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

Effects of single- and double-shift work on hand and cognitive functions in nurses

AIM

This study aims to examine the influence of single and double-shift work schedules on hand function and cognitive capacities, specifically working memory, attention, and response time in nurses.

BACKGROUND

Shift work, particularly in extended formats, is known to affect various physical and cognitive functions critical to nursing duties. Understanding these impacts is vital for managing nurse schedules to minimize health risks and maximize performance.

INTRODUCTION

With an increase in demands on healthcare systems, nurses often endure prolonged working hours, which may impair their cognitive and manual abilities, thereby affecting patient care quality.

METHODS

This study involved 45 nurses aged 20-40 years from shift-oriented units providing direct patient care. Hand function was assessed using the Nine-Hole Peg Test (9-HPT). Cognitive functions such as working memory, attention, and response time were evaluated using the digit span task and the Stroop test, respectively. Two-way analysis of variance (ANOVA) was used for statistical analysis, assessing the interactions of time and shift type, with a significance level set at p < 0.05.

RESULTS OR FINDINGS

The results revealed significant changes in all tested variables between pre- and post-shift assessments and between single and double-shift conditions. Notably, the double-shift work significantly exacerbated declines in all measured functions.

DISCUSSION

These findings suggest that double shifts may intensify the deterioration of essential nursing skills, potentially compromising patient care.

CONCLUSION AND IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

This study underscores the detrimental effects of extended shift work on nurses' cognitive and manual functions. These insights should guide healthcare institutions in revising nurse scheduling practices to safeguard their well-being and maintain high standards of patient care.

Education and training in neurology: developments and future challenges

BACKGROUND AND PURPOSE

Training and education is essential for best practice medicine and is especially important in a rapidly evolving field such as neurology. Due to improved imaging techniques and laboratory testing, there is a better understanding of the pathophysiology of diseases. As a result more treatments have become available. The most important developments in neurology over the last two decades and their effect on training and education are described. In addition, how future training should be aware of the challenges ahead of us is described.

METHODS

This is a narrative review describing developments and challenges based on personal experience and the literature.

RESULTS

Due to major developments in radiological and immunological testing, major changes have been seen in different subspecialties of neurology, including but not limited to, the treatment of ischaemic stroke, the development of new entities in the field of demyelinating diseases and auto-immune encephalitis, and diffuse glioma. These developments challenge the education and training in neurology with, ahead of us, technological developments, an aging population, and potentially more superspecialization.

CONCLUSION

Although there are differences in the training curricula between European countries, the developments and future challenges within the field of neurology are very similar. In the development of future curricula it is important to face these developments and challenges and to adapt to them.

More Than Just a Pain in the Back: Pain Among American Nurses and Its Relationship to Modifiable Work Factors and Work Performance

Nursing is a profession with high rates of workplace injuries, hazards, and turnover. Improving the health and safety of nurses at work is vital to retain and grow the workforce to meet future demands. The purpose of this study was to describe the breadth of pain among American nurses and explore the relationships between this pain and modifiable work factors and perceived work performance. We used a cross-sectional descriptive design of 2312 nurses from across the United States. Nurses completed a survey containing questions about demographics, the presence of pain in the past week, the number of pain sites, pain locations, severity, and the impact on work performance. The median number of pain locations reported was 2, back pain was the most reported pain site, and average pain severity ranged from 4 to 5. Significant modifiable work factors associated with pain were average patient load and shift length. Many participants indicated that their pain impacted work performance, while a smaller proportion acknowledged that their pain impacted patient care. Pain among nurses spans multiple locations, is moderately severe, and impacts work performance. Addressing related modifiable work factors may decrease pain and the impact on the health, safety, and work performance of the nursing workforce.

The Effect of Meal Frequency and Glycemic Index During the Night Shift on Alertness, Hunger, and Gastrointestinal Complaints in Female Health Care Workers-A Two-Armed Randomized Crossover Trial

BACKGROUND

Nutrition strategies for night-shift workers could optimize alertness and minimize hunger and reduce gastrointestinal complaints, enhancing safety and well-being.

OBJECTIVES

This study aimed to investigate the effects of 1 or 3 small meals, with either low or high glycemic index (GI), compared with no meal, on alertness, hunger, and gastrointestinal complaints during the night shift.

METHODS

Fifty-one female health care workers, aged 18 to 61 y, participated in a 2-armed randomized crossover design. In 1 study arm, participants received 1 yogurt meal during the night shift, AND in the other, they received 3. Each study arm involved 3 intervention periods during night shifts, with participants consuming yogurt with low GI (1LGI or 3LGI) OR high GI (1HGI or 3HGI) carbohydrates, or no meal (0NGI). Objective alertness was assessed using a validated brief psychomotor vigilance task (PVT-B), subjective alertness with the Samn-Perelli scale, and hunger and gastrointestinal complaints through questionnaires.

RESULTS

Participants in the 1LGI (β: -4.6; 95% CI: 0.0, 9.3) and 3LGI (β: -3.4; 95% CI: 0.0, 6.8) conditions had fewer lapses during the PVT-B than those in the 3HGI condition. No differences were found between meal conditions for median and reciprocal reaction time or subjective alertness. All 4 conditions reported less hunger (β: from -0.6 to -1.2) compared with no meal. The 3LGI condition resulted in more rumbling intestines than the 3HGI (β: 1.1; 95% CI: 0.4, 1.7) and 0NGI (β: 0.74; 95% CI: 0.11, 1.37) conditions.

CONCLUSIONS

Our study suggests that consuming 3 small low GI meals during the night shift helps maintain alertness and reduces lapses compared with 3 high GI meals. It also minimizes hunger but may cause mild gastrointestinal complaints. This trial was registered at International Clinical Trial Registry (https://trialsearch.who.int/Trial2.aspx?TrialID%3dNL-OMON25574).

Balancing act: exploring work-life balance among nursing home staff working long shifts

BACKGROUND

Nursing home staff often face challenges in achieving a satisfactory work-life balance, particularly because of the nature of shift work. While long shifts offer extended periods off work, their impact on the delicate balance between work and leisure remains understudied in the context of nursing homes. This study investigated the experiences of nursing home staff in Norway working long shifts lasting 12-14 h and their perceptions of the balance between family life and work.

METHODS

Eighteen nursing home staff members were interviewed following a semi-structured qualitative approach. The participants worked in three types of long shifts and provided insights into their experiences, addressing issues such as work hours, shift patterns, and work-family balance.

RESULTS

The study revealed four main categories: (1) impact of long shifts on family life-the highs and lows; (2) maximizing time off with long shifts; (3) reducing job stress with long shifts; and (4) full-time work leads to predictable hours and stable income. The participants emphasised the distinct separation between work and leisure during long shifts, acknowledging limited social life during working periods but appreciating extended periods off. Family life posed challenges, especially with young children, but the participants found benefits in the longer periods of family time during days off. Longer rest periods and reduced commuting time were perceived as advantages of long shifts, contributing to better sleep, reduced stress and overall well-being. Long shifts also allowed for more predictable working hours and income, supporting a stable work-life balance.

CONCLUSION

Balancing work and family life involves more than just the number of hours spent at work; it also encompasses the quality of those hours both at work and at home. Our findings underscore the complex interplay between work and family life for nursing home staff working long shifts. While challenges exist, benefits such as extended time off, improved sleep, reduced stress, and predictable working hours contribute positively to their work-life balance. Long shifts in nursing homes offer a unique perspective on achieving work-life balance, revealing both the challenges and advantages inherent in such schedules. Understanding the experiences of nursing home staff in this context can inform future innovations in shift scheduling, promoting a more balanced and sustainable work environment for healthcare professionals. For some healthcare staff, extended shifts can lead to a better work-life balance.

