Shift nurses’ social jetlag,anxiety, and premenstrual symptoms: A cross-sectional study

BackgroundAlthough rotating shifts are essential for nurses to ensure optimal patient care, rotating shifts expose them to an imbalanced circadian rhythm. Shift work leads to nurses experiencing diminished sleep quality, which affects their wakefulness and judgment, curtails work performance, and affects care quality.AimTo investigate the relationship among social jetlag, anxiety, and premenstrual symptoms in nurses working in 8-hour rotating shiftsMethodsParticipants were 194 shift-working nurses in three South Korean university hospitals from March 21 to April 2 in 2021. Chronotype and social jetlag were assessed using the Munich Chronotype Questionnaire for Shift Workers. Anxiety was measured with the State-Trait Anxiety Inventory X-1. Premenstrual symptoms were measured using the Shortened Premenstrual Assessment Form. This cross-sectional study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.FindingsAmong participants, the mean overall social jetlag was 3 hours 45 minutes. Hierarchical regression analysis revealed that social jetlag (on evening shift) and anxiety significantly influenced nurses’ premenstrual symptoms. Moreover, individuals’ chronotype and preference to work the night shift were identified as predictors of premenstrual symptoms.DiscussionNurses working on shifts are bound to experience greater social jetlag compared with the general population and are at an elevated risk of deteriorated quality of life. Nursing managers should consider individuals’ chronotypes and social jetlag when establishing shift schedules and identify strategies that relieve anxiety in nurses working in rotating shifts.ConclusionSocial jetlag and anxiety adversely affect premenstrual symptoms in female nurses working in 8-hour rotating shifts.     

Insomnia,anxiety, and heart rate variability among nurses working different shift systems in Taiwan

This cross‐sectional comparative study investigated the levels of insomnia, anxiety, and heart rate variability of nurses members working different shift systems. One hundred and twenty‐four participants were recruited from members of the nurses of two Taiwanese hospitals. Data were collected using the Chinese versions of the Athens Insomnia Scale and Beck Anxiety Scale questionnaires and electrocardiograms recorded immediately upon completion of each participant's work shift. A binary logistic regression model was used for analysis. Insomnia, anxiety, and abnormal parasympathetic activity were more acute in nurses who worked a rotating shift than in those performing day or night shift work. Logistic regression analysis showed that age significantly increased the incidence and level of insomnia. Age, years of service, and nurses’ status as a parent significantly intensified incidences of anxiety and abnormal parasympathetic activity. Rotating shift work is one of the main factors causing adverse effects on the physical and psychological health of nurses; therefore, when a shift work system cannot be avoided, a practice of day and night shifts for nurses is preferable to rotating shifts.     

Exercise,diet, and sleep habits of nurses working full-time during the COVID-19 pandemic: An observational study

BackgroundHealthy diet, exercise, and sleep practices may mitigate stress and prevent illness. However, lifestyle behaviors of acute care nurses working during stressful COVID-19 surges are unclear.PurposeTo quantify sleep, diet, and exercise practices of 12-hour acute care nurses working day or night shift during COVID-19-related surges.MethodsNurses across 10 hospitals in the United States wore wrist actigraphs and pedometers to quantify sleep and steps and completed electronic diaries documenting diet over 7-days.FindingsParticipant average sleep quantity did not meet national recommendations; night shift nurses (n = 23) slept significantly less before on-duty days when compared to day shift nurses (n = 34). Proportionally more night shift nurses did not meet daily step recommendations. Diet quality was low on average among participants.DiscussionNurses, especially those on night shift, may require resources to support healthy sleep hygiene, physical activity practices, and diet quality to mitigate stressful work environments.     

