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The impact of shift work on the psychological and physical health of nurses in a general hospital: A comparison between rotating night shifts and day shifts

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Background: Shift work is considered necessary to ensure continuity of care in hospitals and residential facilities. In particular, the night shift is one of the most frequent reasons for the disruption of circadian rhythms, causing significant alterations of sleep and biological functions that can affect physical and psychological well-being and negatively impact work performance. Objectives: The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction. Methods: This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in 17 wards of a general hospital and a residential facility of a northern Italian city. This study involved 213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data collection was the “Standard Shift Work Index,” validated in Italian. Data were statistically analyzed. Results: The response rate was 86%. The nurses engaged in rotating night shifts were statistically significantly younger, more frequently single, and had Bachelors and Masters degrees in nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in comparison with the day shift workers, in a statistically significant way. Conclusion: Our results suggest that nurses with rotating night schedule need special attention due to the higher risk for both job dissatisfaction and undesirable health effects.
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Risk Management and Healthcare Policy 2016:9 203–211
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ORIGINAL RESEARCH
open access to scientific and medical research
Open Access Full Text Article
http://dx.doi.org/10.2147/RMHP.S115326
The impact of shift work on the psychological and
physical health of nurses in a general hospital: a
comparison between rotating night shifts and day
shifts
Paola Ferri1
Matteo Guadi1
Luigi Marcheselli1
Sara Balduzzi1
Daniela Magnani1
Rosaria Di Lorenzo2
1Department of Diagnostic, Clinical
and Public Health Medicine, University
of Modena and Reggio Emilia,
2Department of Mental Health, AUSL
di Modena, Service of Psychiatric
Diagnosis and Treatment, Modena,
Italy
Background: Shift work is considered necessary to ensure continuity of care in hospitals and
residential facilities. In particular, the night shift is one of the most frequent reasons for the
disruption of circadian rhythms, causing significant alterations of sleep and biological functions
that can affect physical and psychological well-being and negatively impact work performance.
Objectives: The aim of this study was to highlight if shift work with nights, as compared with
day work only, is associated with risk factors predisposing nurses to poorer health conditions
and lower job satisfaction.
Methods: This cross-sectional study was conducted from June 1, 2015 to July 31, 2015 in
17 wards of a general hospital and a residential facility of a northern Italian city. This study involved
213 nurses working in rotating night shifts and 65 in day shifts. The instrument used for data col-
lection was the “Standard Shift Work Index,” validated in Italian. Data were statistically analyzed.
Results: The response rate was 86%. The nurses engaged in rotating night shifts were statisti-
cally significantly younger, more frequently single, and had Bachelors and Masters degrees in
nursing. They reported the lowest mean score in the items of job satisfaction, quality and quantity
of sleep, with more frequent chronic fatigue, psychological, and cardiovascular symptoms in
comparison with the day shift workers, in a statistically significant way.
Conclusion: Our results suggest that nurses with rotating night schedule need special attention
due to the higher risk for both job dissatisfaction and undesirable health effects.
Keywords: shift work, night work, health, sleep disorders, job satisfaction, nurses
Introduction
Nowadays, almost a fifth of the worldwide workforce is engaged in shift work, with ~20%
of European and American workers engaged in night shifts.1,2 In the health care system,
shift work is considered necessary and indispensable to ensure continuity of care in hospi-
tals and residential facilities. Rotating and scheduling are the main characteristics of shift
work and nurses are largely locked into schedules that provide 24-hour care and include
night shift work.3 An author has noted that “shift workers are creators and victims at the
same time” of this new work organization.4 Shift work, and night shift in particular, is one
of the most frequent reasons for the disruption of circadian rhythms, causing significant
alterations of sleep and biological functions, which, in turn, can affect the physical and
psychological well-being and negatively condition work performance.5–7 Many studies
have analyzed the impact of shift work on the physical health of workers. In particular,
some authors identified a maladaptation syndrome related to shift work, characterized
Correspondence: Paola Ferri
Department of Diagnostic, Clinical and
Public Health Medicine, University of
Modena and Reggio Emilia, Street Del
Pozzo no 71, 41124, Modena, Italy
Tel +39 059 4223528
Fax +39 059 4222520
Email paola.ferri@unimore.it
Journal name: Risk Management and Healthcare Policy
Article Designation: ORIGINAL RESEARCH
Year: 2016
Volume: 9
Running head verso: Ferri et al
Running head recto: The impact of rotating night shifts and day shifts on health
DOI: http://dx.doi.org/10.2147/RMHP.S115326
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by impaired sleeping/waking, gastrointestinal disorders, and
an increased risk of cardiovascular diseases.8 Recently, a syn-
drome called “shift work disorder” has been identified by the
presence of the following symptoms: alteration of circadian
rhythm of sleep/wake, insomnia, excessive day sleepiness, and
fatigue.9,10 Different percentages of shift work disorder have
been reported in cross-sectional studies, ranging from 24.4%
to 44.3%.2,11–13 Most studies highlighted that the overall quality
of sleep among night shift nurses was significantly poorer than
that of day and no night-rotating workers.5,14,15 Night shift work
induces sleep deprivation which, in turn, alters the daily levels
of alertness and job performance, favoring fatigue.2,16 This
condition, often associated with shifts,17–19 is probably due to
the desynchronization of circadian rhythm or reduced sleep,20,21
similar to jet lag syndrome.22 The sleep alterations related to
shift work have been included among the Circadian Rhythm
Sleep-Wake Disorders, irregular type, of Diagnostic and Sta-
tistical Manual of Mental Disorders, 5th Edition (DSM-5),23
which reports a high frequency of this disorder among the
night shift worker population (5%–10% of the workforce).
