Sleep Quality and Vigilance Differ Among Inpatient Nurses Based on the Unit Setting and Shift Worked

Prevalence of sleep disturbances among intensive care nurses: A systematic review and meta-analysis

BACKGROUND

Demanding intensive care unit (ICU) work environments may lead to sleep disturbances in nurses, impacting their health and potentially patient safety. Yet, the prevalence remains unclear around the world.

AIM

To quantify the prevalence of sleep disturbances in intensive care nurses.

STUDY DESIGN

Systematic review and meta-analysis. A database search was conducted in Embase, PubMed, Web of Science, Scopus and CINAHL from their inception to April 2024 for relevant studies. Data from observational studies (cross-sectional or cohort) that reported the prevalence of sleep disturbances, assessed using the Pittsburgh Sleep Quality Index (PSQI > 5), pooled in random-effects meta-analyses. Subgroup analyses were used to investigate variations in the prevalence estimates in terms of available variables. A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant protocol was registered in PROSPERO (CRD42023476428).

RESULTS

In total, 24 articles were included in this study published from 1996 to 2023. Included studies were from 15 unique countries. Almost all of the studies were descriptive cross-sectional studies (n = 22; 91.7%). The included studies encompassed a range of intensive care nurses, from 42 to 605, involving a total of 3499 intensive care nurses. The reported proportion of intensive care nurses with sleep disturbances ranged from 20.0% to 100.0%, with a median of 76.7% (interquartile range: 62.9-85.7). The pooled prevalence of sleep disturbances in intensive care nurses was 75.1% (95% confidence interval: 37.2-53.1; 95% prediction interval: 30.5-95.4).

CONCLUSIONS

Sleep disturbance is a common issue in intensive care nurses. The study results highlight the importance of implementing effective interventions as early as possible to improve ICU sleep quality.

RELEVANCE TO CLINICAL PRACTICE

High prevalence of sleep disturbances among intensive care nurses necessitates global interventions. Gender-neutral approaches that acknowledge comparable risks and stable prevalence over time require long-term strategies. Raising awareness through programmes is vital for implementing evidence-based interventions to promote sleep health in intensive care nurses.

Global prevalence of excessive daytime sleepiness among nurses: A systematic review and meta-analysis

BACKGROUND

Nurses face significant risks of excessive daytime sleepiness (EDS), which adversely affects workplace safety and productivity. Yet, the extent of EDS in this workforce remains inadequately characterized.

AIM

The aims of this systematic review were to assess the pooled prevalence of EDS among nurses.

METHODOLOGY

We systematically searched PubMed, Embase, Scopus, and ISI Web of Science for observational studies reporting the prevalence of EDS, as measured by the Epworth Sleepiness Scale (ESS), from database inception to May 1, 2024, with no language restrictions. Study quality was evaluated using JBI's critical appraisal tool. Pooled estimates were calculated through random-effects meta-analysis, with subgroup and meta-regression analyses assessing associations between EDS prevalence and study-level factors. Linear regression modeling was used to assess time trends. This study was registered with PROSPERO (CRD42024535109).

RESULTS

We included 36 unique studies encompassing 2677 nurses from 20 countries. EDS occurred in 14.0%-55.6% of nurses. The results of the meta-analysis showed a pooled prevalence of EDS of 32.2% (95% confidence interval [CI]: 28.5-36.1; I2 = 92.6). Prevalence estimate did not vary substantially in terms of study-level data (i.e., region, country income, pre/post covid era, hospital type, proportion of female nurse, average nursing experience, or proportion of married nurses). The prevalence of EDS in nurses has remained unchanged over time.

CONCLUSIONS

This meta-analysis identifies a high global prevalence of EDS among nurses, affecting nearly one-third of this workforce. The findings underscore the urgent need for targeted interventions to mitigate EDS across diverse geographic and economic contexts.

IMPLICATION FOR NURSING AND NURSING POLICY

This study highlights the pervasive issue of EDS among nurses worldwide, necessitating comprehensive strategies to address this challenge across all regions, income levels, hospital settings, and demographic groups.

Sleep Deprivation and Fatigue among Nurses Working Consecutive Night Shifts: A Prospective Observational Study

PURPOSE

This study aimed to identify changes in sleep patterns and fatigue levels during consecutive night shifts among shift nurses and to determine the association between sleep parameters and increased fatigue levels during work.

METHODS

This prospective observational study employing ecological momentary assessments was conducted using data collected from 98 shift nurses working in Korean hospitals between June 2019 and February 2021. The sleep patterns were recorded using actigraphy. The participants reported their fatigue levels at the beginning and end of each night shift in real time via a mobile link. Linear mixed models were used for the analysis.

RESULTS

Nurses spent significantly less time in bed and had shorter sleep durations during consecutive night shifts than on off-duty days, whereas their wake times after sleep onset were much longer on off-duty days than on on-duty days. Fatigue levels were higher on the second and third night-shift days than on the first night-shift days. A shorter time spent in bed and asleep was associated with a greater increase in fatigue levels at the end of the shift than at the beginning.

CONCLUSION

Nurses experience significant sleep deprivation during consecutive night shifts compared with off-duty days, and this sleep shortage is associated with a considerable increase in fatigue levels at the end of shifts. Nurse managers and administrators must ensure sufficient intershift recovery time during consecutive night shifts to increase the time spent in bed and sleeping.

Relationship between night work and health-related quality of life: an analysis based on profiles and cumulative duration of exposure to night work among French workers in the CONSTANCES cohort

OBJECTIVE

The aim of this study is to estimate the association between night work and health-related quality of life (HRQoL) among French workers. The association between cumulative duration of night work and HRQoL was also investigated.

METHODS

Three career-long night work exposure groups were defined at inclusion in the CONSTANCES cohort: permanent night workers, rotating night workers and former night workers. Day workers with no experience of night work were the reference group. HRQoL was assessed using the Short Form Health Survey (SF-12), in particular the physical component summary (PCS) and mental component summary (MCS) scores, with a higher score indicating better HRQoL. Several linear regression models were built to test the association between night work exposure and HRQoL. The relationship between cumulative duration of night work and HRQoL scores was analyzed using generalised additive models.

RESULTS

The sample consisted of 10,372 participants. Former night workers had a significantly lower PCS score than day workers (β [95% CI]: - 1.09 [- 1.73; - 0.45], p = 0.001), whereas permanent night workers had a significantly higher MCS score (β [95% CI]: 1.19 [0.009; 2.36], p = 0.048). A significant decrease in PCS score from 5 to 20 years of cumulative night work was observed among former night workers.