A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 1: demographic and work-related factors

Occupational stressors are commonly encountered in small animal veterinary practice and have been associated with burnout. The working context of veterinarians differs by specialty, and this can potentially lead to variable exposures to risk factors for burnout. The aim of this study was to explore differences in demographic and working conditions of veterinary general practitioners (GPs) and emergency practitioners (EPs) to compare exposure to different potential stressors. An anonymous, online survey was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 participant responses were analyzed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Significant differences (P < 0.05) in the demographics and work-related exposures were found between the two groups. GPs were found to be older than EPs with a greater number of years of experience in their field (P < 0.001). Most veterinary GPs worked only day shifts (207/236, 87.7%); where EPs worked a greater variety of shift patterns, with "only day shifts" being the least common shift pattern (P < 0.001). Most GPs worked a set and predictable roster pattern (195/236, 83.6%), while most EPs did not (51/83, 61.5%). EPs worked more weekends and public holidays (P < 0.001). The EP group performed more hours of work each week but worked less overtime. The main contributing factors for overtime were scheduling factors for GPs and staffing issues for EPs. EPs were commonly not able to take meal-breaks and GPs' meal-breaks were commonly interrupted by work. EPs were more frequently exposed to patient death, euthanasia (including for financial reasons), emotionally distressed clients and delivering negative news (P < 0.001). Both groups indicated that most work environments were collegiate and supportive, and a minority reported toxic colleagues (11.8%) or management teams (26.9%). Just under one-half of respondents reported having witnessed or experienced workplace bullying. Of our respondent group, 52.0% (166/319) were not satisfied with their remuneration. Desire to leave their principal area of practice was prevalent among this survey group (192/319, 60.2%) with approximately one-third considering leaving the veterinary profession. We discuss the implications of these workplace factors, including mitigation strategies.

Assessment of metacognition and retinal optical coherence tomography findings in shift workers

It is known that working in the shift system, especially the night shift, affects physical, mental, and social well-being. We investigated the changes in the inner retinal layers and choroidal layer of the eyes of nurses working night and day shifts using optical coherence tomography (OCT). We also explored the effect of night shift work on metacognition and the relationships between these variables. A total of 79 nurses participated in the study, of whom 40 worked night shifts. The researcher gave the participants sociodemographic information and the Metacognition Questionnaire-30 (MCQ-30) form. Retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL) thickness, inner nuclear layer (INL) thickness, inner plexiform layer (IPL) thickness, central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were measured with OCT. It was found that the level of metacognitive activity associated with cognitive confidence was higher (p = 0.044) for nurses who worked night shifts and that the level of metacognitive activity associated with cognitive awareness was lower (p = 0.015) for nurses who worked night shifts. RNFL-nasal superior (NS) thickness was lower in night shift workers than the day shift group (p = 0.017). Our study revealed significant relationships between metacognition and the OCT findings among night and day shift workers. Our study revealed that RNFL measurements and metacognitive activity may differ and there may be a relationship between these parameters in nurses who work shifts. Further research is needed to investigate the long-term effects of night shift work on retinal health.

The important factors nurses consider when choosing shift patterns: A cross-sectional study

AIM

To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time.

DESIGN

A cross-sectional survey of nursing staff working across the UK and Ireland collected quantitative and qualitative responses.

METHODS

We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis.

RESULTS

Eight hundred and seventy-three survey responses were collected. When nurses worked long shifts and rotating shifts, lower proportions reported being satisfied with their shifts and working their preferred shift length and pattern. Limited advantages were realised when comparing different shift types; however, respondents more frequently associated 'low travel costs' and 'better ability to do paid overtime' with long shifts and 'healthy diet/exercise' with short shifts; aspects related to rotating shifts often had the lowest proportions of agreement. In the qualitative analysis, three themes were developed: 'When I want to work', 'Impacts to my life outside work' and 'Improving my work environment'. Reasons for nurses' shift preferences were frequently related to nurses' priorities outside of work, highlighting the importance of organising schedules that support a good work-life balance.

RELEVANCE TO CLINICAL PRACTICE

General scheduling practices like adhering to existing shift work guidelines, using consistent and predictable shift patterns and facilitating flexibility over working time were identified by nurses as enablers for their preferences and priorities. These practices warrant meaningful consideration when establishing safe and efficient nurse rosters.

PATIENT OR PUBLIC CONTRIBUTION

This survey was developed and tested with a diverse group of stakeholders, including nursing staff, patients, union leads and ward managers.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross-sectional studies was used to guide reporting.

Exploring the relationship between family care, organizational support, and resilience on the professional quality of life among emergency nurses: A cross-sectional study

BACKGROUND

The professional quality of life (ProQOL), encompassing emotional, physical, and psychological well-being, is profoundly influenced by the unique nursing experiences of emergency nurses. Understanding and effectively enhancing their professional well-being are of paramount importance. This study aimed to explore the relationship between family care, organizational support, and resilience with the ProQOL among emergency nurses.

METHODS

This cross-sectional study, conducted between May 1 and June 1, 2023, involved 118 emergency nurses from Hunan Provincial Brain Hospital. Demographic and work-related information were collected. ProQOL, family care, organizational support and resilience were assessed using validated scales. Statistical analysis was conducted to examine the associations between these variables.

RESULTS

Significant differences were observed in the two dimensions of ProQOL (compassion satisfaction and burnout) among emergency nurses with different age, marital status, technical titles, work experience and night shift frequency (P < 0.05). Furthermore, both organizational support and resilience demonstrated a significant positive correlation with compassion satisfaction, while exhibiting a significant negative correlation with burnout (P < 0.05). Additionally, the third dimension of ProQOL (secondary trauma stress) was significantly negatively correlated with resilience (P < 0.05).

CONCLUSION

This study elucidates the pivotal role of organizational support and resilience in influencing the professional quality of life among emergency nurses, highlighting the specific needs of younger and less-experienced practitioners. Our findings lay the groundwork for targeted interventions aimed at enhancing the occupational well-being and job satisfaction of nursing staff.

Effects of working conditions on the perception of night work safety and health effects on nurses

AIM

To examine night working conditions by shift work type and identify the effects of night working conditions on nurses' perceptions of shift work safety and health effects.

BACKGROUND

Night work is the main factor affecting nurses' health. However, the safety of night working conditions has not been sufficiently examined in previous studies.

METHODS

This study used a cross-sectional research design and an online survey using a tool released by the Australian Manufacturing Workers' Union, and the responses of 348 shift work nurses in Korea were analyzed. Logistic regression analysis was used to examine the effects of shift work conditions on the perceived safety of night work and health effects. The STROBE reporting guidelines were utilized, and data were collected from December 1 to December 31, 2021.

RESULTS

The adjusted logistic regression analysis showed that perceived threat to safety and the health effects of shift work were not significant according to shift type. However, night-shift-work nurses who worked alone (P = 0.003), lacked an emergency recovery system (P = 0.026), and had difficulty commuting perceived a threat to their health (P = 0.007). Additionally, nurses who experienced loss of concentration (P = 0.006) and inadequate rest time (P < 0.001) perceived the health effects of shift work.

DISCUSSION

Urgent monitoring of night work conditions is necessary for the 2-shift work type. Nurses must work night shifts together and an emergency system should be established for their safety.

CONCLUSION

Night work conditions should be improved to prevent the hazards of night work and its negative health effects on nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study suggests the necessity of a policy to enhance night work safety, including emergency coping systems and sufficient inter-shift rest time.

Work-Related Health Conditions Among American Nurses: A Scoping Review

Background

Working in the nursing profession is hazardous, and nurses report poor health. Risk factors associated with poor health outcomes have been documented. However, the extent of literature exploring the prevalence of health conditions among American nurses that may be attributable to their work has not been examined.

Method

A scoping review following the Joanna Briggs Institute recommendations was conducted of peer-reviewed quantitative studies to answer the question: What are health conditions experienced by American nurses that may be attributable to their work as nurses?

Results

Thirty articles met the inclusion criteria. Due to the methods used in many articles, studies of the prevalence of health conditions among the nursing population were lacking. Health conditions studied broke into six categories: (a) work-related injuries and hazards; (b) unhealthy lifestyles; (c) mental health conditions; (d) burnout; (e) fatigue, sleep, and migraines; and (f) reproductive health. The role of work in the health conditions studied varied from an immediate impact on health (e.g., a needlestick or injury) to a cumulative impact (e.g., scheduling or workplace demands). Within the work demands, the physical environment; physical, emotional, and cognitive demands of work; and shiftwork were all frequently identified as antecedents that could be further explored and addressed to improve nurse health.