A Greek study confirms that sleep disturbance that occurs
in shift work is strongly associated with chronic fatigue.24
The symptoms of fatigue, including “sleepiness and lack
of energy,” “impaired concentration,” and “feelings of dis-
comfort,” were more severe in the nurses who worked night
shifts than others who worked during the day.25 Most authors
observed that the fatigue related to night shifts can increase
the risk of human errors and injuries and can negatively affect
the quality of patient care.26 Moreover, fatigue reduces perfor-
mance and job satisfaction, favoring absence due to sickness,
absenteeism, turnover, and job attrition and often induces use
of psychotropic drugs.27–30 Fatigue remains the major source
of nurses’ errors in administering medication.31 In a study by
Jamal and Baba, rotating shift nurses showed a lower degree
of job satisfaction.32 In a Greek nursing sample, the levels of
job satisfaction measured by the Index of Work Satisfaction
appeared to relate to shift work.33 Decreased job satisfaction
for nurses is strongly associated with increased job stress.34
Health professionals who worked night shifts showed more
psychological and mental health problems than day workers:
irritability, somatization, obsessive–compulsive disorder,
interpersonal sensitivity, anxiety, altered mood, and paranoid
disorders were significantly higher. These data indicate that
shift work has a negative impact on psychological health and
social life.35–37 Much research concerning the potential effects
of shift work on cardiovascular system has been conducted over
the last 2 decades without producing conclusive findings.8,38–40
In some studies, the relative risk of cardiovascular diseases in
night shift workers was higher than the risk reported by day
workers.41,42 In a study conducted among 75,000 US nurses, the
authors highlighted that mortality induced by cardiovascular
and other causes was significantly increased among female
nurses engaged in rotating night shift (RNS) work for 5
years compared to women who had never worked night shifts,
suggesting a potentially detrimental effect of RNS work on
health and longevity.43 These results were confirmed by the
meta-analysis of Lin et al44 who observed a 2.7% increase in
cardiovascular deaths in RNS workers. Many gastrointestinal
symptoms and disorders associated with shift work have been
reported in literature for >2 decades: dyspepsia, gastritis,
colitis, peptic ulcer, indigestion, appetite disorders, irregular
bowel movements, constipation, heartburn, pain, abdominal
rumblings, flatulence, and gastro-duodenitis.8,45–47 Several fac-
tors may be involved in the gastrointestinal symptoms reported
among shift workers: alterations of the circadian rhythm
of gastric functions (gastric secretion, enzyme activity, and
intestinal motility) and types of foods consumed, medication,
psychosocial stress, and for women, altered menstrual cycle.48
A recent study has shown that abnormal eating habits were
positively associated with shift work in a group of nurses.49 A
Danish study noted that, in a sample of 29,000 nurses, night
and evening shift workers presented an increased risk for
diabetes.50 Moreover, the number of night shifts worked in
the previous year was significantly and positively associated
with the variations in the body mass index of the workers.51 On
the contrary, another recent study did not observe a different
frequency of diseases between the night and the day shift (DS)
workers in a sample of 525 Polish nurses and midwives,52 prob-
ably due to the so-called “healthy worker effect,” as underlined
by the authors. Finally, in 2007, the International Agency for
Research on Cancer of the World Health Organization affirmed
that there is sufficient evidence to support that shift work with
circadian rhythm disruption is a probable carcinogen.53 This
observation has been confirmed by a recent meta-analysis,
which highlighted that night shift work enhanced the risk of
breast cancer morbidity by 8.9%.44
Epidemiological studies as reported above have shown
detrimental effects of shift work on health, but the patho-
logical mechanisms related to shift work have not been
completely elucidated. Moreover, up to now, satisfactory
solutions to minimize shift work impact on health conditions
have not been implemented.54 Many sleep, distress, or fatigue
disorders of health workers are still underestimated as are
other diseases, which frequently occur among professionals.7
The aim of this study is to highlight if shift work with
nights, as compared with day work only, is associated with
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The impact of rotating night shifts and day shifts on health
risk factors predisposing nurses to poorer health conditions
and lower job satisfaction.
Methods
Design and setting
This study was a cross-sectional analysis conducted from
June 1, 2015 to July 31, 2015 in 17 wards of a general hos-
pital (neurology-stroke unit, geriatrics, post-acute geriatric
treatment, emergency medicine, metabolic medicine, car-
diovascular medicine, orthopedics, rehabilitation medicine,
neurosurgery, post-acute extensive phase rehabilitation,
vascular surgery, general surgery, medicine gastroenterology,
cardiology, neurological and post-surgery intensive care,
emergency department, and digestive endoscopy clinic) and
in home care services in a northern Italian city.
Sample
In order to determine the sample size for the two groups of
nurses, a pilot study involving 25 DS nurses was conducted in
April 2015. The results of this preliminary analysis highlighted
an average score of 26.26 (±6.63 standard deviation [SD]) for
fatigue, which was the principal outcome of this research.
