LAUSR

AIMS AND OBJECTIVES This study explores newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed in order to understand what supportshould be provided. BACKGROUND For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management, and at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk. DESIGN AND METHODS Semi-structured interviews were conducted with nurses (N=11) from four different Swedish hospitals and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board inStockholm. The COREQ checklist was followed. RESULTS Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and non-executive cognitive function. CONCLUSION The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance in order to improve wellbeing among nurses and increase patient safety. RELEVANCE TO CLINICAL PRACTICE This study highlights the importance of addressing sleep and fatigue issues in nursing education andwork introduction programmesin order to increase patient safety and improve wellbeing among nurses.