If we know that there is benefit to the employee on the night shift of napping or some other intervention, shouldn't we be responsible for implementing what we know to be a benefit?
Pam Hinds, PhD, RN, FAAN
At 3 a.m., hospital corridors take on a different rhythm. The lights are dimmer. The hallways are quieter. But inside patient rooms, the work of nursing continues at full intensity – calculating medications, responding to alarms, monitoring subtle changes that can mean everything.
At Children’s National Hospital, in Washington, D.C., nursing leader and researcher Pamela Hinds, PhD, RN, FAAN, saw firsthand what was sometimes overlooked: night shift fatigue. For her, this issue wasn’t just an inconvenience; it was a real health and safety concern. What followed was a bold, evidence-informed experiment: a structured, supported napping intervention for night shift nurses.
Recognizing a Pattern
Three experiences converged for Hinds. First, night shift nurses told her directly about their exhaustion and their worry about critical focus, patient safety and the drive home after a long shift. Second, she had worked five years of nights herself and understood the toll of fighting one’s natural circadian rhythm. Third, she watched colleagues walk out at dawn, their faces drained.
“Most of us are morning larks,” Hinds said. “Very few are true night owls. Yet we ask people to become what they’re not naturally wired to be.”
The consequences were not abstract. Nurses reported falling asleep at red lights and stop signs – even at the wheel. For Hinds, that shifted the conversation toward an ethical responsibility to ensure the safety and well-being of night shift staff.
Seeing an Evidence Gap
Rather than framing night shift tiredness as an individual shortcoming, Hinds believed fatigue could be a predictable and modifiable systems-level issue to address.
After collaborating with Jeanne Geiger-Brown, PhD, RN, FAAN, a recognized authority in the field, they convened a multidisciplinary team at Children’s National, composed largely of night shift staff. What they discovered was surprising. They had assumed the literature on night shift nursing fatigue would be robust. Instead, most available research focused on truck drivers, pilots and small healthcare samples.
After reviewing available data and extracting applicable insights, Hinds provided regular updates to nursing administration, sharing emerging findings and gradually building institutional awareness. In the end, the team concluded there was sufficient evidence to justify a demonstration project.
Designing a Structured Napping Intervention
The intervention centered on the introduction of planned, controlled naps for nurses during night shifts on a single unit. Importantly, this was not an informal or ad hoc practice and was implemented in deliberate phases:
1. Education First
Night shift staff received education on sleep hygiene and the physiological realities of night work. Napping was framed as a supplement, not a substitute, for adequate rest. Nurses were reminded of their responsibility to come to work as well-rested as possible.
2. Creating Safe Space
Space was a logistical and cultural challenge. The team worked closely with security to ensure monitored areas (with cameras outside, not inside), and with environmental services to supply clean linens. Every potential room was assessed for safety and appropriateness.
3. Clear Parameters
Naps were limited to 30 minutes. Nurses handed off patient care to a “buddy” nurse during their break, and the charge nurse determined whether staffing conditions allowed a nap on a given night.
Critically, the project team did not monitor who napped. Given historical Human Resources implications for sleeping on duty, surveillance would have undermined trust. The approach was deliberately hands-off and unit-driven.
Engaging Colleagues and Addressing Work Norms
Expanding the initiative hospital-wide required cross-disciplinary engagement. Hinds met with physician groups to explain the rationale and logistics.
When a hospital leader worried about what physicians would say if a family asked, "Where's my nurse?" Hinds had a ready answer: "You'd say the same thing you say when a physician colleague takes a break – that they’re on break and the patient is covered."
Hinds also proactively engaged Human Resources, reframing napping not as a performance issue but as a health and safety initiative. She also worked with security and environmental services – recognizing that lasting change requires collaboration across departments.
Measuring Impact: What the Data Showed
The research team conducted pre-, during-, and post-intervention surveys over 12 months, using a 21-item instrument measuring perceived fatigue, alertness and safety.
- Enhanced perceived alertness
- Positive shifts in self-reported functioning
- Improvement in reports of getting home safely
One particularly meaningful outcome involved driving safety. Prior to the intervention, nurses described occasionally falling asleep at red lights or stop signs. While the improvement was modest, the data moved in the desired direction for safely returning home after their shift.
Notably, not all nurses chose to nap. Some reported difficulty falling asleep; others described drifting into light sleep. A small number experienced sleep inertia – disorientation upon waking – and chose not to nap again.
Expanding the Intervention Beyond Napping
Recognizing that napping is not preferred by all nurses, the research team expanded the intervention to include:
- Mindfulness applications designed to promote alertness during shifts
- Separate mindfulness tools to facilitate sleep at home
- Physical activity options during breaks
The guiding principle remained consistent: no single intervention fits all.
Recruitment, Retention and Workplace Identity
Unexpectedly, the implementation of the new program influenced recruitment. Hinds encountered nurses who had joined Children’s National specifically because they had heard about the napping initiative.
Both described feeling “forgotten” on night shifts at prior institutions. The existence of a structured fatigue mitigation program signaled that the organization valued its night shift workforce and offered a competitive advantage for recruiting and retaining nurses.
Final Advice
For organizations considering a pilot, Hinds offers these tips:
- Engage leadership early and often.
- Ground the initiative in available evidence.
- Involve frontline night shift staff in design.
- Partner with HR, security, and environmental services.
- Respect unit-level autonomy.
- Collect outcome data where feasible.
Space constraints remain an evolving challenge. However, the rise of relaxation rooms across healthcare institutions has created new opportunities. On night shift, these spaces may be able to function as rest areas.
After sustaining the napping intervention for nearly a decade, Hinds is pushing to expand the initiative beyond nursing to all night shift employees – particularly those working 12- or 16-hour shifts. She frames it as an ethical obligation: "If we know that there is benefit to the employee on the night shift of napping or some other intervention, shouldn't we be responsible for implementing what we know to be a benefit?"
Additional Resources
- AACN Acute and Critical Care Staffing Resources
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