Therefore, assuming that among nurses who performed three
RNSs the score of fatigue was increased 3 points, the sample
size, with a significance value of 0.05 and a power of 0.80,
was 2:1 in favor of night shift nurses. Nevertheless, as a 65%
response rate to questionnaire was provided, the correct ratio
between daily and night shift nurses was ~3:1 in a total sample
of minimum 260 individuals. The nurses involved in the pre-
liminary study were excluded from the sample of this study.
The nurses (n=278) who agreed to complete the ques-
tionnaire during the study period were recruited for our
convenience sample: 213 nurses regularly working in three
RNSs and 65 in DSs.
In our hospital, DS nurses worked morning and afternoon
shifts according to a weekly timetable scheduled from Monday
to Friday, whereas RNS nurses worked according to a 6-day
cycle timetable with backward rotation and “quick return”
(first day afternoon; second morning, third night, fourth the
end of the previous night shift; fifth and sixth rest). In Table
1, information regarding the shift timetable is shown in detail.
Instrument
The instrument used for data collection was the “Standard
Shift Work Index” (SSI),55 translated in Italian.4 Before the
administration of SSI, we held a meeting with the professionals
of each hospital unit in order to give information about this
research, encouraging their participation.
The SSI is a self-report questionnaire with good psycho-
metric properties that has been used to compare groups of
shift workers working on different types of shift systems for
assessing the impact of work on the health and well-being
of individuals. This scale can be used as a whole battery, or
in part, as all its measures are independent of each other,
producing individual scores.55,56
We chose the following subsections of SSI, in accordance
with the aims of this study:
1. “Work situation” consists of three questions investigating
work seniority, experience, and time spent at work weekly.
2. “General job satisfaction” consists of five items which
“measure the degree to which the employee is satisfied
and happy with the job” with a 7-point score ranging
from “disagree strongly” (score 1) to “agree strongly”
(score 7).
3. “Information on shifts” consists of five questions con-
cerning time spent on shifts, start and end of shifts,
advantages or disadvantages of shifts, advance shift
scheduling time, and less acceptable shift among morn-
ing, afternoon, and night.
Table 1 Shift details: comparison between RNS and DS nurses
Shift scheduling
information
RNS nurses
(n=179)
DS nurses
(n=53)
Morning: work shift start time, n (%)
6.00 am 2 (1) 0 (0)
7.00 am 177 (99) 30 (57)
7.30 am 0 (0) 4 (7)
8.00 am 0 (0) 15 (28)
8.30 am 0 (0) 3 (6)
Morning: work shift nish time, n (%)
12.00 pm 0 (0) 1 (2)
1.00 pm 129 (72) 24 (45)
1.30 pm 49 (27) 5 (10)
2.00 pm 1 (1) 8 (15)
3.00 pm 0 (0) 15 (28)
Afternoon: work shift start time, n (%)
11.30 am 0 (0) 1 (2)
12.00 pm 0 (0) 6 (11)
1.00 pm 129 (72) 41 (77)
1.30 pm 49 (27) 0 (0)
2.00 pm 1 (1) 0 (0)
Afternoon: work shift nish time, n (%)
7.00 pm 0 (0) 35 (66)
8.00 pm 179 (100) 13 (24)
Night: work shift start time, n (%)
8.00 pm 179 (100) 0 (0)
Night: work shift nish time, n (%)
6.00 am 2 (1) 0 (0)
7.00 am 177 (99) 0 (0)
Abbreviations: DS, day shift; RNS, rotating night shift.
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4. “Personal habits” consists of only two questions regarding
daily personal habits (smoking and coffee consumption).
5. “Sleep” includes many questions aimed at investigating
“sleep habits.” We chose only four questions among all
the sleep items, as shown in Table 5, which are evalu-
ated by a Likert scale ranging from 1 (almost never) to
5 (almost always), “a score, of 5 being associated with
high sleep disturbance.”
6. “Chronic fatigue,” indicated as “general tiredness and
lack of energy,” is composed of 10 items: “five ques-
tions are positively oriented to index general feelings of
vigor and energy, the opposite of fatigue (the items are
reverse recoded)” whereas the other five items investi-
gate “general feelings of tiredness and lack of energy.”
The score is based on a 1–5-point Likert scale (“higher
score is an indication of more fatigue”).
7. “Physical health conditions” contains two subscales
evaluating cardiovascular and gastrointestinal disorders:
the first eight questions aimed at highlighting digestive
conditions, and the second eight questions investigated
cardiovascular conditions, with a Likert scale ranging
from 1 to 4 – “A higher score on each scale is associated
with poorer physical health.
8. “General health questionnaire,” the 12-item version we
chose, is a self-administered test for detecting minor
psychiatric disorders, with a multiple-response scale or
“Likert scale” – “A higher score would indicate poorer
psychological health.
9. “Injuries” is composed of two items for investigating the
number of injuries at work reported in the last 3 years
and the shift in which they occurred.
10. “Demographic and professional information” includes
five items concerning age, sex, marital status, profes-
sional qualifications, and employment contract and
hours worked per week. Cronbach’s alpha for “job
satisfaction,” “poor sleep,” “chronic fatigue,” “physical
health conditions,” and “general health questionnaire”
was 0.79, 0.81, 0.85, 0.65, and 0.82, respectively.
Statistical analysis
After collecting the completed questionnaires, the variables
were reported in EXCEL database. For continuous variables,
numerical categories were chosen in a number sufficiently
representative but not excessive and successively statistically
analyzed with STATA program.