Impact of nurse staffing on intent to leave,job satisfaction,and occupational injuries in Korean hospitals: A cross‐sectional study

The purpose of this study was to examine nurse staffing in comprehensive nursing care units in Korea and examine the corresponding nurse outcomes, including intent to leave, job satisfaction, and occupational injuries. A total of 356 nurses working in comprehensive nursing care units at eight small‐medium sized Korean hospitals participated in this cross‐sectional study. In the day, evening, and night shifts, nurse staffing ranged from 9.00 to 24.82, 9.04 to 24.26, and 9.02 to 25.80, respectively. The nurse staffing on each shift did not have a significant impact on nurses? intent to leave, job satisfaction, and occupational injuries. However, workload had a strong relationship with intent to leave and job satisfaction. Voluntary overtime was related to occupational injuries. These findings demonstrate that workload is an important factor for intent to leave and job satisfaction among nurses working in comprehensive nursing care units. Improvements of the work environment, as well as rearrangement of nurse workload to account for patient acuity and nursing needs, are required for the future expansion of comprehensive nursing care services.     

2种排班模式护理人员满意度分析

目的 探讨护理人员对2种排班模式的满意度。方法 在同一病区对30名护理人员不同时期分别实施AN(A指日班,N指夜班)连续性排班结合周夜班(周夜班组)和AN连续性排班结合轮夜班(轮夜班组)各8个月。比较2组护理人员满意度。 结果 护理人员满意度得分均低于最低标准。周夜班组工作被称赞和认可、福利待遇得分高于轮夜班组,轮夜班组家庭和工作的平衡、排班得分高于周夜班组。 结论 AN连续性排班结合周夜班与AN连续性排班结合轮夜班的排班模式护理人员满意度均低,2种排班模式各有优势。     

Effects of working conditions on intravenous medication errors in a Japanese hospital

AIM: The aim of this study was to explore quantitatively which working conditions influence the occurrence of medical near-miss errors related to intravenous medication at a hospital in Japan. Background: Although working conditions such as stress, fatigue and inexperience have been reported to contribute to medical errors, countermeasures to these conditions have been delayed, and working conditions have deteriorated in many Japanese medical sites. METHODS: A self-reporting questionnaire analysing working conditions that can lead to near-miss errors relating to intravenous medication was sent to 90 nurses working in four wards of one Japanese hospital in 2001. Eighty-eight subjects responded (response rate: 97.8%). Among 534 person-days in which 88 nurses attended works, 525 person-days of data were used for the analyses. RESULTS: Among 525 person-days, the number of near-miss errors was 94 (17.9%). There was no significant difference in the occurrence of near-miss errors among the three shifts (day shift, 19.2%; evening shift, 19.2%; night shift, 12.5%). During the day shift, errors were reported at a significantly higher frequency when the nursing services were delayed longer due to workload. During the evening shift, errors were reported when the nursing services were delayed longer due to workload and when years of experience at the current ward were shorter. In addition, nurses whose perceived level of fatigue before work was lower during the day shift, and nurses whose years of experience as a nurse were longer and who had longer sleep duration during the evening shift experienced near-miss errors with a significantly higher frequency than other nurses. These latter factors could be important conditions that encourage the detection of errors before they occur. CONCLUSIONS: Workload and lack of experience at the current ward are two conditions that can lead to errors. Furthermore, lack of fatigue and long experience as a nurse may help encourage the detection of errors before they occur. It is important to improve working conditions so that health care workers can detect errors before patients are harmed and decrease the number of errors that occur.     

Associations between work schedule characteristics and occupational injury and illness