Conclusions

Healthcare systems should seek to address the hazards and exposures that may be linked to health conditions in the nursing workforce. Understanding and mitigating the impact of the pandemic and nursing work on the workforce's health is crucial to the solvency of the workforce. Occupational health practitioners should assess for workplace hazards and exposures.

What Factors Contribute to Ethical Problems in Patient Care? A Scoping Review and Case Series of Clinical Ethics Consultations

AbstractBackground: Healthcare professionals (HCPs) are frequently exposed to ethical problems in patient care that can affect the quality of care. Understanding risk factors for ethical problems may help practitioners to address these problems at an early stage. This study aims to provide an overview of ethical risk factors in patient care. Risk factors known from the literature and those found in clinical ethics consultation (CEC) cases are reviewed.

METHODS

A scoping review of ethical risk factors in patient care and a CEC case series were conducted, analyzing the documentation (consultation reports, feedback forms, electronic medical records) of 204 CECs from 2012 to 2020 at a somatic and a psychiatric university hospital in Basel, Switzerland.

RESULTS

Ninety-nine ethical risk factors were identified in nine articles, related to four risk areas: patient (41), family (12), healthcare team (29), and system (17). Eighty-seven of these risk factors were documented at least once in the CEC case series. The most prevalent risk factors in the consultations studied were patient vulnerability (100%), missing or unclear hospital ethics policy (97.1%), shift work (83.3%), lack of understanding between patient and HCP (73.5%), poor communication (66.2%), disagreement between patient and HCP about care (58.8%), and multiple care teams (53.4%). The prevalence differed significantly by medical specialty.

CONCLUSIONS

There are highly prevalent ethical risk factors at all levels of clinical care that may be used to prevent ethical problems. Further empirical research is needed to analyze risk ratios and to develop specific risk profiles for different medical specialties.

Examining the Impact of Burnout on Hospital Nurses Engaged in Shift Work: Insights From a Nationwide Cross-Sectional Study in Malaysia

Introduction

Shift workers follow nonstandard schedules that encompass overnight duty, rotational timetables, or permanent night work which can lead to misaligned core circadian physiology. Shift work has been associated with sleep deprivation, burnout, and metabolic syndrome among healthcare workers.

Objective

We aimed to examine if shift nurses working in Malaysian public hospitals are more predisposed to burnout and to determine the predictors of burnout in this profession.

Method

This national-level cross-sectional study was conducted among nurses in public hospitals in Malaysia between July and November 2019 using self-administered questionnaires. Maslach Burnout Inventory-Human Service Survey was used to determine burnout. Multistage stratified sampling was used to recruit nurses from 32 hospitals. A complex sampling analysis was performed.

Results

Among the 1,491 hospital nurses, more than half (70.8%) of them followed shift work schedules. Shift nurses were mostly below 40 years old (80.9%), diploma holders (87.2%), and of lower professional grades (64.2%). The prevalence of overall burnout, as well as the domains of emotional exhaustion and depersonalization, was higher among shift nurses (27.1%) as compared to their counterparts (22.4%). Nurses who performed more than six night shifts per month were 2.6 times more predisposed to burnout.

Conclusion

Shift work is integral to ensure round-the-clock nursing care for patients. However, nurses are increasingly faced with more shift duties due to heavy patient loads and staff shortages. Modified work schedules must be implemented to provide sufficient rest time for shift nurses to mitigate burnout. Additionally, proper human resource projection and distribution are imperative to prevent worsening burnout.

Delaying circadian sleep phase under ultradian light cycle causes time-of-day-dependent alteration of cognition and mood

Light exerts powerful and pervasive effects on physiology and behaviour. These effects can be indirect, through clock synchronization and phase adjustment of circadian rhythms, or direct, independent of the circadian process. Exposure to light at inappropriate times, as commonly experienced in today's society, leads to increased prevalence of circadian, sleep and mood disorders as well as cognitive impairments. In mice, exposure to an ultradian 3.5 h light/3.5 h dark cycle (T7) for several days has been shown to impair behaviour through direct, non-circadian, photic effects, a claim we challenge here. We first confirmed that T7 cycle induces a lengthening of the circadian period resulting in a day by day phase-delay of both activity and sleep rhythms. Spatial novelty preference test performed at different circadian time points in mice housed under T7 cycle demonstrated that cognitive deficit was restrained to the subjective night. Mice under the same condition also showed a modification of stress-induced despair-like behaviour in the forced swim test. Therefore, our data demonstrate that ultradian light cycles cause time-of-day-dependent alteration of cognition and mood through clock period lengthening delaying circadian sleep phase, and not through a direct photic influence. These results are of critical importance for the clinical applications of light therapy in the medical field and for today's society to establish lighting recommendations for shift work, schools, hospitals and homes.

Effects of shift work schedules, compensatory sleep, and work-family conflict on fatigue of shift-working nurses in Chinese intensive care units

BACKGROUND

Shift work is inevitable for nurses in intensive care units. Various studies explored nurses' fatigue in multiple hospital wards. However, few studies focused on fatigue among nurses in intensive care units.

AIMS

To determine the association between shift work schedules, compensatory sleep, work-family conflict, and fatigue of shift-working nurses in critical care units.

STUDY DESIGN

A descriptive cross-sectional multi-center study was conducted in March 2022 among intensive care nurses from five hospitals.

METHODS

Data were collected by online survey, including self-designed demographic questions, the Fatigue Scale-14, the Chinese adult daytime sleepiness scale, and the work-family scale. Pearson correlation was conducted for bivariate analysis. Independent-sample t-test, one-way ANOVA, and multiple linear regression analysis were performed to examine fatigue-related variables.

RESULTS

A total of 326 nurses responded to the survey with an effective response rate of 74.9%. The mean scores of physical fatigue and mental fatigue were 6.80 and 3.72, respectively. The bivariate analyses showed that work-family conflict was positively correlated with physical (r = 0.483, p < .001) and mental fatigue (r = 0.406, p < .001). Multiple linear regression results showed that work-family conflict, daytime sleepiness, and shift system were statistically significant factors influencing physical fatigue (F = 41.793, p < .001). Work-family conflict, sleep duration after the night shift, and daytime sleepiness were the main influencing factors of mental fatigue (F = 25.105, p < .001).

CONCLUSIONS

Nurses with higher work-family conflict, daytime sleepiness, and working 12-h shifts have higher levels of physical fatigue. Higher work-family conflict, shorter sleep duration after night shifts, and daytime sleepiness are associated with higher mental fatigue among intensive care nurses.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers and nurses should consider work-family factors and compensatory sleep in their efforts to reduce fatigue. It is necessary to strengthen work-supporting strategies and compensatory sleep guidance for nurses to promote fatigue recovery.

Food safety culture maturity and its relation to company and employee characteristics

Three facets of food safety culture (FSC) (i.e., food safety management system (FSMS), human-organizational and human-individual building block), were diagnosed through a validated mixed-method assessment in twenty food processing companies. Many underdeveloped dimensions were detected in the FSMS and the human-organizational building block, while the human-individual building block was more mature. It was explored whether company (e.g., company size) and employee characteristics (e.g. leaders vs. non-leaders) are associated with FSC maturity (based on 1410 employee responses) through a cluster analysis and statistical (Mann-Whitney U and Kruskal-Wallis) tests. Results revealed significant differences (p-value <0.05) based on company characteristics (significant differences based on: size, belonging to a larger group, product type, place in the supply chain, training frequency, certificates, maturity of control and assurance activities) and employee characteristics (significant differences based on: leaders vs. non-leaders, daily direct contact with food or not, seniority, time since training and psychosocial well-being). These findings are useful to develop tailored food safety culture improvement interventions to enhance the maturity of food safety culture in food companies, as these might focus on lower perceiving (sub)groups of employees or lower perceiving (sub)groups of companies.

Work-schedule management in psychiatric hospitals and its associations with nurses' emotional exhaustion and intention to leave: A cross-sectional multicenter study

BACKGROUND

Managing nurses' work schedules in hospitals is challenging because employer needs, like shift changes at short notice and overtime, may conflict with nurses' desires for a predictable and stable schedule. Nurses should have a certain degree of control over their work schedules, and their supervisors should support their needs in scheduling. How perceived control over work schedules, perceived support from supervisors in scheduling, shift changes at short notice, and overtime affect nurses' emotional exhaustion and intentions to leave has not been studied.