Categorical variables were reported as absolute and
percentage frequencies. For continuous variables, mean and
SD were calculated. We compared the scale score of each
item between night and DS workers by using the Fisher’s
exact and chi-square test for categorical data and two-sided
unequal unpaired t-test (adopting Satterthwaite degrees of
freedom) for continuous data.
The association between the binary variable shift work
and selected characteristics was analyzed by means of logistic
regression and expressed as odds ratio (OR) with confidence
interval at 95% (95% CI). The OR measures the strength of
association between the characteristics of the cohort and DS
worker. Positive OR means that the odds for the DS worker
were greater when exposed to an increased value of covari-
ates analyzed. Data were analyzed by using the statistical
software Stata version 12 (2011).
Ethical considerations
This study was performed in accordance with the Declara-
tion of Helsinki and was authorized by both the Medical
Director and Director of Nursing of the General Hospital
(NOCSAE) of Modena. The present study was approved by
the Institutional Review Board of Local Nurses Association.
All nurses provided written informed consent. The anonym-
ity and confidentiality of participants were assured and their
decision to participate voluntarily in this study was respected.
Results
The response rate was 86% (239/278). Seven of 239 question-
naires were excluded because they were incomplete. Results
were extrapolated from 232 questionnaires. Demographic
and professional data of our sample are shown in Table 2.
RNS workers were statistically significantly younger than DS
workers (38±7 vs 45±6 SD years old on average; unpaired
t-test; P<0.001). In both groups, >70% of nurses were female.
In all, 31% of RNS workers was single, compared with 9%
of DS workers, in whom married status prevailed (64%) in a
statistically significant way (chi-square test; P=0.002). RNS
workers more frequently had a degree in nursing, compared
with DS nurses (83% vs 75%, chi-square test, P=0.003),
but they less frequently had an employment contract of
indefinite duration in comparison to other group (86% vs
96%, chi-square test, P=0.033). The professional experience,
evaluated as years of work, statistically significantly differed
between the two groups of nurses: 14.1 years on average in
RNS nurses compared to 22.5 in DS nurses (unpaired t-test,
P<0.001), whereas the mean hours spent at work by the two
groups did not show any statistically significant difference.
Regarding job satisfaction, the rotating shift professionals
reported the lowest mean score (23.1±5.7 SD), whereas daily
shift workers reported the highest mean score (26.4±4.2 SD),
with a statistically significant difference (unpaired t-test,
P<0.001) (Table 3). Among all shifts, the afternoon shift
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The impact of rotating night shifts and day shifts on health
and caffeine assumption) of both groups did not statistically
significantly differ.
Concerning chronic fatigue, as shown in Table 4, some
items, but not the total scale, reported statistically significant
higher scores in the group of rotating shift workers compared
to other nurses (unpaired t-test): “I usually feel pretty apa-
thetic” (P=0.007), “I often feel exhausted” (P<0.001), and “I
feel exhausted most of the time” (P=0.026). The two groups
presented a statistically significant difference in sleep disorders
(Table 5). RNS nurses reported lower scores in sleep quality and
quantity compared to DS nurses; in particular, they claimed to
suffer from sleepiness during morning shifts (unpaired t-test,
P<0.001). The average score of digestive symptoms reported
was 15.2 (±5.2 SD) in RNS workers and 14.2 (±4.3) among
DS workers, without any statistically significant difference.
Cardiovascular symptoms statistically significantly differed
only for two items concerning “chest pains” (1.4±0.6 vs
1.2±0.4, P=0.036) and “chest tightness” (1.3±0.6 vs 1.1±0.4,
P=0.036), symptoms more prevalent among RNS workers. In
all, 69.3% of RNS and 69.8% of DS workers did not report
any workplace accident in the previous 3 years; most accidents
reported by both groups occurred in morning shifts (62.5% and
36.4% among daily and rotating shift workers, respectively).
At the psychiatric symptom subsection, RNS workers reported
higher mean scores compared to the other group (13.4±4.9 vs
11.5±4.2, unpaired t-test, P=0.011).
We highlighted statistically significant associations
between work shifts and some characteristics of sample by
means of multivariate multiple logistic regression: positive
correlation between daytime work and quantity (OR =1.28,
95% CI: 1.01–1.62, P=0.039) and quality (OR =1.41, 95%
CI: 1.09–1.83, P=0.009) of sleep, and negative correlation
between daytime and feeling of tiredness (OR =0.45, 95%
CI: 0.34–0.60, P<0.001).
Discussion
In our study, the response rate was relatively high in com-
parison with other studies,3,24,57 indirectly suggesting the
potential impact of this issue on professional well-being. The
Table 2 Sample characteristics: comparison between RNS and
DS nurses
Variables RNS nurses
(n=179)
DS nurses
(n=53)
P-value
Age
(years), m ± SD 38±7 45±6<0.001
Sex, n (%)
Male
Female
Missing data
51 (28)
127 (71)
1 (1)
11 (21)
42 (79)
0 (0)
0.293
Marital status, n (%)
Single
Married
Cohabiting
Divorced
Missing data
56 (31)
77 (43)
37 (21)
8 (4)
1 (1)
5 (9)
34 (64)
9 (17)
5 (9)
0 (0)
0.002
Education, n (%)
Registered nurse
Bachelor in nursing sciences
Master in nursing sciences
Missing data
11 (6)
149 (83)
18 (10)
1 (1)
4 (8)
40 (75)
8 (15)
1 (2)
0.003
Employment contract, n (%)
Temporary
Permanent
26 (14)
153 (86)
2 (4)
51 (96)
0.033
Work schedule, n (%)
Full time
Part time
165 (92)
14 (8)
49 (92)
4 (8)
1.000
Seniority
(years), m ± SD 14.1±7.4 22.5±7.5 <0.001
Hours worked per week
m ± SD 35.3±2.5 35.3±3.0 0.926
Time worked in the present
shift system
(years), m ± SD 11.4±7.0 10.0±7.0 0.229
Note: The values in bold are statistically signicant.