DE CASTRO A.B., FUJISHIRO K., RUE T., TAGALOG E.A., SAMACO‐PAQUIZ L.P.G. & GEE G.C. (2010) Associations between work schedule characteristics and occupational injury and illness. International Nursing Review 57 , 188–194 Background: Nurses often endure working irregular day, night and evening shifts as well as mandatory overtime (i.e. employer‐imposed work time in excess of one's assigned schedule). While these work characteristics are examined as potential risks for nurses' safety and health, it is not clear whether negative health impacts occur simply because of working long hours or in combination with other mechanisms. Aim: This study investigates how these work characteristics are associated with nurses' work‐related injury and illness over and above long work hours. Methods: In this cross‐sectional study, questionnaire data were collected from a sample of 655 registered nurses in the Philippines. Multiple logistic regression was used to assess associations of shift work and mandatory overtime with four work‐related health outcomes. Results: After weekly work hours, shift length and demographic variables were accounted for, non‐day shifts were associated with work‐related injury [odds ratio (OR) = 1.54; 95% confidence interval (CI): 1.07, 2.24] and work‐related illness (OR = 1.48; 95% CI: 1.02, 2.16). Also, frequency of working mandatory overtime was associated with work‐related injury (OR = 1.22; 95% CI: 1.06, 1.41), work‐related illness (OR = 1.19; 95% CI: 1.04, 1.37) and missing more than 2 days of work because of a work‐related injury or illness (OR = 1.25; 95% CI: 1.08, 1.44). Conclusions: These findings suggest that non‐day shifts and mandatory overtime may negatively impact nurses' health independent of working long hours. Mechanisms through which these work characteristics affect health, such as circadian rhythm disturbance, nurse‐to‐patient ratios and work–family conflict, should be examined in future studies.     

Nurses and shift work: effects on job performance and job-related stress

The purpose of this research was to examine the influence of day, afternoon, night and rotating shift schedules on the job performance and job-related stress of nurses. Registered nurses from five hospitals (n = 463) were surveyed using a structured questionnaire which measured both job performance and job-related stress. Analysis of data indicated that both the nurses' job performance and their job-related stress were related to the type of shift they worked. Overall job performance was highest for the nurses on the day shift, followed by the night, afternoon, and rotating shifts. Rotating shift nurses experienced the most job-related stress, followed in turn by the afternoon, day, and night shift nurses. The findings are interpreted within a conceptual framework which examines the social organization of work in the hospital by shift and the effects of shift work on biological rhythm synchronization.     

Night Shifts in Emergency Medicine: The American Board of Emergency Medicine Longitudinal Study of Emergency Physicians

Background

Night shift work is an integral component of the practice of emergency medicine (EM). Previous studies have demonstrated the challenges of night shift work to health and well being among health care providers.

Objective

This study was undertaken to describe the self-reported experience of emergency physicians regarding night shift work with respect to quality of life and career satisfaction.

Methods

The 2008 American Board of Emergency Medicine (ABEM) Longitudinal Study of Emergency Physicians (LSEP) was administered by mail to 1003 ABEM diplomates.

Results

Among 819 participants in the 2008 LSEP Physician Survey, most participants responded that night shift work negatively influenced job satisfaction with a moderate or major negative influence (58%; n = 467/800). Forty-three percent of participants indicated that night shifts had caused them to think about leaving EM (n = 344/809). Most participants responded that working night shifts has had mild negative effects (51%; n = 407/800) or major negative effects (9%; n = 68) on their health. Respondents were asked to describe how working night shifts has affected their health. Common themes included fatigue (36%), poor quality of sleep (35%), mood decrement/irritability (29%), and health maintenance challenges (19%). Among participants in the 2008 LSEP Retired Physician Survey, night shifts were a factor in the decision to retire for 56% of participants.

Conclusions

Emergency physicians report negative impacts of night shift work, including fatigue, poor quality of sleep, mood decrement, irritability, and health challenges. Night shifts have a negative influence on job satisfaction and can be a factor in the decision to retire.     

Self-reported sleep quality,strain and health in relation to perceived working conditions in females