OBJECTIVES

The aims are (1) to describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses in psychiatric hospitals; (2) to assess the variation of these four factors between units at psychiatric hospitals; and (3) to investigate the association between these factors with nurses' emotional exhaustion and intentions to leave.

DESIGN

Cross-sectional survey study.

SETTING(S)

Swiss psychiatric hospitals with 24-hour services.

PARTICIPANTS

Registered nurses (N = 994) from 114 adult-inpatient units.

METHODS

To describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses, we calculated frequencies, percentages, means, and standard deviations of their responses to the survey. To assess the variation between units, we computed intraclass correlations for the four factors. We constructed random-effects models accounting for the clustering of nurses in units for emotional exhaustion and intentions to leave separately.

RESULTS

Perception of work-schedule control was 3.32 (SD 1.39, range 0-5); perception of supervisor work-schedule support was 3.28 (SD 1.14, range 0-4). On average, 9 % of the nurses had to take over a shift at short notice at least three times per month, and 40 % worked at least 15 minute overtime on their most recent shift. Intraclass correlation for all four factors was higher than 0.05. Emotional exhaustion was significantly associated with supervisor support and overtime, and leaving intentions were significantly associated with perceived control, supervisor support and overtime.

CONCLUSION

Perceived control, perceived supervisor support, shift changes at short notice, and overtime are promising factors for interventions to prevent nurses' emotional exhaustion and allay their intentions to leave. Unit managers should provide nurses with increased predictability and influence on their work schedules. This could reduce early career endings and early retirement and counteract nurse shortages.

Working time arrangements and exhaustion: The role of recovery experiences and satisfaction with the schedule

Working time arrangements may be a source of strain and entail negative consequences for workers, one of which can be exhaustion. Based on the job demands-resources and the conservation of resources theories, this study explores recovery experiences from work and satisfaction with the work schedule as possible resources that may prevent or minimize such negative consequences. With a sample of 386 workers (n = 287 women; 99 men) and using a cluster analysis, we identified five working time arrangements: fixed standardized, part-time, irregular standardized, flexible standardized, and nonstandard work schedule (NWS). A one-way ANOVA found that workers in the irregular standardized schedule report higher exhaustion compared to the fixed standardized and the part-time. Exhaustion of workers in NWS is higher compared to the part-time workers. A multiple linear regression analysis found that the link between recovery experiences and exhaustion varies according to the working time arrangement. Lastly, an interaction analysis confirmed the moderator effect of satisfaction with the work schedule in the relationship between recovery experiences and exhaustion for the whole sample. When this analysis was performed separately for each cluster, this effect was only significant for NWS and by disentangling this finding by recovery dimensions, only relaxation had a significant interaction effect. This study clarifies the links between different recovery experiences and exhaustion, and points to the importance of satisfaction with the work schedule in facilitating recovery under demanding working time arrangements. Results are discussed considering the complex nature of the work-family interface.

Shift work characteristics and burnout among nurses: cross-sectional survey

BACKGROUND

Nurses working long shifts (≥12 h) experience higher levels of burnout. Yet other shift characteristics, including fixed versus rotating night work, weekly hours and breaks have not been considered. Choice over shift length may moderate the relationship; however, this has not been tested.

AIMS

To examine the association between shift work characteristics and burnout and exhaustion, and whether choice over shift length influences burnout and exhaustion.

METHODS

Cross-sectional online survey of nursing staff working in the UK and Ireland. We recruited two large National Health Service Trusts, through trade union membership, online/print nursing magazines and social media. We assessed associations using both univariable and multivariable generalized linear models.

RESULTS

We had 873 valid responses. Reports of inadequate staffing levels (odds ratio [OR] = 2.84; 95% confidence interval [CI] 2.08-3.90) and less choice over shift length (OR = 0.20; 95% CI 0.06-0.54) were associated with higher burnout in multivariable models. Similar associations were found for exhaustion, where rarely or never taking breaks was also a predictor (OR = 1.61; 95% CI 1.05-2.52). Nurses who worked long shifts had less choice than those working shifts of 8 h or less (66% of 12-h shift nurses versus 44% 8-h shift nurses reporting having no choice), but choice did not moderate the relationship between shift length and burnout and exhaustion.

CONCLUSIONS

The relationship between long shifts and increased burnout reported previously might have arisen from a lack of choice for those staff working long shifts. Whether limited choice for staff is intrinsically linked to long shifts is unclear.

Factors that affect career success of nurses who practice in assisted reproductive technology

to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.

Factors that affect career success of nurses who practice in assisted reproductive technology

to examine the relationship between career success and work environment of nurses who practice in assisted reproductive technology and to identify factors that affect career success. a cross-sectional study conducted in 53 fertility centres in 26 provinces in mainland China. Data were collected using a demographic data questionnaire, a specialised nursing competence questionnaire, the Career-Success Scale, and the Nursing Work Environment Scale. Descriptive and inferential statistics were applied. 597 assisted reproductive technology nurses participated in our survey, and 555 valid questionnaires were collected. Theoverall mean scores for career success and work environment were 3.75 [standard deviation (SD) = 1.01] and 3.42 (SD = 0.77) respectively. There was a strong positive correlation between career success and work environment (r = 0.742, p < 0.01). Multiple regression showed that attending academic conferences, psychological care, professional development, support and care, salary, and welfare were significant factors that influence career success. attending academic conferences, psychological care, and work environment are positively related to career success. Administrators should consider ways to address these factors.

Consequences of Shift Work and Night Work: A Literature Review

Nonstandard work schedules such as shift work and night work tend to trigger problems for workers in different areas. To illustrate the diversity of areas affected and the relative interest of the scientific community, we conducted a literature review of the effects of shift work and night work on workers. In particular, we intended to identify the main variables addressed in the field of health, the family sphere, and the organizational context. The literature review was carried out using the Web of Science with the following terms: "shift work", "rotating shifts", and "night work". Inclusion criteria incorporated empirical studies and articles written in Portuguese or English published in 2019. We selected 129 of the 619 articles identified. Regarding the impacts of shift work and night work, there existed a high discrepancy of focus between the three defined areas: health, family life, and organizational context. Specifically, health-related variables were the most studied (83.4%), followed by organizational variables (9.2%), and, lastly, family variables (7.4%). Based on these results, it is essential to extend the study of the two underrepresented impacts to other crucial areas, not only for the worker but also for organizations.

The associations of psychological burnout and time factors on medication errors in rotating shift nurses in Korea: A cross sectional descriptive study

AIM

To describe the associations of psychological burnout and time factors on hospital nurses' medication errors.

DESIGN

A cross-sectional survey design was used.

METHODS

A structured questionnaire pertaining to psychological burnout, time factors and medication error was administered to 200 bedside nurses working at two tertiary university hospitals in Korea. The associations between the psychological burnout, time factor and medication error were analysed with the zero-inflated negative binomial regression for over-dispersed and over-abundant zeros count data.

RESULTS

Higher psychological burnout, shorter meal time during duty and longer weekly overtime were associated with an increased likelihood of medication error of nurses working in tertiary university hospitals. For medication safety, nurse managers should provide appropriate administrative support to nurses to cope with psychological burnout of nurses. Work time management should also be considered as human factors to satisfy the needs of nurses, such as securing meal times and maintaining a low level of weekly overtime.

Effects of nurses' schedule characteristics on fatigue: An integrative review

An integrative review of 21 studies found mixed results on the associations of work schedule and nurse fatigue. Suggestions for nurse leaders include monitoring fatigue in shift workers, ensuring supportive work design, promoting a healthy lifestyle, and implementing scheduling interventions.

Association between lifestyle behaviors and health-related quality of life among primary health care physicians in China: A cross-sectional study

Background

Primary health care (PHC) serves as the gatekeeper of health system and PHC physicians take on significant obligations to provide health care services in the pursuit of Universal Health Coverage (UHC). PHC physicians' health-related quality of life (HRQoL) can have a strong impact on patients, physicians and the health care system. Lifestyle interventions are found to be effective to improve HRQoL. The purpose of this study was to evaluate the association between lifestyle behaviors and HRQoL among PHC physicians, so that lifestyle intervention can be tailored by policy makers for health promotion.