Abbreviations: DS, day shift; m, mean; RNS, rotating night shift; SD, standard
deviation.
Table 3 Job satisfaction: comparison between RNS and DS nurses
Answers to SSI “job satisfaction” items RNS nurses (n=179) m ± SD DS nurses (n=53) m ± SD P-value
Generally speaking, I am very satised with my nursing 4.9±1.7 5.7±1.1 0.001
I frequently think of quitting this job 2.7±1.9 2.1±1.7 0.057
I am generally satised with the kinds of activities I do in this job 5.1±1.6 5.8±0.9 0.002
Most people in this job are very satised with it 3.7±1.5 4.1±1.7 0.064
People in this job often think of quitting 4.0±1.8 3.1±1.8 0.003
General job satisfaction 23.1±5.7 26.4±4.2 <0.001
Note: The values in bold are statistically signicant.
Abbreviations: DS, day shift; m, mean; RNS, rotating night shift; SD, standard deviation; SSI, Standard Shift Work Index.
was the least appreciated, according to both groups. No
statistically significant difference between the two groups
was highlighted in the answers to the question whether the
advantages associated with shift work outweighed the disad-
vantages. Concerning information on shifts, 73.1% of daily
workers versus only 22.2% of RNS nurses reported that their
shift timetable was scheduled months in advance (chi-square
=46.53, P=0.000). The personal habits (smoking cigarettes
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Table 4 Fatigue: comparison between RNS and DS nurses
Answers to SSI “fatigue” items RNS nurses (n=179) m ± SD DS nurses (n=53) m ± SD P-value
I generally feel I have plenty of energy 2.9±0.8 3.0±0.7 0.285
I usually feel drained 2.0±0.9 2.3±10.116
I generally feel quite active 3.1±0.8 3.2±0.6 0.583
I feel tired most of the time 2.5±0.9 2.4±0.9 0.289
I generally feel full of vigor 2.8±0.9 2.7±0.8 0.415
I usually feel rather lethargic 1.9±0.9 1.5±0.6 0.007
I generally feel alert 3.3±0.7 3.2±0.7 0.237
I often feel exhausted 2.4±0.9 1.8±0.7 <0.001
I usually feel lively 3.1±0.9 3.1±0.7 0.841
I feel weary much of the time 2.3±0.9 2.0±0.8 0.026
General feelings of fatigue 26.3±6.3 24.5±4.8 0.060
Note: The values in bold are statistically signicant.
Abbreviations: DS, day shift; m, mean; RNS, rotating night shift; SD, standard deviation; SSI, Standard Shift Work Index.
Table 5 Sleep and tiredness: comparison between RNS and DS
nurses
Questions RNS nurses
(n=179) m ± SD
DS nurses
(n=53) m ± SD
P-value
How do you feel about the amount of sleep you normally get?
Morning shifts 2.7±1 3.3±0.9 <0.001
Afternoon shifts 3.7±0.8 3.8±0.6 0.388
Night shifts 2.4±1.2 – –
Days off 3.6±1 4±0.7 0.054
How well do you normally sleep?
Morning shifts 2.4±1 3.4±0.8 <0.001
Afternoon shifts 3.5±0.8 3.8±0.8 0.023
Night shifts 2.5±1.2 – –
Days off 3.8±0.9 4±0.8 0.218
How rested do you normally feel after sleep?
Morning shifts 2.4±0.9 3.3±0.8 <0.001
Afternoon shifts 3.4±0.8 3.8±0.8 0.006
Night shifts 2.4±1.2 – –
Days off 3.7±0.9 4±0.7 0.052
Do you ever feel tired on what type of shift?
Morning shifts 3.5±0.9 3.4±0.6 0.479
Afternoon shifts 2.9±1 2.9±0.8 0.892
Night shifts 3.8±1.1 – –
Days off 2.5±1.1 2.6±0.9 0.632
Total score
Morning shifts 11.3±2.1 13.9±2.9 <0.001
Afternoon shifts 9.4±2.1 10.2±2.6 0.058
Night shifts 14.4±3.8 – –
Days off 8.5±2.4 9.4±3.1 0.099
Note: The values in bold are statistically signicant.
Abbreviations: DS, day shift; m, mean; RNS, rotating night shift; SD, standard deviation.
of apprenticeship for younger workers, quite common in health
care settings worldwide. The higher percentage of nurses with
degrees in the RNS group was probably related to both their
younger age and university nursing courses only recently avail-
able. Nevertheless, both RNS and DS nurses in our sample
were employed for the same number of hours per week.
The comparison between the two groups highlighted that
RNS nurses reported lower job satisfaction. In this regard, the
literature data are conflicting as many authors have agreed on
this point,32,33 but others have demonstrated that nurses’ job sat-
isfaction is independent of the modality of shift schedule.45,57 In
our sample, the RNS workers were informed of their shift sched-
ules with less advance notice than DS nurses and this condition
could have been a reason for dissatisfaction due to the difficulty
in scheduling of both family duties and recreational activities.