Self-reported sleep quality, strain and health in relation to perceived working conditions in females The aims of this study were to examine self-reported sleep quality, perceived strain and health in relation to working conditions; the prevalence and severity of sleep disturbances and daytime distress arising from poor sleep in women on different work shifts. Furthermore, to see whether females with gastrointestinal symptoms, joint-, back- or muscle-pain and who are dissatisfied with working hours differ with regard to the above aspects. Finally, degree of strain-related symptoms and sleep difficulties were tested as predictors of sleep quality and general health outcome. Important research questions are whether registered nurses and those on rotating work shifts have greater sleep problems than others. A total of 156 females, aged 20-59 years, working at three different casualty departments, answered structured questionnaires. The results showed a persistently high rate of psycho-physiological long-term effects of stress related to working conditions. Thirty-four per cent were dissatisfied with their working hours, and exhibited significantly more mental strain, fatigue/excessive tiredness and inability to relax after work because of involuntary thoughts, in relation to working conditions than others did. Sixty-two females (39.7%) complained of insufficient sleep. The sleep quality outcome was significantly predicted by difficulty falling asleep (odds ratio 8.4), difficulty in falling asleep after nocturnal awakening (odds ratio 3.4) and perceived exhaustion (odds ratio 2.6). Females suffering from gastrointestinal symptoms and joint-, back- and muscle symptoms for several days in a week or even everyday were especially sensitive to worse sleep quality. Independent of work shifts, registered nurses exhibited a higher degree of mental strain and prolonged recovery in comparison with others. In conclusions, sleep initiation difficulties, troubled sleep and exhaustion significantly predicted reduced sleep quality outcome with decreased resilience to stress and vulnerability to psycho-physiological disorders in females working within the health care system.     

ICU护士工作反应时间现况及影响因素分析

目的 :比较可反映工作执行力的客观指标反应时间在ICU护士白、夜班上班前和下班后之间的差异及其影响因素。方法 :采用便利抽样法选取2家医院6个ICU的118名护士,通过自设一般资料问卷进行调查,使用精神运动警觉测试仪器实施测量。结果 :护士下班后(白班后为296.75 ms,夜班后为310.25 ms)反应时间均长于上班前(白班前为290.64 ms,夜班前为288.44 ms),夜班后(310.25 ms)长于白班后(296.75 ms),差异有统计学意义(P<0.05)。存在睡眠障碍的护士,夜班前(299.64 ms)及夜班后(363.33 ms)的反应时间均长于无睡眠障碍组(夜班前为285.56 ms,夜班后为306.40 ms)(P<0.05)。性别、孩子个数、医院工作年限、日工作时长、摄入咖啡因饮料、摄入甜品会对ICU护士上班前后反应时间产生不同程度的影响。结论 :建议护理管理者合理运用反应时间指标改善排班方法,识别其保护因素和危险因素,提高ICU护士工作执行能力。     

The effects of extended workdays on fatigue, health, performance and satisfaction in nursing

BACKGROUND: Several authors have claimed that 12-hour shifts in nursing are better for both employees and patient care. However, although the research has found positive effects on satisfaction with working hours and free time, the effects on employee fatigue, health and performance have mostly been neutral or negative. AIM: Work schedules should preferably be beneficial for satisfaction, fatigue, health and performance. This study therefore investigated whether shifts that are extended only slightly can combine the positive effects of the 12-hour shift with the positive effects of the 8-hour shift. The study investigated the effects of 9-hour shifts. METHOD: A total of 134 nurses from three nursing homes in the Netherlands completed a questionnaire on fatigue, health, performance and satisfaction. One group worked 8-hour shifts, and the other worked 9-hour shifts. RESULTS: Nurses who worked 9-hour shifts were on average more fatigued, had more health complaints, and were less satisfied with their working hours and free time than those who worked 8-hour shifts. Their performance was slightly poorer. About 70% to 80% of the 8- and 9-hour nurses preferred to work a maximum of 8 hours during morning/early and afternoon/late shifts. CONCLUSIONS: The 9-hour shift seemed to combine the negative aspects of the 12-hour shift with the negative aspects of the 8-hour shift. It is suggested that the 9-hour shift had more negative effects than the 12-hour shift because: (1) nurses could not choose what shift length they worked; (2) many worked part-time; and (3) they already had many days off. It is also suggested that increases in workload since the 1980s make current extended shifts in nursing more fatiguing.     

