Wake Up Call: A Qualitative Study of Nursing and Medical Managers' Perceptions and Support for Nurses' Night Shift Napping in Intensive Care Units.

Background: Night shift work in healthcare settings is associated with increased fatigue, decreased alertness and potential risks to patient safety. While nurses napping during night shifts has been proposed as a strategy to mitigate these effects, its implementation remains controversial and understudied from a managerial perspective.

Aim: This study aimed to explore nursing and medical managers' perceptions of, and support for nurses' night shift napping policies in intensive care units.

Study design: A qualitative descriptive approach was employed from the beginning of March 2024 to the end of October 2024, utilising semi-structured interviews with 40 nursing and medical managers from various intensive care units. Participants were purposively sampled to ensure diversity in experience and department. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

Results: Five main themes emerged: (1) Understanding perceptions of night shift napping, (2) perceptions of the benefits of night shift napping, (3) assessing support for night shift napping, (4) barriers and challenges of applying napping strategies and (5) developing effective implementation strategies to facilitate the successful adoption of napping policies. While most managers acknowledged the potential benefits of night shift napping, they expressed apprehension about its practical implementation, staff coverage concerns and the potential for policy abuse. Supportive managers emphasised the importance of education, structured guidelines and gradual cultural change to successfully integrate napping practices.

Conclusion: The findings suggest that while there is growing recognition of the potential benefits of night shift napping, significant barriers to implementation persist. The results can inform the development of evidence-based napping policies and guide strategies to address managerial concerns, ultimately improving night shift working conditions and patient care quality.

Relevance to clinical practice: Researching the perceptions and support of nursing and medical managers for night shift napping in ICUs is relevant to clinical practice, as it can provide insights into the potential benefits, challenges and strategies for implementing such policies. These findings may ultimately improve patient safety, staff well-being and quality of care.