It's low tide at 10 p.m. on the nursing unit, the lights are softened, and noise and staffing are at a minimum. The quiet environment and lack of stimulation is exactly what the patients need to rest and promote healing. But the non-stimulating environment is the opposite of what nurses and caregivers who work at night need to be alert and safe.

With more than 30% of healthcare workers on the night shift, often working 12-hour shifts, attention is being paid to factors that contribute to medical errors related to sleep deprivation. Healthcare safety experts are focusing on night-time staffing considerations, hours of work, and mistake-proofing processes.

The body is regulated by a 24-hour internal clock, the circadian rhythm, which is mediated by the effects of light and dark. Given that night shift workers sleep during the day, their environment at night should mimic daytime attributes as much as possible to improve cognition and alertness.

Operational planners explore some of the ways that healthcare built environments can support safety and sleep hygiene for night shift healthcare workers.

  • Infuse proper lighting in caregiver work areas, discreet from the patient room. Cool white lighting has been shown to have a beneficial effect on alertness.   
  • Design nursing units to maximize visibility and collaboration with other team members. The size of the nursing bed unit affects staffing. Units designed with more beds promote “safety in numbers” of available staff.  
  • Provide areas for exercise and physical activity. Staffing is minimal and night nurses often are not able to leave their unit. Placing a treadmill in a staff lounge or building it into the base of computerized workstation revs up the body’s metabolism.
  • Staff lounges with warm light and outdoor views promote relaxation. Encourage nurses to take a power nap in a specially designated “respite” room near a staff lounge.
  • Provide outdoor air access. Consider it a differentiator to upgrade the staff lounge to include a balcony for a breath of fresh air. 

Terry Thurston is the Director of Healthcare Operational Planning at BSA LifeStructures and brings more than 30 years of healthcare experience as an expert in operational, occupancy, and transition planning. Her experience as a chief nursing and patient safety officer allows her to bring a multi-faceted approach to designing safe and efficient healthcare facilities.