Moreover, in our research, reduced job satisfaction was associ-
ated with more frequent physical and psychological symptoms
related to stress, suggesting a clear correlation between these two
conditions, as indicated by other authors.34
The literature agrees
in indicating that RNS work imposes circadian strain and leads
to a greater number of physical and psychological symptoms
with a higher risk for several chronic diseases than other shift
schedules.5,43 The RNS nurses in our sample presented chronic
fatigue, sleep alterations, cardiovascular, and minor psychiatric
symptoms more frequently, although they were younger and
with less family responsibilities than others. Our study high-
lighted that DS nurses presented a lower risk for developing
insomnia whereas RNS nurses more frequently suffered from
sleep disorders, which influenced their subsequent work perfor-
mance. These results, in line with other studies,15,58 suggest that
RNS work represents a stress factor, which can lead to chronic
discomfort and mild somatic alterations, predisposing to the
development of psychological and physical diseases.
We have to emphasize that the counterclockwise (after-
noon/morning/night) and rapidly consecutive rotation
demographic and professional characteristics of the two nurse
groups significantly differed and reflected a particular work
organization, which allocates nurses who are younger, single,
less experienced and in good health to RNSs.52,57 In accordance
with other authors,57 this unequal distribution between workers
on RNS and DS could represent a natural selection of profes-
sionals based on their health and familial conditions or a sort
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The impact of rotating night shifts and day shifts on health
implemented in our hospital did not favor rest and sleep
between one shift and another due to both the rapid sequen-
tiality and backward rotation of shift. In fact, the literature
indicates that different clockwise rotations (morning/after-
noon/night) could be more protective, as well as a no rapid
sequential rotation as nurses require at least 4 days to adjust
their circadian rhythms of cortisol secretions after a night
shift.22,59
RNS workers reported lower scores in sleep quality and
quantity when they had to work morning shifts compared to
DS nurses, suggesting that morning shifts should not start
too early in order to permit adequate sleep and regeneration
of energy. Our research suggests that night shift work, like
jet lag, can frequently induce sleep disorder which, still
underestimated, can represent a risk factor for poor mental
and physical health as well as for accidents.7–23
Limitations
The main limits of this study consist of both its small sample,
composed of two groups, RNS and DS, and the lack of a
comparison with other hospitals and/or residential facilities.
Moreover, its cross-sectional design does not permit us to
completely evaluate the causal relationship between the work-
shift modality and the selected variables. Prospective research
in larger samples collected in many health care environments
could help us to investigate this topic in greater depth.
Conclusion
Our study is one of the few available on the work schedule
organization of an Italian general hospital. It has contrib-
uted to highlight that RNS work can be a stress factor with
an impact on worker’s health and well-being, in particular
on job satisfaction, quality and quantity of sleep, and
psychological and cardiovascular conditions, frequently
inducing chronic fatigue. Our results suggest that workers
with rotating night schedule load need special attention and
frequent health checks due to the higher risk for both job
dissatisfaction and undesirable health effects. Nurse patient
care requires a high level of responsibilities and careful
attention. Consequently, working conditions should be
optimized in order to provide an appropriate quality of care
over a 24-hour period. In accordance with the World Health
Organization definition of shift work as a risk condition
for many health disorders, we suggest that implementing
ergonomic criteria aimed at reducing the adverse effects of
shift schedules can permit a better organization of health
care. In fact, we can infer that if a shift work pattern is more
respectful of the health and well-being of workers, it could
improve the life quality of both workers and patients. The
implications of stress work schedules could be relevant to
the emotional welfare of health workers and their capacity
to maintain compassion and empathy for the people in their
care.60 This study, in accordance with most studies which
highlighted a significant positive association between quick
returns (<11 hours off work between two work shifts) and
insomnia, sleepiness, fatigue and other shift work disor-
ders,13,61 contributes to indicate that a regulation of at least
11 hours off work between two work shifts, as applied in
many European countries, could ensure more shift worker
well-being. Moreover, we can underline that a shift schedule
prepared sufficiently in advance could be more protective
for private life, reducing causes of psychological stress and
social maladjustment.
Our findings are relevant not only for individual nurses
but also for education, service provision, and research. More
studies are necessary to better analyze the burden of shift
work on the health and well-being of workers and patients.
Disclosure
The authors report no conflicts of interest in this work.
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... Shift work has been hypothesized to increase the risk of chronic diseases like CVD through several pathways including circadian rhythm disruption, which may affect glucose and lipid metabolism, appetite regulation, inflammation, hormone secretion, hypertension, atherosclerosis, and autonomic nervous system imbalance (6)(7)(8). In addition, shift workers may have poorer psychosocial working conditions, such as job strain and social stress (6,9), and poorer lifestyle behaviors, such as poor diet, physical inactivity, and smoking habits compared to non-shift workers (9)(10)(11), which can, in turn, increase the risk of CVD. ...
... Shift work has been hypothesized to increase the risk of chronic diseases like CVD through several pathways including circadian rhythm disruption, which may affect glucose and lipid metabolism, appetite regulation, inflammation, hormone secretion, hypertension, atherosclerosis, and autonomic nervous system imbalance (6)(7)(8). In addition, shift workers may have poorer psychosocial working conditions, such as job strain and social stress (6,9), and poorer lifestyle behaviors, such as poor diet, physical inactivity, and smoking habits compared to non-shift workers (9)(10)(11), which can, in turn, increase the risk of CVD. ...