CONCLUSIONS

Former night workers had poorer physical HRQoL in contrast to permanent and rotating night workers who had similar or even better HRQoL than day workers, suggesting the well-known healthy worker survivor effect. Consequently, both current and former night workers require regular and specific follow-up focused on the physical components of their health.

Sleep quality and fatigue among nurses working in high-acuity clinical settings in Saudi Arabia: a cross-sectional study

BACKGROUND

Poor sleep quality is prevalent among nurses worldwide. Around two-thirds of nurses doing shift work are known to experience sleep problems and fatigue. Fatigue and sleep problems are linked to poor performance, impaired alertness, injuries, chronic diseases, compromised healthcare quality, and medical errors, all of which detrimentally impact nurses and threaten patients' safety. This area of research has received insufficient attention in Saudi Arabia; therefore, the purpose of this study was to examine the levels of sleep quality and perceived fatigue and their association among nurses working in acute care settings in comprehensive hospitals in Saudi Arabia.

METHODS

A descriptive cross-sectional study using the Pittsburgh Sleep Quality Index and Chalder Fatigue Scale. Data was obtained via an online questionnaire that was distributed to nurses using the QuestionPro platform through hospital administrators, social media (WhatsApp), and personal contact.

RESULTS

A total of 173 nurses completed the online survey. Most participants reported poor sleep quality (n = 127, 73.4%) and severe perceived fatigue (n = 156, 90.2%). Furthermore, the study revealed a significant correlation between the overall sleep disturbance and fatigue global scores (r = 0.57, P < 0.001), indicating that poor sleep quality was significantly associated with higher fatigue levels among the study sample.

CONCLUSIONS

The current study found a significant association between sleep quality and severe fatigue in nurses working in high acute care settings in Saudi Arabia. It is very clear from the results that nurses are experiencing poor sleep and severe fatigue, which in turn, will negatively impact the nurse's quality of life and patient safety.

The Association between Working Hours with Vigilance and Executive Function of Intensive Care Unit Nurses

Background

Vigilance and executive functions are integral to nursing practice. Prolonged working hours are associated with heightened fatigue and increased nursing errors. However, the impact of work duration on the vigilance and executive function of ICU nurses remains unexplored.

Objective

This study aims to elucidate the association between ICU nurses' working hours, vigilance, and executive function.

Design

A cross-sectional study. Setting. Intensive care medicine department of a tertiary hospital in Zhengzhou, China. Participants. A total of 51 registered nurses who participated in 12 h shifts in the ICU completed the survey.

Methods

E-prime software was employed to develop four test tasks to measure the vigilance and executive functioning of ICU nurses. The test was performed before the start of the shift and after 4, 8, and 12 h.

Results

The analysis revealed no statistically significant differences in the response time of vigilance for ICU nurses across shifts (p=0.503) or working hours (p=0.078). However, a significant difference existed in lapses across working hours (p=0.005), significantly increasing after 8 and 12 h. The analysis indicated a significant difference in Flanker effect size across different working hours (p=0.035). The analysis revealed no significant differences in the switch cost (p=0.200) or response accuracy (p=0.479) of the task switching across working hours. The response accuracy for the 2-back task differed significantly (p=0.003) across working hours.

Conclusion

Limited evidence demonstrated that vigilance and specific aspects of executive functioning (inhibitory control and working memory) of ICU nurses were negatively correlated with the duration of their work in a real clinical setting. Furthermore, no vigilance and executive function differences were identified between day and night shifts. Implications for Nursing Management. Nursing administrators should reconsider scheduling 12 h shifts, shortening shifts, or implementing short rest periods to reduce fatigue and cognitive load. In addition, flexible scheduling and rationalizing the order of work may help reduce the possible risks associated with prolonged work.

Assessment of sleep quality and its factors among clinicians working in critical care units and operation theaters at North West Ethiopia, 2022: a multicenter cross-sectional study

The quality of sleep has an effect on the health of clinicians and the quality of patient care. Maintaining cognitive function/mood, facilitation of glucose metabolism, and strengthening of the immune system are among the roles that adequate sleep may contribute. Poor sleep quality is multifactorial, and studies had shown inconsistencies in the factors that contribute to the development of this poor sleep quality. The prevalence of poor sleep quality among clinicians working in the critical care unit and operation theater in the study setting was not investigated yet.

OBJECTIVE

The objective of this study was conducted for the purpose of assessing the quality of sleep and associated factors among clinicians working in the critical care unit and operation theater.

METHODS

A cross-sectional study was conducted from 15 May to 15 June 2022. Data were collected using a self-administered questionnaire from 421 clinicians selected by simple random sampling techniques. Sleep quality was measured by the Pittsburg sleep quality index. The data were entered into Epi-data and exported to SPSS. Frequency and percentage were used for the descriptive analysis. Binary and multivariate logistic regression analysis were used to identify factors associated with poor quality of sleep. The strength of the association was measured with an OR within the 95% CI and P-value of <0.05.

RESULT

About half 220 (52.3%) of the study participants age between 25 and 30 year old and the majority 321 (76.2%) of them were males. The prevalence of poor sleeps quality was 81.5% (95% CI: 77.9-85.5). Working night shift (AOR: 3.37, 95% CI: 1.754-6.484), having depressive symptoms (AOR: 3.25, 95% CI: 1.485-7.147) and having no regular exercises (AOR: 0.299, 95% CI: 0.166-0.537) were predisposing factors for poor sleep quality.

CONCLUSION AND RECOMMENDATION

The prevalence of poor sleep quality among clinicians working in the ICU and operation room was high. Clinicians who had no regular exercise, who worked in night shift, and who had depressive symptoms were associated with poor quality of sleep. Clinicians should have an awareness on the symptoms of depression, implement sleep hygiene education programs and promoting regular exercise. The authors recommend healthcare policy makers for improving working schedules.

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.

Overtime and alertness of rotating-shift nurses: An observational study using ecological momentary assessment

AIMS AND OBJECTIVES

This study aimed to determine the effect of overtime on alertness at work among rotating-shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts.

BACKGROUND

Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work.

DESIGN

A prospective observational study was employed. The study followed STROBE checklist for observational studies.

METHODS

Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real-time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed-effect models were employed to investigate the association between overtime and alertness.

RESULTS

A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous-day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous-day overtime hours and consecutive overtime days in all shifts.