Methods

A survey covering 31 provinces and administrative regions in China was conducted in 2020 using a stratified sampling strategy. Data on sociodemographic characteristics lifestyle behaviors and HRQoL were collected by a self-administered questionnaire. HRQoL was measured through EuroQol-five dimension-five level (EQ-5D-5L) instrument. A Tobit regression model was performed to evaluate the association between sociodemographic characteristics, lifestyle behaviors and HRQoL.

Results

Among 894 PHC physicians who completed the survey, Anxiety/Depression (AD) was the dimension with the most problems reported (18.1%). Regular daily routine (β = 0.025, 95%CI 0.004 to 0.045) and good sleep quality (β = 0.049, 95% CI = 0.029 to 0.069) were protective factors for HRQoL, while smoking (β = −0.027, 95% CI = −0.079 to −0.003) and frequency of eating breakfast (β = −0.041, 95%CI = −0.079 to −0.003) were negatively associated with HRQoL. Physical activity and alcohol drinking were not significantly associated with HRQoL.

Conclusion

These findings suggest that tailored interventions on daily routine, improving sleep quality, and tobacco control among PHC physicians may be effective strategies to improve their HRQoL.

Shift Work Domains and their Interactions with Empty Calorie Food/Beverage Consumption: A 14-day Intensive Longitudinal Study

BACKGROUND/OBJECTIVES

Shift work has been linked to unhealthy eating behaviors such as imbalanced diet, or increased empty calorie food/beverage consumption. However, most research has focused on the impact of shift timing. The concept of shift work is complex, and it contains several domains such as shift timing, intensity, and speed. Previous studies have suggested that greater shift intensity and quicker shift speed may contribute to adverse health effects. However, evidence regarding associations between other domains of shift work and empty calorie food/beverage consumption has been relatively lacking. Therefore, the purpose of this study was to evaluate how other shift work domains related to empty calorie food/beverage consumption and whether different shift work domains interacted to influence the intake of foods or beverages.

DESIGN

A 14-day intensive longitudinal study employing ecological momentary assessment.

SETTINGS AND PARTICIPANTS

Eighty registered nurses working in 24 accredited Taiwanese hospitals (i.e., 9 medical centers, 12 regional hospitals, and 3 district hospitals) were recruited.

METHODS

During the study period, a convenience sample of 77 participants completed 2444 momentary surveys about empty calorie food/beverage consumption on a smartphone. Three shift work domains (shift timing, intensity, and speed) were evaluated based on registry-based work schedules. To study how these shift work domains influenced empty calorie food/beverage consumption, we employed three-level mixed-effects regression models for data analyses.

RESULTS

Findings suggested that greater night shift intensity increased the likelihood of sugar-sweetened beverage intake (odds ratio = 1.64, 95% confidence interval [1.01, 2.68]). The impacts of work shift intensity and shift timing on sugar-sweetened beverage consumption varied by shift speed. Among participants assigned a schedule with either medium or rapid shift speed, higher work shift intensity was associated with a higher probability of sugar-sweetened beverage consumption. Compared to day shifts, those who were assigned a quicker shift speed on evening shifts were more likely to consume sugar-sweetened beverages. However, associations between night shift intensity and sugar-sweetened beverage intake did not change by shift speed. Furthermore, shift intensity and shift timing did not interact to affect empty calorie food/beverage consumption.

CONCLUSIONS

This study demonstrated assignments of shift schedules (i.e., high night shift intensity, more changes in shift timings) might influence workers' consumption of empty calorie foods/beverages. Therefore, identifying and mitigating hazardous shift schedules may help to improve shift workers' eating behaviors and benefit their overall health.

Occupational health and safety practices and associated factors among workers in Ethiopia's Metehara and Wonji sugar industries: a convergent parallel mixed design

INTRODUCTION

Information regarding workers' practices concerning safety measures in Ethiopia's sugar industries is inadequate.

OBJECTIVES

To assess occupational health and safety practices and associated factors among workers in Ethiopia's Metehara and Wonji sugar industries.

DESIGN

A convergent parallel mixed design.

SETTING

Metehara and Wonji sugar industries in Ethiopia (December 2021 through May 2022).

PARTICIPANTS

We used a stratified random sampling method to select 1648 participants for the collection of quantitative data. We employed a purposive sampling method to carry out 20 in-depth interviews in order to gather qualitative data.

PRIMARY OUTCOME MEASURES

We computed the extent of occupational health and safety practices using a 21-item questionnaire. Finally, results were graded as 'good' if ≥60% of them were answered correctly and 'poor' if <60% were correctly answered. We created a qualitative data interpretation from the subject's perspective.

RESULTS

The percentage of good occupational health and safety practices was 29.6% (95% CI: 27% to 32%). Inappropriate provision of personal protective equipment (adjusted OR (AOR)=1.42, 95% CI: 1.10 to 1.83), a lack of strict safety regulation (AOR=1.64, 95% CI: 1.27 to 2.12), a lack of incentives (AOR=1.31, 95% CI: 1.04 to 1.66) and inadequate management support (AOR=1.19, 95% CI: 1.04 to 1.66) were identified as associated factors. Health service usage defects, inappropriate protective equipment use and failure to follow occupational safety commands were identified as challenges.

CONCLUSIONS

Occupational health and safety measures were not used effectively. The qualitative component of this study confirmed that most participants expressed undesirable practices in occupational health and safety measures. Inappropriate protective device provisions, a lack of strict safety regulation, the absence of incentives and inadequate management support were found to be linked with the use of occupational health and safety measures. The contributing factors we identified potentially indicate areas for future intervention.

The effect of full-time culture on quality and safety of care – a literature review

Purpose

The purpose of this study is to increase knowledge and understanding of the relationship between full-time-culture and the outcome for quality and safety of care.

Design/methodology/approach

The paper is a literature review with a qualitatively oriented thematic analysis concerning quality or safety outcomes for patients, or patients and staff when introducing a full-time culture.

Findings

Identified factors that could have a positive or negative impact on quality and patient safety when introducing full-time culture were length of shift, fatigue/burnout, autonomy/empowerment and system/structure. Working shifts over 12 h or more than 40 h a week is associated with increased adverse events and errors, lower quality patient care, less attention to safety concerns and more care left undone. Long shifts give healthcare personnel more flexibility and better quality-time off, but there is also an association between long shifts and fatigue or burnout. Having a choice and flexibility around shift patterns is a predictor of increased wellbeing and health.

Originality/value

A major challenge across healthcare services is having enough qualified personnel to handle the increasing number of patients. One of the measures to get enough qualified personnel for the expected tasks is to increase the number of full-time employees and move towards a full-time culture. It is argued that full-time culture will have a positive effect on work environment, efficiency and quality due to a better allocation of work tasks, predictable work schedule, reduced sick leave, and continuity in treatment and care. There is limited research on how the introduction of full-time culture will affect the quality and safety for patients and staff, and few studies have been focusing on the relationship between longer shift, work schedule, and quality and safety of care.

Shift work organization on nurse injuries: A scoping review

BACKGROUND

Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety.

OBJECTIVE

To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse.

METHODS

A scoping review was conducted using search results from five bibliographic databases.

RESULTS

Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes.

CONCLUSIONS

Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.

Evaluation of work conditions of nurses employed in a shift system in hospital wards during the COVID-19 pandemic

BACKGROUND

Nurses work in a shift system that determines the provision of round-the-clock care of a patient in hospital conditions; however, it entails health consequences.

OBJECTIVE

The aim of the study was the evaluation of work conditions of nurses engaged in shift work in hospital wards during the COVID-19 pandemic.

METHODS

The study was conducted in 2020, and included 108 nurses working in a shift system in hospital wards. The research method was a diagnostic survey, using an author-constructed questionnaire.

