A sleep expert says a new model is needed to manage nurses' shift work and fatigue-related risk.
Massey University's Sleep/Wake Centre found one in three nurses have fallen asleep at the wheel while driving home from work.
The centre's director Professor Philippa Gander told Morning Report nurses' shifts could be better managed to make it safer for them and their patients through a code of practice.
Changes to rostering and the approaches to managing the risk in different medical settings were needed, she said.
"If you have a nurse who is suffering from the effects of sleep loss and being on a series of night shifts working at the wrong time she or he is not going to be able to function as well as they would if they were fully rested and working during the day," she said.
The report also noted that "after 5 years, nurses working nights have significantly higher mortality rates from all causes and from cardiovascular disease. After 15 years of night work, nurses have a higher risk of death from lung cancer and ischemic stroke. With increasing years of night work, there is also a linear increase in risk of type 2 diabetes that appears to be partly mediated through increasing body weight, a linear increase in the risk of breast cancer, and an increased risk of colorectal cancer risk after 15 years."
"So how do we manage the risk? The risks are very different if you are in ICU and you have a patient who is sedated you are in a highly technical procedurised environment and there's plenty of help around you versus being a mental health nurse who has unpredictable patients who may be up and about all night doing things that you've got no idea what is going to happen next."
A new model was needed, she said, combining the expertise of nurses in different practice areas with sleep science knowledge and hospital managers' needs.