CONCLUSIONS

The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty.

RELEVANCE TO CLINICAL PRACTICE

Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

[Working at night in intensive care and resuscitation]

The care teams working in the intensive care unit (ICU) most often practice on twelve-hour day-night cycles. Collaboration is close and regular, with a high level of trust shared between the professionnals to ensure the often complex care required by the patient's condition. While ICU practice is of great interest to caregivers who make it their specialty, it can also become less attractive over time due to the physical, family and social constraints of night work.

A cross-sectional study on sleep disturbances and associated factors among nurses

BACKGROUND

Many studies have measured sleep disturbances among nurses globally, but none have addressed this issue in Vietnam. Therefore, this study aimed to assess the prevalence of sleep disturbance and identify associated factors among staff nurses in Vietnam. To identify sleep disturbances and associated factors among staff nurses in Vietnam.

METHODS

A cross-sectional design was used in this study. Participant nurses (n = 420) completed a general information questionnaire, the Vietnamese version of the General Sleep Disturbance Scale (GSDS), the Perceived Stress Scale, and the Short Form 12. Data were collected between July and September 2019 from three public hospitals located in southwestern Vietnam. Data were analyzed using Chi-square, independent Student's t-test, and multivariate logistic regression analysis.

RESULTS

The average GSDS score was 41.10 (SD = 19.48), indicating sleep disturbances among 46.9% of nurses. Age, health condition, stress, and quality of life had an impact on sleep disturbance. Multivariate logistic regression analysis confirmed that nurses with high stress and poor physical health status were more likely to experience sleep disturbances.

CONCLUSION

Vietnamese nursing staff suffers from a high rate of sleep disturbances. Significant predictors included high stress and poor physical health status. Administrators of healthcare services should carefully consider how to conduct interventions to help the nurses handle their sleep disturbances such as stress management and physical health promotion.

Correlation of Circadian Rhythms of Heart Rate Variability Indices with Stress, Mood, and Sleep Status in Female Medical Workers with Night Shifts

PURPOSE

Heart rate variability (HRV) indices have been used as stress indicators. Rare studies investigated the associations of circadian rhythms of the HRV indices with the stress, mood, and sleep conditions in populations under stress.

METHODS

In total 257 female participants (203 shift workers and 54 non-shift workers) were included. All the participants completed a structured questionnaire to assess the stress, mood, and sleep conditions and performed 24-hour Holter electrocardiogram monitoring on the day away from shifts. Using epochs of 1-min or 5-min beat-to-beat intervals, the HRV indices (SDNN, RMSSD, LF, HF, LF/HF, and LFnu, SD1, SD2, SD1/SD2) were plotted as a function of time and fitted into cosine periodic curves, respectively. Three mathematical parameters based on the cosine periodic curves were extracted, MESOR (M, overall averages of the cosine curve), amplitude (A, amplitude of the peak of the cosine curve), and acrophase (θ, latency to the peak) to quantify the circadian rhythms of the HRV indices. Multivariable linear regression models were used to reveal the associations of these parameters with the clinical assessments of stress, mood, or sleep conditions, as well as with the 24-h averages of the HRV indices.

RESULTS

The parameters M and A of SDNN, RMSSD, LF, and HF, and θ of LF/HF and LFnu significantly differ between shift and non-shift workers. The parameter θ of LF/HF positively correlates with the severity of stress and anxiety. The parameter A of LF/HF and LFnu also positively correlates with daytime sleepiness and sleep fragmentation. In addition, the parameters M and A instead of θ of SDNN, RMSSD, LF, LF/HF, and LFnu significantly correlate with the 24-h averages of HRV indices.

CONCLUSION

The circadian rhythms of the HRV indices over 24 hours can, to some extent, predict the severity of stress, emotion and sleep conditions in female populations under stress.

Medication Error During the Day and Night Shift on Weekdays and Weekends: A Single Teaching Hospital Experience in Riyadh, Saudi Arabia

Background

The association between medication error incidence and time (day shift vs night shift) have not been extensively studied in Saudi Arabia, this study aimed to answer this question: is there a relationship between medication error incidence and time of the day (day shifts vs night shifts) on weekdays and weekends?.

Objective

To identify whether medication errors and their sub-categories are significantly different between day shifts, night shifts, during weekdays and weekends.

Methods

A retrospective analysis of medication errors reported by health-care practitioners from January 2018 to December 2019 through the Electronic-Occurrence Variance Reporting System (E-OVR) of a university teaching hospital in Riyadh, Saudi Arabia. Statistical analysis was used to determine the differences between the medication errors and their sub-categories and day and night shifts during weekdays (from Sunday to Thursday) and weekends (Friday and Saturday).

Results

A total of 2626 medication errors were reported over 2 years from January 2018 to December 2019. The most prevalent sub-category of medication errors was prescribing errors (55%), while the least common sub-category of medication errors was administration errors (0.6%). There was a statistically significant difference between medication errors and day of the week. Medication errors that happened on weekdays were greater than at weekends (P = 0.01). During weekends, medication errors were more likely to occur at the night shift compared to the day shift (P < 0.05).

Conclusion

Timing of medication errors incidence is an important factor to be considered for improving the medication use process and improving patient safety. Further researches are needed that focus on intervention to reduce these errors, especially during night shifts.

Influence of rotating shifts and fixed night shifts on sleep quality of nurses of different ages: a systematic literature review and meta-analysis