Occupational stress, job satisfaction, and working environment among Icelandic nurses: a cross-sectional questionnaire survey

BACKGROUND: Nurses' occupational stress decreases job satisfaction, increases turnover rate, and reduces nursing quality. At different workplaces nurses are confronted with different work tasks, working conditions and hence different sources of stress. OBJECTIVES: The purpose of this study was to explore what factors contribute to work-related stress among Icelandic nurses working within and outside the hospital environment. DESIGN: The study used a cross-sectional survey design. SETTINGS AND PARTICIPANTS: The study population was composed of all working nurses registered at the Icelandic Nurses' Association (INA). Approximately 95% (N=2,234) of Icelandic nurses are members of the INA. Questionnaires were posted to 522 (23.4%) randomly selected participants. The response rate was 42% (N=219), representing 9.8% of the population. Data was analyzed from 206 nurses; 35% worked outside the hospital setting and 65% were hospital based. METHODS: Data was gathered on demographic information and indicators of working conditions, occupational stress, workload, and job satisfaction. A stepwise, multiple linear regression model was employed to calculate significant predictors of occupational stress. RESULTS: The findings suggest that the strenuous conditions of Icelandic nurses are felt more severely among hospital nurses than among nurses working outside hospital settings. The study identified which sources of occupational stress are specific to each of the two groups. CONCLUSIONS: The study found several factors that contribute to work-related stress. These findings can be used to guide preventive measures to diminish occupational stress among Icelandic nurses.     

How to use light and dark to produce circadian adaptation to night shift work.

The circadian rhythms of night shift workers do not usually adjust to their unusual work and sleep schedules, reducing their quality of life and producing potentially dangerous health and safety problems. This paper reviews field studies of simulated night work in which shifted light-dark cycles were constructed with artificial bright or medium-intensity light to produce circadian adaptation, ie the shifting of circadian rhythms to align with night work and day sleep schedules. By using these studies we describe fundamental principles of human circadian rhythms relevant to producing circadian adaptation to night shift work at a level designed for the reader with only a basic knowledge of circadian rhythms. These principles should enable the reader to start designing work/sleep-light/dark schedules for producing circadian adaptation in night shift workers. One specific schedule is presented as an example. Finally, we discuss phase-response curves to light and clarify common misconceptions about the production of circadian rhythm phase shifts.     

Nurses' satisfaction with shiftwork and associations with work,home and health characteristics: a survey in the Netherlands

Title. Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands. Aim. This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. Background. Shiftwork contributes to health problems, decreased well‐being and poorer health habits. It also affects employees’ decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. Methods. A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. Results. All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics ‘job demands’ and the home characteristics ‘autonomy at home’ and ‘home demands’ were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. Conclusions. Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes.     

Effect of working consecutive night shifts on sleep time,prior wakefulness,perceived levels of fatigue and performance on a psychometric test in emergency registrars

Objective: To evaluate the effect of working consecutive night shifts on sleep time, prior wakefulness, perceived levels of fatigue and psychomotor performance in a group of Australian emergency registrars. Methods: A prospective observational study with a repeated within‐subjects component was conducted. Sleep time was determined using sleep diaries and activity monitors. Subjective fatigue levels and reciprocal reaction times were evaluated before and after day and night shifts. Results: A total of 11 registrars participated in the study with 120 shifts analysed. Sleep time was found to be similar during consecutive night and day shifts. The mean number of hours spent awake before the end of a night shift was 14.33. Subjective fatigue scores were worst at the end of a night shift. There was no difference in reciprocal reaction time between the end of night shift and the start of day shift. Conclusions: Registrars sleep a similar amount of time surrounding night and day shifts. Despite reporting the highest levels of fatigue at the end of a night shift, there is no significant difference in reaction times at the end of night shift compared with the beginning of day shift. This correlates with the finding that at the end of night shift the registrars have been awake for less than 16 h, which is the point at which psychomotor performance is expected to decline.     