... The classic opinion proposes that circadian dis-ruption caused by shift work results in the desynchronization of endogenous and exogenous components and disturbances of the cardiovascular system (29). It has also been proposed that shift work is associated with increased psychosocial stress (6,9), leading to hypersecretion of cortisol and catecholamines, which may contribute to disorders increasing the risk for IHD. Furthermore, smoking, physical inactivity in leisure time, changes in appetite-regulating hormones and other factors leading to an unhealthy diet and being obese, increased alcohol consumption, the likelihood of ignoring symptoms of disease, elevated blood lipids, and high blood pressure are some underlying factors that have been suggested to be involved in the association between shift work and IHD (9)(10)(11). ...
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Objective: This study aimed to examine the effects of various aspects of night and shift work on the risk of incident ischemic heart disease (IHD) and atrial fibrillation (AF) using detailed and registry-based exposure data. Methods: This prospective cohort study included >30 300 healthcare employees (eg, nurses, nursing assistants) employed for at least one year in Region Stockholm 2008-2016. Information on daily working hours was obtained from a computerized administrative employee register and outcomes from national and regional registers. Using discrete-time proportional hazard models, we analyzed the outcomes as functions of working hour characteristics the preceding year, adjusted for sex, age, country of birth, education, and profession. Results: We observed 223 cases of IHD and 281 cases of AF during follow-up 2009-2016. The risk of IHD was increased among employees who the preceding year had permanent night shifts compared to those with permanent day work [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.06-2.43] and among employees working night shifts >120 times per year compared to those who never worked night (HR 1.53, 95% CI 1.05-2.21). When restricted to non-night workers, the risk of IHD was increased for employees having frequent quick returns from afternoon shifts. No increased risks were observed for AF. Conclusions: Night work, especially working permanent night shifts and frequent night shifts, is associated with an increased risk of incident IHD but not AF. Moreover, frequent quick returns from afternoon shifts (among non-night workers) increased IHD risk. Organizing work schedules to minimize these exposures may reduce IHD risk.
... However, this supposed cross-functional relationship could not be considered without clear conceptualizations and strong appraisals of nursing procedures (29). Additionally, literature suggested also the negative effect of night shiftwork in healthcare workers, especially nurses, usually provoking tiredness, sleepiness, humor alteration and weight increase (30)(31)(32)(33) and many problems in job performances and psychosocial health (31,34). Night shiftwork, also significantly modified the circadian rhythm of influenced individuals (35). ...
... However, this supposed cross-functional relationship could not be considered without clear conceptualizations and strong appraisals of nursing procedures (29). Additionally, literature suggested also the negative effect of night shiftwork in healthcare workers, especially nurses, usually provoking tiredness, sleepiness, humor alteration and weight increase (30)(31)(32)(33) and many problems in job performances and psychosocial health (31,34). Night shiftwork, also significantly modified the circadian rhythm of influenced individuals (35). ...
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... Nearly a fifth of the global workforce now works shifts, with night shifts accounting for 20% of European and American employees, In the health-care industry, shift employment is considered essential for maintaining service continuity in hospitals and nursing homes, Nurses are largely committed to shift patterns that provide 24-hour care and include night shifts, which are defined by rotation and scheduling (7). Nowadays, a fifth of the worldwide workforce now works shifts, with Europe accounting for 40% of the total, working in shifts ensures that patient care is consistent around the clock in the healthcare industry (8). ...
... value of (0.05), this result supported by (7). The aim of this study was to highlight if shift work with nights, as compared with day work only, is associated with risk factors predisposing nurses to poorer health conditions and lower job satisfaction. ...
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Nurses are one of the most important members of health care delivery systems, and they have an important role in providing safe health care, including patient care. Nurses must maintain their health in order to help others, to improve work in health care institutions such as increasing the number of employees, increasing basic resources , leads to an improvement in the health condition of the nurses and thus is reflected in the results of the patients. The nursing staff in the hallway or ward must provide nursing services to patients without interruption 24 hours a day, seven days a week, continuity, teamwork and service of the nursing function. Human satisfaction is characterized in This concept is a completely subjective variable that emphasizes the physical, psychological and social aspects of health and has an impact on individual experiences, emotions, age, gender, education level, socioeconomic status, risk factors, and the physical and social environment of places Living and working. The present study aims to: Compare between the HRQoL for the nurses at day and night shift.
... Kim and Sohn (2019) argued that nurses' work performance is sensitive to various work-related conditions. Therefore, several empirical analyses have been conducted to examine the influence of workrelated conditions on nurses' work performance, including workload (Merkusi & Aini, 2020), organizational support (Kokoroko & Sanda, 2019), burnout (Kumar & Bhalla, 2019;Sharma & Dhar, 2016), shift duty (Dehring et al., 2018;Ferri et al., 2016), working environment (Alsufyani et al., 2021;Deng et al., 2019), and occupational stress (Merkusi & Aini, 2020;Rasool et al., 2020). Notably, occupational stress is a steady condition exerting adverse effects on nurses' work performance. ...