The objective of this study was to understand the influence of rotating shifts and fixed night shifts on the sleep quality of nurses using a systematic literature review and meta-analysis and to determine whether the sleep quality of nurses working rotating shifts or fixed night shifts differs from that of nurses working fixed day shifts. We conducted a meta-analysis on literature that had used the Pittsburgh Sleep Quality Index (PSQI) to gauge sleep quality and had been published between 2000 and 2020 in the Cochrane Library, CINAHL, MEDLINE, and PubMed databases. This study was conducted in accordance with PRISMA, and the quality of the literature was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. CMA 3.0 was employed for data analysis, and meta-regression analysis was conducted to examine the differences between the PSQI scores of nurses working fixed day shifts and those working rotating shifts or fixed night shifts. Following assessment, a total of 29 papers (34 items of data) were analyzed. The papers included a total of 3,935 nurses who worked fixed day shifts, 3,777 nurses who worked rotating shifts, and 1,559 nurses who worked fixed night shifts. Our subgroup analysis indicated that the sleep quality of nurses working rotating shifts was poorer than the sleep quality of nurses working fixed day shifts; the standardized mean difference (SMD) was 0.38 (95% CI: 0.24-0.52, p< .001), and the meta-regression analysis found that the difference in sleep quality between nurses over 40 years old working rotating shifts and those working fixed day shifts was significantly smaller than the difference in sleep quality between nurses 40 years old or younger working rotating shifts and those working fixed day shifts (β = -0.368, p= .011). The sleep quality of nurses working fixed night shifts was also poorer than the sleep quality of nurses working fixed day shifts; the SMD was 0.58 (95% CI: 0.38-0.78, p< .001), and the meta-regression analysis revealed that the difference in sleep quality between nurses over 40 years old working fixed night shifts and those working fixed day shifts was not significantly different from the difference in sleep quality between nurses 40 years old or younger working fixed night shifts and those working fixed day shifts (β = -0.118, p= .608). This meta-analysis found that both nurses working rotating shifts and those working fixed night shifts had poorer sleep quality than those working fixed day shifts and that age influenced the difference in sleep quality only between nurses working rotating shifts and those working fixed day shifts; the difference in sleep quality between nurses 40 years old or younger working rotating shifts and those working fixed day shifts was greater than the difference in sleep quality between nurses over 40 years old working rotating shifts and those working fixed day shifts.

Predicting nurse fatigue from measures of work demands

Fatigue arising from excessive work demands is a known safety challenge in hospital nurses. This study aimed to determine which measures of work demands during nursing work are most predictive of hospital nurse fatigue levels at the end of the work shift. Measures of work demands of registered nurses from two hospital units in the United States were collected from organizational data sources, wearable sensors, and questionnaires. Fatigue levels were measured at the start and end of each shift using the Brief Fatigue Inventory. Multilevel linear regression analysis was used to predict end of shift fatigue based on work demand variables. The best fit model included multiple variables from organizational data sources and a physical activity variable measured by a wearable sensor. Organizational data can be used to create dynamic measures of work demands as they occur and predict end of shift fatigue levels in hospital nurses.

Sleep-Related Problems in Night Shift Nurses: Towards an Individualized Interventional Practice

Rotating shifts (mostly 8- or 12-h) are common among nurses to ensure continuity of care. This scheduling system encompasses several adverse health and performance consequences. One of the most injurious effects of night-time shift work is the deterioration of sleep patterns due to both circadian rhythm disruption and increased sleep homeostatic pressure. Sleep problems lead to secondary effects on other aspects of wellbeing and cognitive functioning, increasing the risk of errors and workplace accidents. A wide range of interventions has been proposed to improve the sleep quality of nurses and promote an increase in attention levels. In recent years, particular attention has been paid to individual and environmental factors mediating the subjective ability to cope with sleep deprivation during the night shift. Given the predictive role of these factors on the negative impact of a night shift, an individualized intervention could represent an effective countermeasure by ensuring suitable management of shift schedules. Therefore, the aims of this mini-review are to: (a) provide an updated overview of the literature on sleep problems in night shift nurses and their adverse consequences; and (b) critically analyze the psychosocial factors that mediate the negative impact of shift work with the ultimate goal of defining an effective countermeasure based on an individualized approach.

Fatigue and the Female Nurse: A Narrative Review of the Current State of Research and Future Directions

Background: The female nurse exhibits a multitude of personal and environmental characteristics that renders this population especially prone to fatigue. The consequences of fatigue in nurses are widespread and impactful at the personal, organizational, and societal levels. These include high injury rates and burnout in the nurse and poor patient and organizational outcomes. Objective: This article discusses the implications of fatigue in female nurses, including the impacts of fatigue across multiple entities (e.g., worker, patient, organization). It also reviews the current state of the research, including recent work on nurse fatigue and work schedule characteristics, and key areas for future work that would help empirically establish approaches to counter the detrimental and widespread effects of fatigue. Method: A narrative literature review was conducted resulting from an analysis of the literature limited to peer-reviewed studies. Results: A confluence of factors combines to elevate the prevalence and risk of fatigue in the female nurse. Numerous measures have established that performance-based fatigue results from nursing work schedules in nurses. Data also demonstrate that fatigue accumulates across successive shifts. Recent evidence supports the use of objective fatigue measures, including psychomotor reaction time and muscle function-related variables. Current gaps in the literature are delineated in the text. Conclusions: Strategic and well-designed research studies, as well as recent technological advances in fatigue tracking tools have the potential to help workers, administrators, and organizations develop fatigue management programs that could reduce the heavy burdens of fatigue on a multitude of health, safety, and economical outcomes.

Differences in Daytime Activity Levels and Daytime Sleep Between Night and Day Duty: An Observational Study in Italian Orthopedic Nurses

Working nonstandard work schedules is often associated with increased sedentary behavior and risk of sleep disorders. Night shift workers are prone to accumulating sleep debt, which they recover by sleeping during the day. The effect on daytime activity levels is unknown. The present study aims to objectively assess whether daytime sleep could affect daytime activity levels of shift worker nurses, resulting in an accumulation of their activity debt differently between working and rest periods. The study population (N = 37; mean age 41.7 ± 9.1 years) was composed of orthopedic nurses working on a rotating schedule, including either a night shift (NS) or only day/afternoon shift (DS). Actigraph monitoring lasted both on the working and the rest period. For the NS nurses, the working period recorded higher daytime activity levels than the rest period, while daytime sleep during the working and rest periods was similar. Conversely, DS nurses showed higher daytime activity levels and shorter daytime sleep during the working period. NS nurses were less active than DS nurses during the working period, probably because NS tended to have a longer daytime sleep. During the rest period, daytime activity levels for both groups were decreased. For NS nurses, sleep recorded the better sleep parameters during the rest period, while sleep parameters did not show significant differences between the working and the rest periods in DS. During the working period, NS nurses slept worse than the DS nurses. Both groups tended to accumulate a debt in daytime activity levels during the rest period. While daytime sleep may be an excellent way to counteract sleep debt and increase sleep duration over 24 h period, on the other hand, it makes nurses less active.

Effect of shift work on fatigue and sleep in neonatal registrars

OBJECTIVE

We aimed to study fatigue and sleep in registrars working 12-hour rotating shifts in our tertiary neonatal intensive unit.