Characteristics of shift work and their impact on employee performance and wellbeing: A literature review

ObjectivesTo identify the characteristics of shift work that have an effect on employee's performance (including job performance, productivity, safety, quality of care delivered, errors, adverse events and client satisfaction) and wellbeing (including burnout, job satisfaction, absenteeism, intention to leave the job) in all sectors including healthcare.DesignA scoping review of the literature was undertaken.Data sourcesWe searched electronic databases (CINAHL, MEDLINE, PsychINFO, SCOPUS) to identify primary quantitative studies.Review methodsThe search was conducted between January and March 2015. Studies were drawn from all occupational sectors (i.e. health and non health), meeting the inclusion criteria: involved participants aged ≥18 who have been working shifts or serve as control group for others working shifts, exploring the association of characteristics of shift work with at least one of the selected outcomes. Reference lists from retrieved studies were checked to identify any further studies.Results35 studies were included in the review; 25 studies were performed in the health sector. A variety of shift work characteristics are associated with compromised employee's performance and wellbeing. Findings from large multicentre studies highlight that shifts of 12 h or longer are associated with jeopardised outcomes. Working more than 40 h per week is associated with adverse events, while no conclusive evidence was found regarding working a ‘Compressed Working Week’; working overtime was associated with decreased job performance. Working rotating shifts was associated with worse job performance outcomes, whilst fixed night shifts appeared to enable resynchronisation. However, job satisfaction of employees working fixed nights was reduced. Timely breaks had a positive impact on employee fatigue and alertness, whilst quick returns between shifts appeared to increase pathologic fatigue. The effect of shift work characteristics on outcomes in the studies reviewed is consistent across occupational sectors.ConclusionsThis review highlighted the complexity that encompasses shift work, but many studies do not account for this complexity. While some consistent associations emerge (e.g. 12 h shifts and jeopardised outcomes), it is not always possible to conclude that results are not confounded by unmeasured factors.     

Self-assessed occupational health and working environment of female nurses, cabin crew and teachers

AIM: The aim of this study was to describe and compare the self-assessed occupational health among female nurses, cabin crew and teachers, in relation to their working environment. Background: Similarities between the three occupations, i.e. predominantly female and service-oriented, render them interesting in comparison with respect to health and working environment. METHODS: The participants were female Icelandic cabin crew, nurses and elementary school teachers. A questionnaire including items on socio-demographics, working environment (addressing work pace, job security, monotonous work, assistance, physically strenuous work and physical environmental factors) and a symptom list was used for data collection. Factor analyses on the symptom list resulted in five symptom scales: Musculoskeletal, Stress and exhaustion, Common cold, Gastrointestinal and Sound perception scale. A total of 1571 questionnaires were distributed. The response rate was 65.7-69%, depending on occupation. Data were collected in 2002. RESULTS: Cabin crew reported worse gastrointestinal, sound perception and common cold symptoms than nurses and teachers. Cabin crew and teachers reported worse symptoms of stress and exhaustion than nurses (p < 0.05). When compared with teachers and nurses cabin crew reported less job security and more physically strenuous and monotonous work. Nurses were likelier to seek assistance from co-workers or patients as well as to take care of an older relative than teachers and cabin crew. Regression analysis found that within each occupation distress from environmental factors resulted in higher score on all the symptom scales. CONCLUSIONS: Nurses experience less stress and exhaustion than teachers and cabin crew. In comparison with one or both of the other occupations nurses are more likely to assist each other with their work, experience job security, reporting physically complex work and take care of older relatives. This should be highlighted as positive aspects of nurses' work praised as displaying responsibility and interconnectedness of nurses'.     

护士工作倦怠与身心健康、工作满足感相关性的调查研究

目的探讨护士工作倦怠与身心健康、工作满足感的关系。方法采用Maslach工作倦怠量表、心身症状量表、工作满足感量表对245名护士进行问卷调查,并对结果进行分析。结果(1)护士情绪疲惫与个人成就感呈中度倦怠、去人格化呈低度倦怠,身心健康水平、工作满足感呈中度水平。(2)护士情绪疲惫、去人格化与身心健康呈正相关(r=0.459,r=0.180,P<0.01),与工作满足感呈负相关(r=-0.284,r=-0.208,P<0.01),个人成就感与工作满足感呈正相关(r=0.303,P<0.01),与身心健康无显著相关性。(3)多元线性逐步回归分析显示,情绪疲惫是身心健康的主要预测因子、个人成就感与情绪疲惫是工作满足感的主要预测因子。结论护士工作倦怠影响身心健康与工作满足感。