Beverly M. Hittle, PhD, University of Cincinnati, College of Nursing; Cassie Wardlaw, PhD, University of Cincinnati, College of Nursing; Joshua Lambert, PhD, University of Cincinnati, College of Nursing; Karen Bankston, PhD, University of Cincinnati, College of Nursing
Purpose/Objectives
To identify the prevalence of sleep deficiency (i.e., below recommended sleep duration and sleep quality) during the COVID-19 pandemic among a national cohort of registered nurses self-identified as Black.
Background
The COVID-19 pandemic increased workload,[1] stress,[1] and disrupted sleep of workers in the healthcare industry.[2] Deficient sleep (i.e., sleep duration, quality) is associated with a multitude of chronic health conditions[3,4] and occupational incidents and injuries.[5] Nurses are at increased risk for sleep deficiencies as a result of work hours (e.g., night shift, 12-hour shifts).[6] In the United States, workers self-identified as Black experience a higher prevalence of short sleep duration than white workers,[7] including those in the healthcare industry. This sleep disparity is thought to be a result of social and environmental experiences.[8] Despite the increased risk of sleep deficiencies experienced by nurses, little is known about the sleep of registered nurses’ who self-identify as Black. Currently, when the healthcare industry strives to increase the diversity of the healthcare workforce,[9,10] it is of utmost importance to identify potential increased risks to Black registered nurses’ health and safety.
Methods
This cross-sectional study design used self-reported data collected nationally from self-identified, Black registered nurses working in the hospital or long-term care setting. Nurses were invited to participate through email and social media contact from national Black nurse professional organizations. Data were collected September through November 2020, with a sample size goal of 100. Guided by The Work and Health Disparities Conceptual Model,[11] online survey questions were drawn from validated instruments and national surveys. Sleep duration questions specific to work schedule (i.e., day shift, night shift) and days off were based on the Behavioral Risk Factor Surveillance System[12] survey. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), where a score greater than or equal to five is considered poor sleep quality.[13] Because data were collected during the COVID-19 pandemic, questions were asked about the perceived impact of the pandemic on sleep and workload. Descriptive analyses (i.e., means, standard deviations, frequencies) were used to determine sleep deficiency prevalence.
Findings
There were 101 registered nurses who responded and were eligible for the study. After reviewing for missing data, total respondents were 63. Average respondent age was 46 years and tenure as a licensed registered nurse was 13.4 years. Average sleep quality scores per the PSQI was 9.95 (S.D. = 3.12), resulting in 96.6% of respondents reporting poor sleep quality. Average sleep duration for nurses working day shift (n=35) was 5.88 hours (S.D.= .96). Average sleep duration for night shift nurses (n=25) was 6.53 hours (S.D.= 1.67). Average sleep of all nurses (n=63) when working was 6.15 hours (S.D.= 1.33). When asked to report sleep duration on workdays, prior to the COVID-19 pandemic, respondents reported an average of 6.38 hours (S.D. = 1.43). When asked whether COVID-19 highly impacted their current nursing job, 88.9% reported yes. When asked whether COVID-19 highly impacted their sleep duration and quality, 51.6% (n= 62) and 56.7% (n=60) respectively reported yes.
Discussion
Average sleep duration among registered nurses identifying as Black during the COVID-19 pandemic was reported at 6.15 hours, well below the recommended 7-9 hours/24-hour period.[14] Although this average is not as low as others reported among nurses caring for COVID-19 patients,[2] it still remains below what is recommended for optimal health. In comparison, recalled sleep duration during pre-pandemic time was still not meeting recommendations and was lower than what has been reported among national nurse cohorts prior to the pandemic.[15] Almost all nurses in this study reported poor sleep quality. In a meta-analysis, pooled prevalence rates of poor sleep quality among nurses were reported at 61% with an average PSQI score of 7.13.[16] It should be noted these data were collected starting at the end of September 2020. This was six months after the onset of the pandemic, and four months after the murder of George Floyd, which sparked racial protests nationwide. Although the pandemic was reported to have disrupted sleep quality among healthcare workers, the national context and subsequent stress need to be considered as another impact on Black nurses and their sleep.
Conclusions
Nurses who self-identify as Black reported sleep deficiency pre and during the COVID-19 pandemic. Sleep deficiency may potentially be worse for Black nurses as compared to their white counterparts and may be more strongly impacted by environmental and social influences. This may put Black nurses at higher risk for developing chronic health conditions and/or occupational injuries, including stress and burnout. As such, nurses identifying as Black may need more holistic support to achieve healthy sleep.