METHODS AND PARTICIPANTS

This study involved neonatal registrar's working day (08:00-21:00) and night (20:30-08:30) shifts. Participants maintained a sleep diary, answered a self-reported sleepiness questionnaire assessing subjective sleepiness, and performed a 10-minute psychomotor vigilance task (PVT) at the start and end of each shift. Primary outcomes: (1) Fatigue at the (i) "start vs end" of day and night shifts, (ii) end of the "day vs night" shifts, and (iii) end of "first vs last shift" in block of day and night shifts. (2) Duration and quality of sleep before the "day vs night" shifts. Mean reaction time (RTM), relative coefficient of variation (RTCV), and lapses (reaction time > 500ms) were used as measures of fatigue on PVT. Secondary outcome: Subjective sleepiness (self-reported sleepiness questionnaire) at the 'start vs end" of day and night shifts.

RESULTS

Fifteen registrars completed the study. Acuity was comparable for all shifts. (1) Psychomotor responses were impaired at the end vs start of day shifts [RTM (p = 0.014), lapses (p = 0.001)], end vs start of night shifts [RTM (p = 0.007), RTCV (p = 0.003), lapses (p<0.001)] and end of night vs day shifts [RTM (p = 0.007), RTCV (p = 0.046), lapses (p = 0.001)]. Only lapses were significantly increased at the end of the last (p = 0.013) vs first shift (p = 0.009) in a block of day and night shifts. (2) Duration of sleep before the night (p = 0.019) and consecutive night shifts was decreased significantly (p = 0.034). Subjective sleepiness worsened after day (p = 0.014) and night shifts (p<0.001).

CONCLUSION

Fatigue worsened after the 12-hour day and night shifts with a greater change after night shifts. Lapses increased after block of day and night shifts. Sleep was decreased before night shifts. Our findings need to be confirmed in larger studies.

Prevalence of Poor Sleep Quality in Nursing Staff: A Meta-Analysis of Observational Studies

Objective: Poor sleep quality is common in nursing staff. This meta-analysis aimed to examine the pooled prevalence of poor sleep quality in nursing staff. Methods: A systematic search in PubMed, EMBASE, PsycINFO, and Web of Science databases was performed. Studies that reported sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) were synthesized using a random-effects model. Results: Fifty-three studies were analyzed. The pooled prevalence of poor sleep quality was 61.0% (95% CI: 55.8-66.1%). The pooled total PSQI score was 7.13 ± 0.18 (95% CI: 6.78-7.50). The pooled component scores were 1.47 ± 0.20 (95% CI of mean score: 1.08-1.85) in sleep latency, 0.91 ± 0.15 (95% CI of mean score: 0.61-1.21) in sleep duration, 1.59 ± 0.13 (95% CI of mean score: 1.35-1.84) in overall sleep disturbances, 0.33 ± 0.18 (95% CI of mean score: 0-0.67) in sleeping medication, 1.21 ± 1.20 (95% CI of mean score: 0.83-1.60) in daytime dysfunction, 1.39 ± 0.14 (95% CI of mean score: 1.11-1.67) in subjective sleep quality, and 0.66 ± 0.11 (95% CI of mean score: 0.44-0.87) in habitual sleep efficiency. Subgroup and meta-regression analyses found that PSQI cutoff values, mean age, body mass index (BMI), sample size, study quality, and work experience moderated the prevalence of poor sleep quality. Conclusions: Poor sleep quality appears to be common in nursing staff. Considering its negative impact on health, effective measures should be taken to improve poor sleep quality in this population. Longitudinal studies should be conducted to examine the contributing factors of nurses' poor sleep quality.

Nurses and Night Shifts: Poor Sleep Quality Exacerbates Psychomotor Performance

In Europe, 40% of health-care employees are involved in shift work. The altered sleep/wake rhythm of night-shift nurses is also associated with deteriorated cognitive efficiency. In this study, we examine the effects of the night shift on psychomotor performance, sleepiness, and tiredness in a large sample of shift-working nurses and evaluated if poor sleep quality, sex, age, or years on the job could impact on a better adaptation to shift work. Eighty-six nurses with 8-h-rapidly-rotating-shifts were evaluated at the end of three shifts (morning/afternoon/night) for sleepiness and tiredness. Sleepiness, as measured by the Karolinska Sleepiness Scale, and tiredness, as measured by the Tiredness Symptoms Scale, were more pronounced after the night shift. These increases were paralleled by lower attentional performance on the psychomotor vigilance task (PVT) after the night shift. While sex, age, and years on the job did not affect PVT performance after the night shift, lower sleep quality (Pittsburgh Sleep Quality, PSQI > 5) was associated with decreased performance. The high prevalence of altered sleep quality showed that nurses, and shift workers in general, are at risk for a poor sleep quality. The evaluation of sleep quality through PSQI could represent a rapid, inexpensive tool to assess health-care workers assigned to rotating night shifts or to evaluate nurses who coped poorly with night-shift work.

Morning and evening salivary melatonin, sleepiness and chronotype: A comparative study of nurses on fixed day and rotating night shifts

AIMS

To compare morning and evening salivary melatonin levels, sleep quality and chronotype between nurses working fixed day shifts and those working rotating night shifts.

BACKGROUND

Rotating night shift work is an inevitable part of nursing and is a major reason for disrupted sleep.

DESIGN

Cross-sectional comparative design.

PARTICIPANTS AND SETTINGS

We used cluster sampling to recruit 520 female nurses working fixed day and rotating night shifts in the United Arab Emirates.

METHODS

Morning and evening melatonin were measured from corresponding saliva samples. The Pittsburgh Sleep Quality Index used to evaluate sleep quality and self-assessment of preferred circadian times was used to assess participants' chronotypes. Data were collected between October 2017-December 2018.

RESULTS

Rotating night shift nurses had significantly lower evening melatonin compared with the fixed day shift group. No significant difference was found in sleep quality between the groups, although more participants in the rotating night shift group (N = 110, 42.31%) expressed better sleep quality than those in the fixed day group (N = 90, 36.00). Participants in the rotating night shift group expressed better subjective sleep, longer sleep duration, less disturbed sleep and better daily function (p > .05) than the fixed day group. Rotating night shift participants were more likely to have evening or intermediate chronotypes and more likely to report alignment of shift work to their chronotype compared with fixed day shift participants (p = .001). Longer shift duration, marital status and city location were associated with reduced evening melatonin among nurses on rotating night shifts.

CONCLUSION

Rotating night shift nurses showed evidence of better sleep than those from the fixed day shift. Proper shift assignment, chronotype and alignment with shift work appeared to produce better sleep quality.

