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Health Care Night-Shift Workers Often Neglect Selves


(Yawns) You know, one in 10 health-care workers has an overnight shift, and in our second report, NPR's Allison Aubrey tells us they are not exactly paying attention to their own health.


In the middle of the night when emergency room doctor, Elizabeth Jacobs, is treating an asthmatic toddler or consoling a nervous parent, there's one predictable substance that keeps her going.

Dr. ELIZABETH JACOBS (Emergency Room Doctor): Anything with caffeine, soda, you name it. I mean, I definitely drink a lot of caffeine to keep myself awake at night.

AUBREY: Jacobs has heard all the advice about limiting the stimulant. Caffeine stays in the bloodstream about 10 hours, with the strongest effect in the first four. So the recommendation to overnight workers is to drink their last soda or coffee four hours before their shift ends. This way, they're sleepy when they get home. It's a nice theory, but Jacobs says if she follows this advice, it's even tougher to manage her half-hour drive home.

Dr. JACOBS: I'm fighting rush hour traffic and everybody's awake and alert, and I'm exhausted.

AUBREY: So Jacobs stays caffeinated. And she says in the ER, there's always plenty of sugary food.

Dr. JACOBS: And there actually have been studies on that, as well, looking especially at nurses who work night shifts and how they're heavier, their diet's not as good, they have higher cholesterol, etc.

AUBREY: So Jacobs tries to limit snacks.

Dr. JACOBS: I try. It's sometimes hard. A piece of cake at 3:30 in the morning can go a really long ways to happiness.

AUBREY: So for now, Jacobs isn't complaining about her rotating shifts. It's early in her career. She's still trim, and she's thriving. But experts say eventually, the work takes a toll. To optimize physical and mental health, one recommendation is to schedule workers using a system of forward rotation.

Mr. DAVID GROSS (Washington Hospital Center): In other words, day shift; then the next week, evening shift; and then the next week, the night shift.

AUBREY: David Gross is a sleep expert with Washington Hospital Center in the District of Columbia. He says the very best scenario is to limit rotations to every few weeks.

Mr. GROSS: The longer the time interval between the changing of the shifts, the more time the body's circadian rhythm can catch up to it. But if you're changing the shift every day, obviously, the circadian clock, which we all do have, you know, doesn't have any time to change.

AUBREY: The research on forward rotation is not new, but it's solid. Still, Gross says the idea has never taken off. Employers don't encourage it, and in health care, nurses and doctors have lots of reasons to select other schedules. First, the money's better working nights, and the rotating shifts present logistical problems off the job. Nurse Chiti Ochula(ph) of Washington Hospital Center says forward rotations may be better for her personal health, but not for her family.

Ms. CHITI OCHULA (Nurse, Washington Hospital Center): If you have to work nights for like two, three or four weeks in a row, your body just gets used to that, and if you have children, like I do--oh, my goodness, like I do--because when I work night shift, I come home when they're not in school. They think Mommy's home-home, like in the daytime, they want to play.

AUBREY: When all Ochula needs is sleep. Catching up on it requires good napping skills. Gross says the best way to get them in is just before or just after a shift.

Mr. GROSS: Probably a nap as short as 20 minutes--20 to 60 minutes has probably shown to be therapeutic. After that, it starts to get a little impractical and might actually make it more difficult to fall asleep later at night.

AUBREY: But not everyone can regulate naps. Perhaps the best predictor of who will make a successful shift worker is whether they have ER Doc Elizabeth Jacobs' innate abilities.

Dr. JACOBS: I sleep like a cat. I can sleep whenever, wherever--airplanes, airports, cars, middle of conversations. Totally doesn't matter, I can just fall asleep.

AUBREY: Given the reports of sleep problems and disturbances that most Americans face, even those not working the night shift, it seems very few people can sleep like Elizabeth Jacobs can. Allison Aubrey, NPR News, Washington.

INSKEEP: This is MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.

Allison Aubrey is a correspondent for NPR News, where her stories can be heard on Morning Edition and All Things Considered. She's also a contributor to the PBS NewsHour and is one of the hosts of NPR's Life Kit.