs at the University of Texas at Arlington. From 1984 to 2004, she was employed at Parkland Health & Hospital System in Dallas, most recently as senior vice president of nursing administration.

And there’s another advantage to being on duty at night.

“The current 24-hour status of grocery stores, shopping and banking options online, etc., have made handling activities of daily living in nontraditional hours easier,” Mancini said. “Some would say it’s easier to handle these chores when everyone else is at work.”