IMPACT

Organizational policy must consider a novel model for work schedules that allow adequate off-duty days for sleep recovery among nurses.

Judging health care priority in emergency situations: Patient facial appearance matters

RATIONALE

Extensive research has shown that implicit trait inferences from facial appearance can bias everyday life in a pervasive way, influencing our decisions in different social contexts such as mate choice, political vote and criminal sentence. In situations characterized by time pressure and scant information, decisions based on inferences from facial appearance may have particularly critical and serious consequences, such as in emergency healthcare. No studies today have investigated this aspect in an actual emergency.

OBJECTIVE

The aim of the present study was to go beyond this gap and to determine whether implicit inferences from patients' facial appearance could be predictive of disparities in clinical evaluations and priority of treatment.

METHODS

In total, 183 cases of patients were evaluated by independent judges at zero acquaintance on the basis of different implicit facial appearance-based inferences, including trustworthiness and distress. Color-based priority code (White, Green, or Yellow) attributed by the triage nurse at the end of the registration process were recorded.

RESULTS

Our results showed that more trustworthy- and distressed- looking patients' faces have been associated with a higher priority code.

CONCLUSIONS

The present study shows that specific facial appearance-based inferences influence the attribution of priority code in healthcare that require quick decisions based on scarce clinical information such as in emergency. These results suggest the importance to bring to the attention of the healthcare professionals' the possibility of being victims of implicit inferences, and prompt to design educational interventions capable to increase their awareness of this bias in clinical evaluation.

Sleep Improvement Effect on Sexual Life Quality Among Rotating Female Shift Workers: A Randomized Controlled Trial

BACKGROUND

Poor sleep quality consequences among shift working nurses are well recognized.

AIM

To investigate the impact of sleep improvement on sexual quality of life.

METHODS

The study was a parallel randomized controlled trial, conducted among 120 female nurses in 2 educational hospitals in the Northeast of Iran, Shahroud. Using random blocks of four, 120 eligible participants were randomly assigned to study groups. Data collecting tools included a demographic data questionnaire, Pittsburgh Sleep Quality Index to assess sleep quality, and the survey of sexual quality of life-female and Sexual Self-Efficacy Questionnaire to evaluate level of sexual quality of life and sexual self-efficacy, respectively. The intervention consisted of 3 weekly sleep intervention sessions that lasted from 90 to 120 minutes.

OUTCOMES

The study's primary and secondary outcomes were sleep quality, and the level of sexual self-efficacy and sexual quality of life, respectively.

RESULTS

By 3-month follow-up, the loss to follow-up rate was 5.9%. The mean sleep quality score was 7.61 ± 2.26 in the recruited participants. Following the intervention, the sleep quality score showed statistically significant differences compared to the control group [mean difference (CI 99.98%), -1.89 (-2.40, -1.38)]. Participants in the intervention group showed modest increases in both measures; sexual self-efficacy [mean difference (CI 99.98%), 8.82 (6.83, 10.81)] and sexual quality of life [mean difference (CI 99.98%), 19.64 (18.08, 21.20)].

CLINICAL IMPLICATIONS

These findings suggest that sleep improvement could promote the sexual quality of life among shift working nurses.

STRENGTHS & LIMITATIONS

Strengths of this study include the use of a validated outcome measure. Focusing the study on female nurses and the small size of the study population are the limitations.

CONCLUSION

Improved sleep showed an impact on sexual quality of life among rotating female shift workers. Khastar H, Mirrezaie SM, Chashmi NA, et al. Sleep Improvement Effect on Sexual Life Quality Among Rotating Female Shift Workers: A Randomized Controlled Trial. J Sex Med 2020;17:1467-1475.

How safe staffing can improve emergency nursing: time to cut the Gordian knot

The phrase 'cut the Gordian knot' describes a bold and direct solution to a complicated problem. Nursing presence has been defined as nurses' ability to pay attention to patients and make them feel that their needs have been considered. In the emergency department (ED), nursing presence can be adversely affected by factors such as fatigue, workplace bullying, moral distress and inadequate staffing levels, which could lead to suboptimal patient outcomes and compromise the goals of nursing. Nursing presence is also important for nurses' job satisfaction and therefore for staff retention. This article explores the combined effects of fatigue, workplace bullying, moral distress and inadequate staffing levels on emergency nurses. To cut the Gordian knot it also provides recommendations for mitigating these issues in EDs through safe staffing decisions that consider patient acuity and skill mix.

Decreased psychomotor vigilance of female shift workers after working night shifts

Background

We compared psychomotor vigilance in female shift workers of the Bergmannsheil University Hospital in Bochum, Germany (N = 74, 94% nurses) after day and night shifts.

Methods

Participants performed a 3-minute Psychomotor Vigilance Task (PVT) test bout at the end of two consecutive day and three consecutive night shifts, respectively. Psychomotor vigilance was analyzed with respect to mean reaction time, percentage of lapses and false starts, and throughput as an overall performance score, combining reaction time and error frequencies. We also determined the reaction time coefficient of variation (RTCV) to assess relative reaction time variability after day and night shifts. Further, we examined the influence of shift type (night vs. day) by mixed linear models with associated 95% confidence intervals (CI), adjusted for age, chronotype, study day, season, and the presence of obstructive sleep apnea (OSA).

Results

At the end of a night shift, reaction times were increased (β = 7.64; 95% CI 0.94; 14.35) and the number of lapses higher compared to day shifts (exp(β) = 1.55; 95% CI 1.16–2.08). By contrast, we did not observe differences in the number of false starts between day and night shifts. Throughput was reduced after night shifts (β = -15.52; 95% CI -27.49; -3.46). Reaction times improved across consecutive day and night shifts, whereas the frequency of lapses decreased after the third night. RTCV remained unaffected by both, night shifts and consecutive shift blocks.

Discussion

Our results add to the growing body of literature demonstrating that night-shift work is associated with decreased psychomotor vigilance. As the analysis of RTCV suggests, performance deficits may selectively be driven by few slow reactions at the lower end of the reaction time distribution function. Comparing intra-individual PVT-performances over three consecutive night and two consecutive day shifts, we observed performance improvements after the third night shift. Although a training effect cannot be ruled out, this finding may suggest better adaptation to the night schedule if avoiding fast-changing shift schedules.

Does work-induced fatigue accumulate across three compressed 12 hour shifts in hospital nurses and aides?

