Minimizing Turnover by Understanding What Night-Shift Nurses Need to Thrive

Hospitals rely on round-the-clock caregivers to seamlessly provide optimal patient care, yet the distinct challenges and pressures faced by night-shift nurses often remain in the shadows. A new qualitative study led by a Cleveland Clinic nurse highlights the unique demands of night-shift work and provides insight into how healthcare organizations can better support, engage and retain these essential caregivers.

Nurses who work the night shift face a range of pressures that can affect their health, performance and well-being, explains lead researcher Beth Ann Gunselman, MSN, CNP, RN, a nurse practitioner in the Department of Hospital Medicine at Cleveland Clinic Avon Hospital, a 126-bed community hospital.

The after-dark schedule can make it harder to maintain a healthy work-life balance and address family and personal responsibilities. A disrupted circadian rhythm puts night-shift nurses at risk of fatigue and sleep disorders.

In addition, reduced staffing levels and limited access to on-site resources during nighttime hours lead to changes in responsibilities and variations in the clinical workload. Nurses have voiced that responsibilities beyond patient care and the need to remain alert in a quieter, darker environment can create additional mental and physical strain.

The pathway to research

“The simple truth is that staying up all night is hard on a person,” Gunselman says. “I wanted to take a deeper dive into understanding the pain points and incentives that shape night-shift nurse job satisfaction and longevity. My thought was that by understanding and acknowledging night-shift nurses’ perceptions, we can be proactive in providing meaningful support, thereby ensuring consistent, high-quality patient care around the clock.”

Inspired by the many years she spent working nights, Gunselman conducted in-person interviews with 14 night-shift nurses. Participants were asked to describe their experiences and provide their perceptions of working the night shift.

Nurses weigh in

The interviews revealed several positive and negative factors affecting nurses’ job satisfaction, including staff turnover, managerial support, lack of access to clinical resources and personal scheduling conflicts. Teamwork was among the positive themes that repeatedly emerged during the interviews.

“It was clear that mutual support, trust and teamwork help reduce isolation and ensure safe, effective patient care at night, when fewer resources and staff are available,” explains Gunselman, who presented her findings at Cleveland Clinic’s annual 2025 Nursing Research Symposia.

“Several participants indicated that a benefit of working night shifts is the closeness that develops among nursing members and the help they provide one another when juggling patient care demands.”

Some participants said they valued the slower pace of the night shift, while others emphasized the hardships of working with a smaller overnight team.

Logistical concerns, such as accessing meals, obtaining supplies and coordinating care with colleagues, were described as being more complicated when fewer providers and resources were immediately available, Gunselman says.

Importantly, night-shift nurses expressed a desire for more meaningful interactions with unit leaders; they perceived that their concerns and accomplishments often received less recognition than those of their dayshift peers. Participants voiced a desire for nursing managers/leaders to acknowledge and appreciate the dilemmas faced by night-shift staff.

Since nurse leaders may be less likely to interact with night-shift teams, study participants suggested that managers develop team-building activities and intentional engagement strategies.

“When leaders acknowledge the emotional and practical demands of working the night shift and create space for open communication, nurses feel valued, supported and respected,” Gunselman says. “Recognizing and rewarding accomplishments — whether through formal awards, professional development opportunities or simple expressions of appreciation — can motivate staff and strengthen teamwork.”

Gunselman also emphasizes the importance of the hiring process, noting the benefits of selecting nurses who are naturally suited to night- shift work.

“During the interview process, managers should spend time focusing on verbalizations that reflect characteristics conducive to night- shift work,” she says. “It’s important to identify and potentially rule out nurses who view night-shift work as merely a stepping stone.”

Planning for the future

Although the “night owl” schedule can be arduous for some, Gunselman learned that many night-shift nurses actually prefer the overnight shift but would benefit from additional acknowledgement and support from leadership. She hopes the study’s findings prompt healthcare leaders to be more visible in fully embracing the value of overnight caregivers.

“Consciously and proactively investing in night-shift nurses may contribute to preserving a stable and satisfied workforce,” she adds.