Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Dr. Constance Glenn DNP, MSN, FNP-BC, CNE

Practice Mentor

Dr. Kassandra August-Marcuccio, RN, DNP


Background and Significance: Shift work including work schedules beyond the typical "nine-to-five," causes the disruption of sleep-wake behaviors (Healy et al., 2021). The circadian misalignment is a potential pathway for the development of metabolic diseases, excessive daytime sleepiness, sleep deprivation, and declines in alertness and performance among night shift workers (James et al., 2017; McHugh et al., 2020; Parry et al., 2018). Emerging evidence suggests that physical activity synchronizes the sleep-wake cycles (Healy et al., 2021).

Purpose: This quality improvement project (QI) aimed to improve night-shift nurses ‘subjective daytime sleepiness by incorporating a 4-week worksite walking activity during working hours.

Design: This QI used a pre-post-design to compare the subjective daytime sleepiness scores of the night shift nurses before and after the walking intervention (WI).

Methods: A convenience sample of 12 registered nurses (RNs) and nursing assistants (NAs) was identified from three in-patient units in the southern New England facility. The model of Improvement and a Plan-Do-Study- Act (PDSA) cycle were utilized to drive the QI. An Epworth Sleepiness Scale (ESS) survey was disseminated to the night-shift healthcare workers before and after the 4-week WI to evaluate the improvement of their subjective daytime sleepiness. The night-shift nursing staff walking activity was tracked using wrist-pedometers.

Results: Monitoring of the nursing staff’ subjective daytime sleepiness was continued for 3 months. There was a decrease in the nurses’ abnormal range of sleepiness from 33% at the beginning of the walking intervention (WI) to 16% post- WI.

Conclusions/Implications: This QI project did not induce a significant improvement but did create a decrease in subjective daytime sleepiness as well as a culture change among the night shift healthcare workers on the units at this facility where the WI was implemented.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

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Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.



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