Nap time

For patients' sake


Give emergency room doctors a nap, and not only will they do a better job, they’ll be nicer to you.

Ryan McVay

“Napping is a very powerful, very inexpensive way of improving our work,” says Steven Howard, MD, associate professor of anesthesia and an author of a Stanford study showing the benefits of naps for health-care workers published in the November 2006 Annals of Emergency Medicine.

Howard has taken the results of the study one step further and begun implementing an official napping program at the hospital at the Veterans Affairs Palo Alto Health Care System. “This is the first time a napping program has been instituted to try to get at the problem of fatigue in the workplace for health-care workers,” he says.

To determine just how much a nap would help alleviate sleep deprivation, researchers recruited 49 subjects — 24 nurses and 25 doctors — who worked through the night from 7:30 p.m. to 7:30 a.m. They divided the subjects into two groups. One group worked straight through the night as usual, the other was allotted a 40-minute nap break at 3 a.m., in the middle of their shift.

At the end of their shift, both groups took a series of tests including a 40-minute simulated car drive, a 10-minute written memory recall test, a computer-based I.V. insertion simulation and a questionnaire developed by NASA that measured different mood states including anger, confusion, depression, fatigue, tension and vigor.

The nap group scored fewer performance lapses, reported more vigor, less fatigue and sleepiness, and showed improved mood. The doctors and nurses who napped also tended to complete the simulated intravenous insertion more quickly, and they were safer drivers in the tests.

By contrast, many of those without naps would “crash over and over again” in the driving simulations, says the first author of the study, Rebecca Smith-Coggins, MD, associate professor of medicine (emergency medicine). Their cars would often leave the road or collide with oncoming vehicles. “I felt so bad after seeing how tired they were.”

Despite scientific evidence showing the benefits of napping for workers, little has been done in the United States to put in place any institutionalized napping programs, primarily because of a cultural bias, Howard says. Battling this bias and finding a comfortable napping spot close to the workstation have been the primary challenges he’s faced while getting the VA-Palo Alto napping program rolling.

“The social connotation of someone who naps is lazy, slothful,” Howard says. “Attitudes toward people who nap are hard to break.”

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