1. Geiger-Brown, Jeanne PhD, RN
  2. McDonald, Anthony PhD


Preventive measures range from napping to installing driver monitoring systems in cars.


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Of the 2.9 million employed RNs in the United States, many will at some point work the night shift. Although research is limited, one 2007 study by Hwang and colleagues in Sleep found that as many as 30% report significant drowsiness during every postwork commute. Drowsy driving is an inevitable consequence of shift work. Nurses who are sleepy during the shift are likely to drive while drowsy at shift's end. Drowsy drivers have impaired attention, slow reaction times, and make poor decisions behind the wheel, similar to alcohol-impaired drivers.

Figure. Jeanne Geige... - Click to enlarge in new windowFigure. Jeanne Geiger-Brown
Figure. Anthony McDo... - Click to enlarge in new windowFigure. Anthony McDonald

As with alcohol-impaired driving, a driver whose drowsiness causes an accident can be held criminally liable in many states. Unlike alcohol-impaired driving, drowsy driving can result from the drive itself-particularly on curved sections of roadway and during monotonous straight driving, periods of microsleep cause impaired driving. Many drowsy-driving accidents are off-the-road crashes where the driver, who is traveling at a high speed, drifts out of the traffic lane and strikes other cars, trees, poles, or pedestrians.


All drowsy driving is preventable because drivers can recognize the prodrome of dozing off (yawning, rubbing the eyes, heavy eyelids, nodding head, tunnel vision, slowed responses, loss of recall of the last few miles of driving). According to the National Highway Traffic Safety Administration (NHTSA) report Asleep at the Wheel (2017), upon the first sign of drowsiness, the driver should immediately pull off the road, ingest 200 mg of caffeine, and take a 20-to-30-minute nap in the car while waiting for the caffeine to increase alertness. The responsibility for taking these measures falls on nurses and their employers. Nurses are responsible for obtaining adequate sleep and avoiding driving when too sleepy to do so safely. Napping prior to leaving the facility in the morning or using a ride-sharing service are alternatives to driving while drowsy. In addition, employers should ensure that work schedules are arranged to allow sufficient sleep and planned napping during work breaks.


Even with these measures, as long as shift work continues in nursing, drowsy driving will still occur. In such cases, crashes can be prevented by drowsy driving mitigation technology, such as alarms to alert drivers who become impaired by sleepiness. Some new cars (Audi, Mercedes, and Volvo) use this technology. Aftermarket devices are usually small, mounted devices that detect signs of drowsiness or impaired driving. Night shift nurses should strongly consider obtaining and using either of these types of devices; however, the current cost of several hundred dollars for dashboard-mounted devices may discourage their purchase. Employers should support the purchase of drowsy-driving mitigation devices for any nurse with a commute longer than 30 minutes.


While drowsy driving is an inevitable consequence of shift work, the tacit acceptance of sending tens of thousands of nurses onto the highways to drive drowsy every morning after night shift is unacceptable. There have been senseless injuries and deaths of nurses and of the driving public when a nurse who left the night shift fell asleep at the wheel. The NHTSA estimates that drowsy driving causes 72,000 crashes and 800 deaths per year. While the real number of fatalities is believed to be far higher, all are preventable, whether through proactive steps by nurses and employers or by the use of a drowsy-driving mitigation device. Nurses and employers need to act together to reduce this inevitable risk among night shift nurses.