Shift Work - A Necessary Evil

It’s known that people who work shift work — particularly rotating shifts – tend to get sick more easily than those who work so-called "normal hours." With our changing society and want/need to have things going 24 hours a day, seven days a week, more people than ever are working evening and night shifts. Few know what it’s like to work nights than nurses, though.

According to an article published today in the American Journal of Preventive Medicine, approximately one-fifth of all workers in the US work some sort of shift work and up to half of all hospital employees work shifts.

Those of us who have worked night shifts can relate to sleep difficulties, fatigue, increased stress levels and even difficulty eating that result. Some of the problems can be directly related to working nights — such as disturbing the circadian rhythm, making sleep more difficult, but other problems aren’t quite as obvious, like problems eating or digesting food. Many nurses lose their appetite when working shift work, while others are always hungry and may not always make the healthiest food choices.

There have been studies that show a relationship between night shifts and health issues, including an increased risk of accidents — both at work and at home – because of fatigue, exhaustion, or slower reaction times. How many nurses driving home at night haven’t felt at one time or another that they shouldn’t really be driving? How many night nurses haven’t found their minds a bit muddled when trying to make a simple arithmetic calculation at 2:00AM?

But if we look beyond health issues involved in working shifts, we see that there are other concerns. The authors of this article call one “social desynchronization.” This social desynchronization makes it difficult for shift workers to properly and effectively balance their work and family lives. In a study conducted in Sweden, researchers found that workers who weren’t able to reach a good work-life balance reported worse health than those whose lives were balanced. So even an issue that doesn’t seem related to health does end up affecting health after all.

While redesigning the night shift may be feasible in the manufacturing environments, is it feasible in the healthcare system? Most hospitals have tried the standard interventions, such as educating nurses how to better manage their health, but have they tried other options that could help?

One such option, according to the study authors, is decreasing the night shift length — something that goes against the ever increasing popularity of 12-hour shifts. Many nurses love the 12-hour shift option, others hate it. How does an administration keep everyone happy?

In many institutions, nurses work one shift: permanent nights, evenings, or days. Or, if they work 12-hours shifts: days or nights. Two studies examined this method and came up with different results. In one of over 200 people, although the quality of sleep improved in the workers who worked a permanent shift, there were no changes in the affects on health (fatigue, appetite, general health). The second study involved only 63 people and the results showed an improvement in health, as well as an improvement in the quality of sleep.

Since we don’t have a choice and we know that night shifts are a must in nursing, is self-scheduling the answer? In self-scheduling, nurses have much more control over when they work, as long as all the shifts are covered and shared fairly. The self-scheduling model doesn’t reduce the number of night shifts worked, but it allows for more flexibility. In two studies mentioned in this article, workers who self-scheduled showed an improved health and work-life balance overall. Complaints of fatigue and worker absence dropped.

Obviously there are no definitive answers to the problems that face shift workers. But as it becomes more difficult to attract nurses to the profession and even more difficult to retain them, perhaps finding some sort of solution should be a priority.