Fatigue-related impairments in the nursing workforce contribute to a multitude of health, safety, and economic consequences at the individual, organizational and societal levels. Long and compressed work schedules are commonly worked in the healthcare industry, but more research is needed to understand the cumulative effects of multiple work shifts on physiology-based performance outcomes in nurses. The purpose of this study was to compare the effects of a single nursing work shift versus three compressed (one every 24 hours) 12 hour shifts on performance-based fatigue in nurses and aides. Twenty-six fulltime hospital working nurses and aides (age = 36.1 ± 13.3 years) reported to the lab for testing before, immediately after working a single 12 hour shift, and after working three 12 hour shifts in a 72 hour period. Outcome measures included vigilance-based reaction time, lapses of attention, and muscle function assessments (lower and upper body muscle strength, explosive strength and vertical jump performance). All variables except hand grip strength showed a significant decline following the three work shifts. The psychomotor vigilance reaction time and lapses of attention variables also generally showed a significant decline from the end of shift one to the end of shift three, indicting an accumulation of fatigue in these metrics with increasing number of shifts worked. Muscle function variables responded early in the duty cycle, showing a significant decline after a single work shift, but did no further decline by the end of the third shift. These findings use objective measures to substantiate that fatigue impairments occur from working a single 12 hour shift, and in several instances, increase further with more successive work shifts. Caution should be employed by personnel and administrators with work schedules involving multiple compressed 12 hour shifts. Fatigue management strategies may be used to improve risks and consequences from fatigue-related mishaps, and this study reports several variables that appear sensitive to identifying and tracking fatigue in this population.

Shift-work nurses' work environments and health-promoting behaviours in relation to sleep disturbance: A cross-sectional secondary data analysis

AIMS AND OBJECTIVES

To examine the association of nursing work environments and health-promoting behaviours with shift-work nurses' sleep disturbance.

BACKGROUND

Shift-work nurses reportedly have sleep problems, which affect their sleep quality and quantity. Given the high risk of developing performance decrements and medication errors in sleep-disturbed nurses, factors related to sleep disturbance among shift-work nurses should be investigated.

DESIGN

A cross-sectional secondary data analysis.

METHODS

Our study analysed data from 339 nurses who had been involved in rotating shift work including night shifts for more than 6 months. To examine associations of nursing work environments and health-promoting behaviours with sleep disturbance, multiple linear regression models were generated. This study is reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guideline.

RESULTS

Nurses with more collegial relations with physicians were significantly less likely to have high levels of sleep disturbance (B = -4.01, p = 0.04). Those with higher levels of sleep disturbance were significantly more likely to report less stress management (B = -9.56, p < 0.01) and higher health responsibility (B = 9.30, p < 0.01).

CONCLUSIONS

To alleviate shift-work nurses' sleep disturbance, organisational supports for collaborative relations with physician and increased healthcare accessibility are needed. Individual nurses should develop healthy lifestyles to reduce occupational stress and alleviate sleep disorders.

RELEVANCE TO CLINICAL PRACTICE

To improve shift-work nurses' sleep, collegial relations with physicians and healthy lifestyles should be promoted.

Not only a Problem of Fatigue and Sleepiness: Changes in Psychomotor Performance in Italian Nurses across 8-h Rapidly Rotating Shifts

Although many studies have detailed the consequences of shift work in nurses concerning health, fatigue, sleepiness, or medical errors, no study has been carried out trying to disentangle the contribution of sleepiness and fatigue associated to shift work from the attentional performance. The aim of this pilot study is (A) to investigate the effects of an 8-h rapidly rotating shift on fatigue and sleepiness among staff nurses and (B) how these factors affect their psychomotor performance. Fourteen nurses were selected for a within-subject cross-sectional study according to this sequence of shifts: morning⁻afternoon⁻night, which were compared as function of tiredness, sleepiness, and performance at the Psychomotor Vigilance Task (PVT). Subsequently, a within-subject Analysis of Covariance (ANCOVA) evaluated if the observed differences between shifts persist when the contribution of sleepiness is controlled. Our results clearly indicate that night shifts are associated with significant greater sleepiness and tiredness, and worsened performance at the PVT. As hypothesized, ANCOVA showed that these differences disappear when the contribution of sleepiness is controlled. Results point to a lower psychomotor performance in night compared to day shifts that depends on sleepiness. Hence, interventions to minimize the consequences of the night shift should consider a reduction of sleepiness.

EXCESSIVE DAYTIME SLEEPINESS AND HEALTH DAMAGE IN NURSING CLINIC SURGICAL WORKERS

ABSTRACT Objectives: to evaluate excessive daytime sleepiness and to analyze the association between sleepiness and physical, social and psychological damages in nursing clinic surgical workers. Method: a cross-sectional study carried out with nursing workers from a surgical clinic unit of a teaching hospital in the South of Brazil. The data collection was carried out in 2016, it was used self-administered tools on socio-labor characterization, the Work-Related Damage Scale and the Epworth Sleepiness Scale, with descriptive and bivariate analysis, with a significance level of 5%. Results: 41 workers participated in the study; workers with excessive daytime sleepiness (9 workers) and severe sleepiness (three workers) were identified. The majority presented physical illness and there was an association between social (p<0.001) and psychological (p=0.001) damages in drowsy workers. Conclusion: workers with excessive daytime sleepiness were identified and it was evidenced an association between lack of sleep and impairment of the worker's health in a psychosocial context.

Who is sleepier on the night shift? The influence of bio-psycho-social factors on subjective sleepiness of female nurses during the night shift

Sleepiness is a common complaint during the night shift and may impair performance. The current study aims to identify bio-psycho-social factors associated with subjective sleepiness during the night shift. Ninety-two female nurses working rotating shifts completed a sociodemographic questionnaire, the Munich ChronoType Questionaire for shift workers, the Pittsburg Sleep Quality Index, and the Pre-sleep Arousal Scale. Subjective sleepiness was measured hourly during two night shifts using the Karolinska Sleepiness Scale, and activity monitors assessed sleep duration 24-h before each shift. Findings showed that increased sleepiness was associated with increased age in nurses with early chronotypes and with more children. High cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes. The impact of bio-psycho-social factors on night shift sleepiness is complex, and depends on mutual interactions between these factors. Nurses most prone to increased sleepiness must develop personal strategies for maintaining vigilance on the night shift. Practitioner Summary: This study aims to identify bio-psycho-social factors associated with subjective sleepiness of female nurses during the night shift. Increasing sleepiness was associated with increased age in nurses with early chronotypes and with more children. Increased cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes.