RESULTS

88.9% nurses reported a negative effect of shift work on their physical health: 'musculoskeletal pain', 'elevated arterial blood pressure', and 'hormonal disorders' - 54.5% of respondents used pharmacological treatment. The causes of physical disorders were: 'microclimate', 'physical effort', 'noise', and 'forced body position'. Shift work exerted a negative effect on psychological health of the majority of respondents (75.0%): 'deconcentration', 'sleep disorders', 'feeling of occupational burnout' - treatment in 38.9% of respondents. Psychological health disorders were caused by: 'circadian rhythms disturbance by shift work', 'chronic stresses, and 'conflicts at work'. 69.7% of respondents reported that their shift work was disturbed by organizational factors, including: a 'badly planned work schedule', 'enhanced pace of work due to staff shortage', 'ambiguous division of duties, rights, responsibilities', 'shortages of equipment at the workplace'.

CONCLUSION

The examined nurses experienced a negative effect of shift work on their physical and psychological health which, for some of them, was the cause of pharmacological treatment. Many organizational factors hindered the work of nurses in a shift system in hospital wards.

An organizational design perspective on the monthly self-scheduling process in nursing homes: A multiple case study

AIMS

To describe the monthly self-scheduling process in nursing homes (NH), to determine how specific organizational design characteristics (including interpersonal relationships and leadership style) influence this process, and to examine the effect on individual, team, and organization-related outcomes.

DESIGN

A multiple case study using an organizational design perspective as the overarching theoretical and explanatory framework.

METHODS

Data collection was performed in four Belgian NH during Spring 2019 using semi-structured interviews (n = 39), documents, and observations. Open, axial, and selective coding was used for the data reduction process, and a within-case and cross-case analysis was performed. The COREQ checklist was used for reporting the findings.

RESULTS

One group (two NH) used self-scheduling because it corresponds with their decentralized organizational design. Together with a motivating head nurse and additional resources during the core phase of the process, this led to positive outcomes. In contrast, another group used self-scheduling under the assumption that it would solve the mismatch between their organizational design and other organizational problems, which resulted in less positive work attitudes.

CONCLUSION

Self-scheduling should match the organizational structure and culture. Additional resources and an adaptive leadership style can help mobilize and support employees. Future research may use quantitative methods to confirm positive outcomes.

IMPACT

This study contributes to the rare literature on self-scheduling in NHs by focusing on the monthly self-scheduling process and by including an organizational design perspective. NH management can become informed of different self-scheduling methodologies and the impact of specific organizational characteristics on this process. Head nurses can become aware that they need to adapt their leadership style to obtain improved outcomes.

PATIENT OR PUBLIC CONTRIBUTION

Three members of the study team met with several caregivers during field visits to conduct interviews and to observe the monthly self-scheduling process.

Occupational fatigue and health of gas station workers: A review

BACKGROUND

Occupational health factors such as shift work, sleep, fatigue, and work environment jeopardise the health and safety of gas station workers. This calls for new research to investigate how the working environment and characteristics impact the occupational health of workers at gas stations. However, minimal research has been conducted in this field, especially those involving psychological and behavioural factors, occupational stress, and so forth.

OBJECTIVE

This review was performed to investigate the present condition of the occupational risk of gas station workers in this safety-critical position.

METHODS

Five databases (Web of Science, ScienceDirect, PubMed, Google Scholar, and PsycINFO) were searched for relevant peer-reviewed studies. Results were selected according to these criteria: studies on fatigue, shift work, sleep, and physical and mental health of gas station employees; published on or before November 11, 2021; papers in English.

RESULTS

Twenty studies were considered for the final analysis. The results showed that shift work at gas stations leads to psychological and physiological problems. The psychological consequences included anxiety, stress, and depression, while the physiological consequences included biochemical changes and lifestyle consequences.

CONCLUSION

Shift work and the specific working environment of gas station employees adversely affect their sleep, stress levels, physical and mental health, and turnover intention. This systematic review allowed us to consider the occupational risk factors that can lead to sickness or accidents and contribute to reducing these risk factors. Realistic countermeasures ought to be established and interventions must be explored to mitigate risks to life, property, and the environment in operating gas stations.

The Effectiveness of Blue-Light-Emitting Glasses in Security Guards Exposed to Night Shift Work on Work-Related and General Fatigue: A Randomised Controlled Cross-Over Study

This study aimed to evaluate the effectiveness of glasses that emit blue light in reducing the need for recovery, general fatigue, and stress levels in security guards who work night shifts. Light manipulation is seen as a promising strategy to mitigate complaints related to shift work, such as sleepiness and impaired cognitive performance. In a randomized controlled cross-over study design, 86 Dutch security guards used light-emitting glasses (exposure duration: 30 min) during night shifts in a five week period versus a five week control period without glasses. Measurements (Need for Recovery Scale; Checklist Individual Strength; stress level assessed by a fitness tracker) were performed at baseline, at five weeks, and again at 11 weeks. The chronotype was measured at baseline as a potential covariate. A mixed model for repeated measure analyses showed no significant reduction in the need for recovery, nor a reduction in general fatigue scores, during the intervention period. Paired Samples T-Test analyses showed no significant changes in stress levels for the intervention period. Conclusively, blue light exposure using light-emitting glasses for security guards during night shifts showed no directly measurable effect on the reduced need for recovery, overall fatigue, and stress levels.

The Time-Varying Effect of Participatory Shift Scheduling on Working Hour Characteristics and Sickness Absence: Evidence from a Quasi-Experiment in Hospitals

Participatory shift scheduling for irregular working hours can influence shift schedules and sickness absence. We investigated the effects of using participatory shift scheduling and shift schedule evaluation tools on working hour characteristics and sickness absence. We utilized a panel data for 2015-2019 with 16,557 hospital employees (6143 in the intervention and 10,345 in the control group). Difference-in-differences regression with ward-level clustered standard errors was used to estimate the average treatment effect on the treated coefficients relative to timing of the intervention with 95% confidence intervals (CI). Using participatory scheduling tool increased long working hours and weekend work and had delayed effects on the short (1-3 days) sickness absences. Increased effects were observed: 0.2 [95% CI 0.0-0.4] days for the second, and 0.8 [95% CI 0.5-1.0] for the third year after the onset of intervention. An average increase of 0.5 [95% CI 0.1-0.9] episodes on all sickness absence episodes was observed for the third year. Using the shift schedule evaluation tool with the participatory shift scheduling tool attenuated the adverse effects. To conclude, participatory shift scheduling increased some potentially harmful working hour characteristics but its effects on sickness absence were negligible, and further attenuated by using the shift schedule evaluation tool.

Occupancy-aided ventilation for airborne infection risk control: Continuously or intermittently reduced occupancies?

Ventilation is an important engineering measure to control the airborne infection risk of acute respiratory diseases, e.g., Corona Virus Disease 2019 (COVID-19). Occupancy-aided ventilation methods can effectively improve the airborne infection risk control performance with a sacrifice of decreasing working productivity because of the reduced occupancy. This study evaluates the effectiveness of two occupancy-aided ventilation methods, i.e., the continuously reduced occupancy method and the intermittently reduced occupancy method. The continuously reduced occupancy method is determined by the steady equation of the mass conservation law of the indoor contaminant, and the intermittently reduced occupancy method is determined by a genetic algorithm-based optimization. A two-scenarios-based evaluation framework is developed, i.e., one with targeted airborne infection risk control performance (indicated by the mean rebreathed fraction) and the other with targeted working productivity (indicated by the accumulated occupancy). The results show that the improvement in the airborne infection risk control performance linearly and quadratically increases with the reduction in the working productivity for the continuously reduced occupancy method and the intermittently reduced occupancy method respectively. At a given targeted airborne infection risk control performance, the intermittently reduced occupancy method outperforms the continuously reduced occupancy method by improving the working productivity by up to 92%. At a given targeted working productivity, the intermittently reduced occupancy method outperforms the continuously reduced occupancy method by improving the airborne infection risk control performance by up to 38%.

Working hours, sleep, and fatigue in the agriculture, forestry, and fishing sector: A scoping review

INTRODUCTION

Agriculture, forestry, and fishing industry (AgFF) workers often work extremely long hours during peak production seasons, resulting in sleep deprivation and fatigue. The National Occupational Research Agenda has classified fatigue as a "significant safety issue" and area of concern for many industry sectors, including AgFF. This review explores current research and practice in AgFF and proposes next steps.

