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Difficulty sleeping due to work stress and scheduling contributes to nurses’
anxiety and depression
More than half of nurses had difficulty sleeping during the first six months of the COVID-19 pandemic—and getting less sleep increased their odds of experiencing anxiety and depression, according to a new study led by researchers at NYU Rory Meyers College of Nursing.
“Nurses are already at risk for higher rates of depression and insufficient sleep compared to other professions, thanks to the stress of patient care and the nature of shift work. The pandemic seems to have further exacerbated these issues to the detriment of nurses’ well-being,” said Amy Witkoski Stimpfel, PhD, RN, assistant professor at NYU Rory Meyers College of Nursing and the lead author of the study, which was published in the Journal of Occupational and Environmental Medicine.
Nurses have faced unparalleled challenges working on the frontlines of the COVID-19 pandemic, including staffing shortages, an early lack of personal protective equipment (PPE), and witnessing widespread suffering and death. Research is beginning to reveal the impact of these ongoing stressors on nurses’ mental health and well-being.
In this study, the researchers surveyed 629 nurses and interviewed 34 nurses from June through August 2020. The nurses, who worked across healthcare settings in 18 states, were asked about their experiences working during the first six months of the pandemic in the U.S.
The survey revealed high rates of depression (22 percent), anxiety (52 percent), and insomnia (55 percent) among nurses. Notably, difficulty sleeping was both a contributing factor to and an outcome of poor mental health.
Only sleeping for five hours or less before a shift increased the odds of depression, anxiety, and insomnia. However, nurses also described how anxiety and thinking about stressful working conditions—understaffing, being redeployed to a COVID unit, lack of PPE, and many patient deaths—led to difficulty falling asleep and waking up at night. In addition to stress-related sleep problems, changes in nurses’ work schedules from either working extra hours or abruptly switching between day and night shifts led to nurses getting fewer hours of sleep.
“We found that sleep problems were interwoven with anxiety and depressive symptoms,” said Witkoski Stimpfel. “Prior research supports this bidirectional relationship between sleep and mental health. We know that getting sufficient sleep fosters mental and emotional resilience, while not getting enough sleep predisposes the brain to negative thinking and emotional vulnerability.”
To better support nurses and their well-being, the researchers urge employers to take action to address work stress and factors that influence sleep. In addition to making sure that nurses have the resources like staffing, beds, and PPE to effectively do their jobs, employers can offer training on stress management and provide referrals to mental healthcare professionals for those in need. Employers should also pay attention to scheduling, ensuring nurses have time away from work, protecting them from excessive overtime hours and shifts that quickly switch between day and night, and offering flexible working arrangements.
“Our findings help us better understand the difficulty nurses are facing—and why some nurses are leaving their jobs or the field altogether—but also reveal opportunities for hospitals and other employers to support this critical workforce,” said Witkoski Stimpfel.
Additional study authors include Lloyd Goldsamt and Victoria Vaughan Dickson of NYU Meyers and Lauren Ghazal of the University of Michigan. The research was supported by an NYU COVID-19 Research Catalyst grant.
全文翻譯（僅供參考）
由於工作壓力和日程安排造成的睡眠困難導致了護士的焦慮和抑鬱症
根據紐約大學羅裏-梅耶斯護理學院的研究人員領導的一項新研究，超過一半的護士在COVID-19大流行的前六個月有睡眠困難--而且睡眠不足增加了他們出現焦慮和抑鬱的幾率。
"由於病人護理的壓力和輪班工作的性質，與其他職業相比，護士已經面臨着更高的抑鬱症和睡眠不足的風險。這場大流行似乎進一步加劇了這些問題，損害了護士的福祉，"紐約大學羅裏-梅耶斯護理學院助理教授、RN博士Amy Witkoski Stimpfel説，她是這項研究的主要作者，該研究發表在《職業與環境醫學雜誌》上。
護士們在COVID-19大流行病的前線工作面臨着無與倫比的挑戰，包括人員短缺、早期缺乏個人防護設備（PPE），以及目睹廣泛的痛苦和死亡。研究開始揭示這些持續的壓力對護士的心理健康和幸福的影響。
在這項研究中，研究人員調查了629名護士，並在2020年6月至8月期間採訪了34名護士。這些護士在18個州的不同醫療機構工作，他們被問及在美國大流行病的頭六個月的工作經歷。
調查顯示，護士的抑鬱症（22%）、焦慮症（52%）和失眠症（55%）的比例很高。值得注意的是，睡眠困難既是造成心理健康不良的一個因素，也是一個結果。
只有在輪班前睡了5個小時或更少，才會增加抑鬱症、焦慮症和失眠的幾率。然而，護士們還描述了焦慮和對緊張的工作條件的思考--人員不足、被重新部署到COVID單元、缺乏PPE和許多病人死亡--導致了入睡困難和夜間醒來。除了與壓力有關的睡眠問題外，護士的工作安排發生變化，要麼加班，要麼突然在白班和夜班之間轉換，導致護士的睡眠時間減少。
"我們發現，睡眠問題與焦慮和抑鬱症狀交織在一起，"威特科斯基-斯廷普費爾説。"先前的研究支持睡眠和心理健康之間的這種雙向關係。我們知道，獲得充足的睡眠可以促進心理和情緒的恢復力，而沒有足夠的睡眠則使大腦容易產生消極的思維和情緒的脆弱性。"
為了更好地支持護士和他們的福祉，研究人員敦促僱主採取行動，解決工作壓力和影響睡眠的因素。除了確保護士有資源，如人員配置、牀位和個人防護設備，以有效地完成他們的工作，僱主可以提供壓力管理的培訓，併為有需要的人提供轉介給心理保健專家。僱主還應該注意時間安排，確保護士有時間離開工作崗位，保護他們免受過長的加班時間和在白天和晚上快速切換的輪班，並提供靈活的工作安排。
"我們的研究結果幫助我們更好地瞭解護士所面臨的困難--為什麼一些護士要離開他們的工作或完全離開這個領域--但也揭示了醫院和其他僱主支持這一關鍵勞動力的機會，"Witkoski Stimpfel説。
其他研究作者包括紐約大學梅耶斯分校的Lloyd Goldsamt和Victoria Vaughan Dickson以及密歇根大學的Lauren Ghazal。這項研究得到了紐約大學COVID-19研究催化劑撥款的支持。