The Impact of a Rigorous Multiple Work Shift Schedule and Day Versus Night Shift Work on Reaction Time and Balance Performance in Female Nurses: A Repeated Measures Study

OBJECTIVE

The aim of this study was to determine the impact of a demanding work schedule involving long, cumulative work shifts on response time and balance-related performance outcomes and to evaluate the prevalence of musculoskeletal disorders between day and night shift working nurses.

METHODS

A questionnaire was used to identify the prevalence of past (12-month) and current (7-day) musculoskeletal disorders. Nurses worked three 12-hour work shifts in a 4-day period. Reaction time and balance tests were conducted before and after the work period.

RESULTS

The work period induced impairments for reaction time, errors on reaction time tasks, and balance performance, independent of shift type. Musculoskeletal symptom prevalence was high in workers of both work shifts.

CONCLUSIONS

Compressed work shifts caused performance-based fatigue in nurses. Reaction time and balance tests may be sensitive fatigue identification markers in nurses.

Fatigue in Intensive Care Nurses and Related Factors

BACKGROUND

Fatigue negatively affects the performance of intensive care nurses. Factors contributing to the fatigue experienced by nurses include lifestyle, psychological status, work organization and sleep problems.

OBJECTIVE

To determine the level of fatigue among nurses working in intensive care units and the related factors.

METHODS

This descriptive study was conducted with 102 nurses working in intensive care units in the West Black Sea Region of Turkey. Data were collected between February and May 2014 using a personal information form, the Visual Analogue Scale for Fatigue (VAS-F), the Hospital Anxiety and Depression Scale and the Pittsburg Sleep Quality Index.

RESULTS

The intensive care nurses in the study were found to be experiencing fatigue. Significant correlations were observed between scores on the VAS-F Fatigue and anxiety (p=0.01), depression (p=0.002), and sleep quality (p<0.001).

CONCLUSION

Anxiety, depression and quality of sleep were significantly affected by the intensive care nurses' levels of fatigue. These results can be of benefit in taking measures which may be used to reduce fatigue in nurses, especially the fatigue related to work organization and social life.

Association between Off-Peak Hour Birth and Neonatal Morbidity and Mortality among Very Low Birth Weight Infants

OBJECTIVE

To assess the independent association between overnight or "off-peak" hour delivery and 3 neonatal morbidities strongly associated with childhood neurocognitive impairment.

STUDY DESIGN

Retrospective population based cohort study of all infants with birth weights of 500-1499 g born without severe congenital anomalies in California or Pennsylvania between 2002 and 2009. Off-peak hour delivery was defined as birth between 12:00 a.m. and 6:59 a.m. The study outcomes were death; bronchopulmonary dysplasia, retinopathy of prematurity, and severe (grade 3 or 4) intraventricular hemorrhage among survivors; the composite of each morbidity or mortality; and the composite of death or 1 or more of the evaluated morbidities.

RESULTS

Of 47 617 evaluated infants, 9317 (19.6%) were born during off-peak hours. The frequencies of all study outcomes were higher among infants born during off-peak compared with peak hours. After adjusting for maternal, infant, and hospital characteristics, off-peak hour delivery was associated with increased odds of severe intraventricular hemorrhage among survivors (OR 1.39, 95% CI 1.23-1.57) and the composite outcomes of death or severe intraventricular hemorrhage (OR 1.16, 95% CI 1.07-1.25) and death or major morbidity (OR 1.08, 95% CI 1.02-1.15). There was no evidence of subgroup effects based on delivery mode, birth hospital neonatal intensive care level or annual very low birth weight infant delivery volume, or weekday vs weekend off-peak hour delivery for any study outcome.

CONCLUSIONS

Very low birth weight infants born between midnight and 7:00 a.m. are at increased risk for severe intraventricular hemorrhage and death or major neonatal morbidity.

Effects of Accumulating Work Shifts on Performance-Based Fatigue Using Multiple Strength Measurements in Day and Night Shift Nurses and Aides

Objective This study aimed to examine the effects of accumulating nursing work on maximal and rapid strength characteristics in female nurses and compare these effects in day versus night shift workers. Background Nurses exhibit among the highest nonfatal injury rates of all occupations, which may be a consequence of long, cumulative work shift schedules. Fatigue may accumulate across multiple shifts and lead to performance impairments, which in turn may be linked to injury risks. Method Thirty-seven nurses and aides performed isometric strength-based performance testing of three muscle groups, including the knee extensors, knee flexors, and wrist flexors (hand grip), as well as countermovement jumps, at baseline and following exposure to three 12-hour work shifts in a four-day period. Variables included peak torque (PT) and rate of torque development (RTD) from isometric strength testing and jump height and power output. Results The rigorous work period resulted in significant decreases (-7.2% to -19.2%) in a large majority (8/9) of the isometric strength-based measurements. No differences were noted for the day versus night shift workers except for the RTD at 200 millisecond variable, for which the night shift had greater work-induced decreases than the day shift workers. No changes were observed for jump height or power output. Conclusions A compressed nursing work schedule resulted in decreases in strength-based performance abilities, being indicative of performance fatigue. Application Compressed work schedules involving long shifts lead to functional declines in nurse performance capacities that may pose risks for both the nurse and patient quality of care. Fatigue management plans are needed to monitor and regulate increased levels of fatigue.

Sleep Quality Associated With Different Work Schedules: A Longitudinal Study of Nursing Staff

Purpose:

To explore the differences in sleep parameters between nurses working a slow, forward rotating shift and those working a fixed day shift.

Method:

A longitudinal parallel-group comparison design was used in this prospective study. Participants (female) were randomly assigned to a rotating shift or a fixed day shift group. Participants in the rotating shift group worked day shift for the first 4 weeks, followed by evening shift for the second and night shift the third. Those in the day shift group worked day shift for all 12 weeks. Each kept a sleep diary and wore an actigraph (actigraph data were used to calculate total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO], and sleep efficiency [SE]) for 12 days, from Workday 1–4 in each of Weeks 4, 8, and 12.

Results:

TST in nurses working evening rotating shift was higher than that for those working the day or night rotating shift and fixed day shift. WASO was significantly longer on Day 2 for rotating shift participants working evening versus day shift. SOL and SE were significantly shorter and lower in rotating shift nurses working night versus both day and evening shifts.

Conclusions:

A comprehensive understanding of the sleep patterns and quality of nurses with different work shifts may lead to better management of work shifts that reduces the influence of shift work on sleep quality.