METHODS

We conducted a scoping literature review to examine the extent and nature of research in this area. Article inclusion criteria included peer-reviewed journal articles written in English; published after 1989; covering AgFF workers in high-income countries; with data on working hours/schedules and sleep related to safety and health.

RESULTS

Limited research has addressed long hours and sleep deprivation among AgFF workers. We identified 8350 articles for title and abstract review. Among those, 407 underwent full-text review and 96 met all inclusion criteria (67% agriculture, 25% fishing/seafood processing, 8% forestry). The literature provided some evidence fatigue contributes to fatalities, injuries, and illnesses in AgFF. Older, new, young, foreign-born, and female workers, as well as those who work in small organizations or longer hours (40+) may be at higher risk for fatigue-related injury and illness. Few studies have developed or evaluated interventions to control risks.

DISCUSSION

Given that fatigue is a factor in injury and illness for this sector, future AgFF surveillance and research should increase efforts to capture fatigue and sleep data, directly investigate the role of long hours and nonstandard work schedules in the sector, and most importantly, create practical interventions to manage fatigue.

Personality Factors as Predictors in Burnout Level Changes for Surgical Area Nurses

Surgical area nurses provide comprehensive care to patients throughout the surgical process. Increases in life expectancy lead to the appearance and development of diseases, translating into an increase in the number of necessary interventions. Increases in the workload can be another risk factor for the development of burnout in professionals in this area. Knowledge of psychological and personality-related variables provides relevant information of level changes in the dimensions of burnout syndrome. Three logistic regression models, based on a cross-sectional study with 214 nurses working in the surgical area in the Andalusian Health Service, Spain, were built for each dimension. These models included different variables related to depression and personality, with some being significant at the population level and consequently true risk or protection factors. Friendliness, responsibility and extraversion are protection factors for the personal accomplishment dimension, whilst neuroticism is a risk factor for this dimension. Friendliness is also a protection factor for depersonalization, whilst depression is a risk factor. Finally, neuroticism, responsibility and depression are risk factors for the emotional exhaustion dimension of burnout. These findings provide relevant information that makes anticipation of this syndrome in this group easier.

Nurses' steps, distance traveled, and perceived physical demands in a three-shift schedule

BACKGROUND

The physical job demands of hospital nurses are known to be very high. Although many studies have measured the physical activities of nurses subjectively using questionnaires, it remains necessary to quantify and measure nurses' physical activity at work using objective indicators. This study was conducted to address this gap in the literature by analyzing nurses' physical activity using both objective measurements and subjective perceptions. The number of steps, distance traveled, and actual work hours were measured during work, and the influence of related factors was analyzed.

METHODS

Using a cross-sectional design, survey and activity tracking data were collected from nurses who worked in three shifts in two tertiary hospitals located in the capital region of South Korea. The participants comprised 117 nurses working in four different units (medical ward, surgical ward, intensive care unit, emergency room), and data from 351 shifts were used in the final analysis. Between-group differences in the main variables were analyzed using the t-test, the Mann-Whitney test, analysis of variance, or the Kruskal-Wallis test, as appropriate. The relationships were examined through multiple linear regression analysis.

RESULTS

The average number of steps and distance traveled were greatest for nurses working in the emergency room, followed by the intensive care unit, surgical ward, and medical ward (in descending order). Younger nurses and those with shorter unit experience tended to have the greatest number of steps and distance traveled.

CONCLUSION

Using activity trackers, this study derived physical activity measures such as number of steps and distance traveled, enabling an objective examination of physical activity during shifts. Nurses' level of physical activity differed depending on the type of nursing unit, nurses' age, and unit experience. These results suggest the need for support programs that are specific to the job demands of specific nursing units.

Related factors influencing Chinese psychiatric nurses' turnover: A cross-sectional study

WHAT IS KNOWN ON THE SUBJECT

Because of increasingly stressful, dangerous and unpredictable psychiatric nursing work, psychiatric nurses have experienced higher job stress than general ward nurses. Little is known about the factors that affect the turnover intention of Chinese psychiatric nurses. Understanding the influencing factors of nurses' turnover intention will help to formulate targeted measures to stabilize psychiatric nursing teams.

WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE

The results showed that 70.2% of psychiatric nurses had higher turnover intention. The strong turnover intention of Chinese psychiatric nurses is a problem that needs to be considered by managers. The results showed that having more children, between 31 and 39 years old, and having a part-time job were strongly associated with turnover intention. In addition, "job stress" was also an important factor, psychiatric nurses' turnover intention decreased as their job stress level decreased.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Nursing managers should pay attention to nurses who have more children, between 31 and 39 years old, and take on part-time jobs. Additionally, nursing managers should reduce job stress and implement targeted programmes to prevent psychiatric nurses' turnover. Experience-sharing meetings and mindfulness-based stress reduction training are also useful to improve the mental health status of psychiatric nurses with great job stress. Nursing managers should arrange human resources and shifts appropriately to give nurses with more children more time with their families. Provide more development opportunities for psychiatric nurses between 31 and 39 years old. Managers explore the reasons why nurses take on part-time jobs and take targeted interventions (such as increasing income) to reduce the behaviour that happens.

ABSTRACT

Introduction Nurses' turnover is the main cause of nursing shortages, greatly affected by nurses' intention to leave. Nurses' turnover rate is particularly high in psychiatric wards. Several factors influencing the turnover intention of psychiatric nurses have not been well identified in China, and the association between job stress and turnover intention is still limited. Aims To examine the relationship between job stress and turnover intention and identify the influencing factors of psychiatric nurses' turnover intention. Methods Data were collected from 2355 psychiatric Chinese nurses using a cross-sectional design with an online questionnaire investigation. Results Psychiatric nurses had higher turnover intention. Significant factors influencing their turnover intention were job stress, having more children, age between 31 and 39 years old, part-time jobs, education, income and patient-to-nurse ratio. Discussion Demographics and job-related factors should be considered when developing strategies to reduce the turnover intention of psychiatric nurses. Implications for practice Nursing managers should pay attention to nurses with higher job stress levels and different demographic characteristics. Effective measures should be taken to reduce psychiatric nurses' job stress and turnover intention, such as arranging reasonable shifts, implementing targeted family-friendly policies, increasing their occupational possibilities and promoting mental health.

A Comparison of Shift Length and Nursing and Quality Outcomes in Acute Inpatient Mental Health Units

OBJECTIVE

This study compared outcomes between units that used either 8-hour or 12-hour shifts in acute inpatient mental health units.

BACKGROUND

Most hospitals continue to use 12-hour shifts despite research suggesting safety concerns with longer shifts. There is a gap in the literature on effects of shift lengths on nursing and patient outcomes in acute mental health units.

METHODS

This study is a retrospective comparative analysis of cross-sectional data between 32 inpatient mental health units that used 8-hour versus 12-hour shifts. Independent samples t test was used to examine differences on several staffing, quality, and safety measures.

RESULTS

A moderate effect size was found between the groups in quality and safety measures involving patient disruptive behaviors, with the 8-hour group having more desirable outcomes.

CONCLUSIONS

Nurse leaders in acute mental health units should consider the impacts of shift length on quality and safety when determining staffing patterns. More research is needed to evaluate correlations or causality.

Ambulatory Oncology Nurses Weigh in About 12-Hour Shifts

BACKGROUND

Studies conducted in hospital settings have associated negative clinical outcomes with 12-hour shifts. Despite this, 12-hour shifts are common in nursing and popular among nurses. Little is known about outcomes associated with 12-hour shifts in ambulatory care settings.

OBJECTIVE

A mixed-methods, quality improvement project was conducted in a large, ambulatory cancer center to evaluate oncology nursing staff perspectives on 12-hour shift work.

METHODS

One hundred ambulatory oncology nurses completed surveys and 11 participated in focus group interviews.

FINDINGS

Nurses expressed predominately positive perspectives about 12-hour shift work in ambulatory oncology care.

CONCLUSIONS

Ambulatory oncology nurses perceived benefits to quality, safety, and satisfaction for both nurses and patients related to 12-hour shifts. Further evaluation of patient, nurse, and organizational outcomes unique to ambulatory settings is essential for nurse executives in formulating data-driven staffing plans. The incorporation of 12-hour shifts should be considered.

