Sleep Health Among a Cohort of Nursing Workforce

Abstract

Background: The nursing workforce and the care they provide are essential to the health of individuals, families, communities, and populations. Approximately half of nurses report unhealthy sleep, which includes inadequate sleep duration, difficulty falling or staying asleep, short sleep duration, and inconsistent timing of sleep. Poor sleep health among the nursing workforce is associated with adverse health outcomes in the nurse, job turnover, and a decrease in safe and effective nursing care. National research priorities have underscored the need to examine sleep health among nursing workforces to inform effective mitigation strategies and best practices to optimize nursing sleep health and the provision of 24-hour safe, quality nursing care. Purpose: The purpose of this study was to examine the association between job characteristics and sleep health (sleep duration insomnia symptoms, chronotype, self-reported snoring, and daytime dysfunction) across demographic characteristics, care settings and specialties, and sleep hygiene behaviors among a national cohort of registered nurses practicing in the United States and Canada. The specific aims were to: 1) Describe multidimensional sleep health across demographic characteristics (race, ethnicity, and immigration status) among registered nurses, 2) Describe the association between multidimensional sleep health and job characteristics (shift type, shift length, hours worked/week, and practice setting/specialty) among registered nurses, and 3) Test whether individual sleep hygiene behaviors (regularity of falling asleep with light on, brightness of ambient light during sleep, and blue light blocking application installed on electronic device) were effective at mitigating the association between job characteristics and sleep health among registered nurses. Methods: The current study leveraged a subset of the existing national cohort data set of the Nurses’ Health Study 3 (N = 1,342) to conduct three quantitative cross-sectional analyses. The first analysis (Paper one) consisted of a chi-squared test of independence to assess multidimensional sleep health across demographic characteristics of race, ethnicity, and immigration status among nurses. Paper two involved multiple logistic regression analyses to estimate the association between multidimensional sleep health and job characteristics across nursing care settings and specialties. In paper three, logistic regression analysis was used to test for the modifying effect of sleep hygiene behaviors when examining the association between nursing job characteristics and sleep health among nurses practicing in various care settings and specialties. Results: The first study analysis found that nearly 50% of the sample reported a healthy sleep duration on workdays, and more than 75% reported a healthy sleep duration on workfree days. The second analysis results indicated that working more than or equal to 12-hour shifts was not associated with decreased odds of healthy sleep compared to those working less than 12-hour shifts. The third analysis results demonstrated that individual sleep hygiene behaviors did not mitigate the decreased odds of healthy sleep associated with job characteristics. Conclusion: The results from the three dissertation analyses provide important insights that broaden the scientific understanding of sleep health on workdays and workfree days and the complexities of the association with job characteristics among nursing workforces. Programs and policies aimed at improving sleep health among nurses should be extended beyond individual sleep health behaviors and be tailored to the distinct job design in nursing specialties. Future research is needed to expand the conceptualization of nursing work factors and how they influence sleep health among nurses and the associated patient populations.