Nurses' perceptions of night shifts: A qualitative study

AIM

To describe the experiences and perceptions of emergency nurses regarding the shortening of night shifts and identify aspects of nurses' preferences for night shifts.

BACKGROUND

Shift work can be associated with distinct physical and psychological disadvantages for nurses, especially night nurses. Knowledge regarding the factors influencing their perceptions of night shifts is limited.

METHODS

A qualitative description design. Fifteen nurses from the emergency setting with 6 to 14 years of work experience participated in interviews. Semistructured interviews were conducted between November 2018 and March 2019. A thematic analysis was performed for the data analysis.

FINDINGS

The following three themes emerged: (1) maintaining quality within quantity, (2) maintaining comfort within busyness, and (3) buffering the gap between ideal and reality.

CONCLUSIONS

Considering work intensity and patient safety, nurses believe that an 8 h night shift is the most suitable length for the emergency department. Long shifts are probably more suitable for other departments with lower night workloads.

Does Shiftwork Impact Cognitive Performance? Findings from the Canadian Longitudinal Study on Aging (CLSA)

Few large nationwide studies have investigated the relationship between shiftwork and cognitive performance, and little is known about whether and how psychological distress may impact this relationship. This study aimed to examine: (1) the cross-sectional relationship between shiftwork (yes/no) and some aspects of cognitive performance (declarative memory and executive functioning) and (2) the potential moderating effect of psychological distress among 20,610 community-dwelling adults from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). Differences by sex and retirement status were also explored. Shiftwork was significantly associated with poorer performance for executive functioning (interference condition: ß = 0.47, 95% CI: 0.31 to 0.63; MAT: ß = -0.85, 95% CI: -1.21 to -0.50) but not for declarative memory. Completely and not/partly retired males showed poorer cognitive performance on executive functioning. However, no evidence of a moderating effect by psychological distress was found. Our findings confirm the association between shiftwork and cognitive performance and highlight important health correlates of shiftwork.

Self-rostering, work-life balance and job satisfaction in UK nursing: a literature review

Nursing vacancies are high across the UK, with some nurses considering leaving the profession. Evidence suggests that employers, including the NHS, need to be more flexible about working times to support employees' work-life balance and job satisfaction. Self-rostering is one approach that has the potential to enhance nurses' work-life balance and job satisfaction, enabling scope for greater autonomy. This could in turn lead to fewer nurses leaving the profession and contribute to making nursing more attractive as a career. This literature review focused on nurses in the NHS and found that self-rostering had a positive effect on their work-life balance and job satisfaction. However, a move to self-rostering can pose challenges and it should be assessed for suitability before implementation. Given the nursing vacancy crisis in the UK and many nurses' intentions to leave the profession, the potential benefits of self-rostering for nurses cannot be overlooked.

Prevalence, influencing factors, and adverse consequences of workplace violence against nurses in China: A cross-sectional study

AIMS

The primary objective of this study was to determine the prevalence of workplace violence among nurses in China and its association with demographic characteristics, quality of work life, and coping styles. The secondary objective was to explore how nurses deal with workplace violence and the emotional/psychological impact of workplace violence on nurses.

BACKGROUND

Workplace violence is a common occupational hazard that causes physical and psychological harm to nurses.

METHODS

A cross-sectional study was conducted with 2769 nurses from China. A demographic information questionnaire, hospital workplace violence questionnaire, Chinese version of the work-related quality of life scale, and coping style scale were used in this study. The Chi-squared test, Mann-Whitney U test, and binary logistic regression analysis were used to investigate the effects of demographic characteristics, quality of work life, and coping styles on nurses' workplace violence.

RESULTS

Post-Work Recovery from Fatigue and Sleep Episodes among Nurses Who Are Engaged in 16-Hour Night Shifts: A Prospective Observational Study

Poor recovery from fatigue among shift-working nurses can cause a transition from acute to chronic fatigue. We aimed to clarify the relationship between nurses' recovery from fatigue and sleep episodes after 16 h night shifts while considering age. This prospective study included 62 nurses who worked 16 h night shifts. Fatigue was assessed by a questionnaire before, during, and after the night shift, and the morning following the night shift. Sleep episodes were continuously measured using a wearable device. We performed a hierarchical cluster analysis of multivariate sleep parameters in first and main sleep episodes after night shifts. A linear mixed model was used to estimate the difference between clusters in recovery from fatigue after the night shift, considering age. The participants were classified into a high sleep quality group (HSQG) and low sleep quality group (LSQG) in sleep episodes after the night shift. There was a significant main effect of clusters, and HSQG was significantly more effective than LSQG in recovering from fatigue. However, no main effects of age or interaction were observed. The quality of first and main sleep episodes at home was associated with recovery from the night shift to the next day, regardless of age.

A qualitative study of developers' discussions of their problems and joys during the early COVID-19 months

Many software developers started to work from home on a short notice during the early periods of COVID-19. A number of previous papers have studied the wellbeing and productivity of software developers during COVID-19. The studies mainly use surveys based on predefined questionnaires. In this paper, we investigate the problems and joys that software developers experienced during the early months of COVID-19 by analyzing their discussions in online forum devRant, where discussions can be open and not bound by predefined survey questionnaires. The devRant platform is designed for developers to share their joys and frustrations of life. We manually analyze 825 devRant posts between January and April 12, 2020 that developers created to discuss their situation during COVID-19. WHO declared COVID-19 as pandemic on March 11, 2020. As such, our data offers us insights in the early months of COVID-19. We manually label each post along two dimensions: the topics of the discussion and the expressed sentiment polarity (positive, negative, neutral). We observed 19 topics that we group into six categories: Workplace & Professional aspects, Personal & Family well-being, Technical Aspects, Lockdown preparedness, Financial concerns, and Societal and Educational concerns. Around 49% of the discussions are negative and 26% are positive. We find evidence of developers' struggles with lack of documentation to work remotely and with their loneliness while working from home. We find stories of their job loss with little or no savings to fallback to. The analysis of developer discussions in the early months of a pandemic will help various stakeholders (e.g., software companies) make important decision early to alleviate developer problems if such a pandemic or similar emergency situation occurs in near future. Software engineering research can make further efforts to develop automated tools for remote work (e.g., automated documentation).

Retirement Center Worker Sleep Health Assessment During the COVID-19 Pandemic

BACKGROUND

Sleep health disturbances can increase risks for workplace injury, error, and poor worker health. Essential workers have reported sleep disturbances since the COVID-19 pandemic onset, which may jeopardize their health and safety. The aims of this project were to assess sleep health among Continuing Care Retirement Community (CCRC) workers, examine potential differences between worker types, and describe the self-perceived impact of COVID-19 on workers' workload and sleep.

METHODS

Through an academic-practice partnership, this needs assessment used a cross-sectional design that collected self-report data during fall 2020 from CCRC workers. Guided by the Workplace Health Model, survey questions included work characteristics, sleep health, and COVID-19 impact on sleep and workload.

FINDINGS

Ninety-four respondents completed the survey across multiple departments. Respondents (n = 34, 36.2%) reported sleeping below recommended hours on workdays. The majority scored above the population mean on Patient-Reported Outcomes Measurement (PROMIS) measures of sleep disturbance (n = 52, 55.3%), sleep-related impairment (n = 49, 52.1%), and fatigue (n = 49, 52.1%). Differences in workday total sleep time and fatigue were noted among shift workers versus nonshift workers, with shift workers reporting less sleep and more fatigue. Shorter sleep duration was noted among respondents working shifts 10 or more hours compared with those working 8 hours. Pandemic-related workload increase was reported by 22.3% (n = 21) of respondents, with 17% (n = 16) noting more than one type of workload change. Since COVID-19 onset, 36.2% (n = 34) reported no sleep changes and 35.1% (n = 33) reported sleeping less. A medium, positive relationship was found between increased changes in work due to COVID-19 and increased difficulties sleeping (r = .41, n = 73, p = .000).

CONCLUSION/APPLICATION TO PRACTICE

Proper sleep health is essential to workplace safety and worker health. By assessing sleep health during a crisis, occupational health nurses can identify opportunities to support worker health and safety, through sleep education, monitoring for sleepiness and fatigue, ensuring countermeasures are available (e.g., caffeine), and assessing for opportunities to change organizational policies.