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Introduction: An occupational stress was reported as an inhibitor of optimal performance among nurses. Emotional intelligence (EI) has emerged as a successful behavioral buffer against occupational stress and as a facilitator for better performance. This study aimed to investigate the potential relationship between nurses' EI and their work performance; and to examine the mediating role of occupational stress. Design: A predictive correlational design was adopted. Method: Self-reported questionnaires were administered to 391 full-time bedside nurses recruited from one of the big hospitals in Saudi Arabia, between April and June 2021. Data were coded and analyzed using IBM SPSS version 25.0. Simple and multiple linear regression analyses were used to test the hypotheses. The significance level for all tests was set at p ≤ 0.05. Bonferroni correction method was used to control the family-wise error rate. Results: The findings revealed an affirmative association between nurses' EI and work performance (β = 0.69, p < 0.001; r2 = 0.483). Additionally, an inverse association was established between nurses' EI and their perception of occupational stress (β = -0.54, p < 0.001; r2 = 0.286), and between nurses' perception of occupational stress and work performance (β = -0.52; p < 0.001; r2 = 0.226). Additionally, our results showed that occupational stress played a mediating role in the relationship between nurses' EI and work performance. Conclusion: This study presented a novel framework that includes two factors affecting work performance among nurses in Saudi Arabia. Our results suggest that EI is vital for effective work performance among nurses. Additionally, EI was found to be a useful coping strategy against occupational stress. Clinical relevance: EI has been described as a valuable asset for better performance and effective group cohesiveness among nurses. Optimal nurses᾽ performance leads to meeting patients᾽ needs and organizational goals.
... According to studies, persons who work night shifts are subjected to a disturbed circadian rhythm, stress, lack of physical exercise, and sleep debt, all of which can have a negative influence on their health 5 Furthermore, the Central Council for Statistics/Ministry of Planning has awarded official approval to use the study questionnaire with some modifications , AL-Najaf Health Directorate has given their permission to collect the samples from the hospitals , to fill out the form by each subject, and finally, after the researcher has clarified the purpose of the study to them, the subject agreement is obtained from the nurses; getting informed consent; maintaining participant confidentiality; and making participation in the questionnaire voluntary. ...
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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.
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Method: This cross-sectional research was conducted in a sample of 298 nurses and 115 nursing students. Socio-demographic and career information was collected. Balanced Emotional Empathy Scale (BEES) and Maslach Burnout Inventory (MBI) were administered. Data were statistically analysed. Results: 63% of our sample answered questionnaires (54% of nurses and 84% of students). The BEES global mean score was slightly inferior to empathy cut-off of 32. In the student group, two BEES dimension scores were statistically significantly higher than nurses (p=0.011 and p=0.007 respectively, t-test). Empathy was negatively related to age (p=0.001, ANOVA). Emotional exhaustion (EE) scores of MBI reported statistically significantly lower levels for students (p<0.0001, t-test). EE was negatively related to BEES mean total score in students (r=-0.307, p<0.002) and nurses (r=-0.245, p<0.002), personal accomplishment of MBI presented positive correlation with BEES mean total scores in students (r=0.319, p<0.002) and nurses (r=0.266, p<0.001, Pearson's correlation). Female students showed superior empathy capacity in comparison to male students in all 5 dimensions of BEES (p<0.001), whereas females nurses in only one dimension (p<0.001). Conclusions: Our data suggest empathy declines with age and career. High levels of empathy can be protective against burnout development, which, when presents, reduces empathy.
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Objectives: Night shift work has been associated with poor sleep, weight gain, metabolic syndrome, which are recognised risk factor for diabetes. However, only a few studies have examined the effect of shift work on diabetes risk. Here, we study the association between shift work and incidence of diabetes in Danish nurses. Methods: We used the Danish Nurse Cohort with 28 731 participating female nurses recruited in 1993 (19 898) or 1999 (8833), when self-reported baseline information on diabetes prevalence, lifestyle and working time were collected, and followed them in the Danish Diabetes Register for incidence of diabetes until 2013. Nurses reported whether they worked night, evening, rotating or day shifts. We analysed the association between working time and diabetes incidence using a Cox proportional hazards model adjusted for diabetes risk factors, separately with and without adjustment for body mass index (BMI) which might be an intermediate variable. Results: Of 19 873 nurses who worked and were diabetes-free at recruitment, 837 (4.4%) developed diabetes during 15 years of follow-up. The majority of nurses (62.4%) worked day shifts, 21.8% rotating shift, 10.1% evening and 5.5% night shifts. Compared with nurses who worked day shifts, we found statistically significantly increased risk of diabetes in nurses who worked night (1.58; 1.25 to 1.99) or evening shifts (1.29; 1.04 to 1.59) in the fully adjusted models including BMI. Conclusions: Danish nurses working night and evening shifts have increased risk for diabetes, with the highest risk associated with current night shift work.
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To identify core antecedents of job stress and job satisfaction, and to explore the potential of stress interventions to improve job satisfaction. Decreased job satisfaction for nurses is strongly associated with increased job stress. Stress management strategies might have the potential to improve job satisfaction. Comparative scoping review of studies (2000-2013) and location of their outcomes within the 'job demands-job resources' (JD-R) model of stress to identify commonalities and trends. Many, but not all, antecedents of both phenomena appeared consistently suggesting they are common mediators. Others were more variable but the appearance of 'emotional demands' as a common antecedent in later studies suggests an evolving influence of the changing work environment. The occurrence of 'shift work' as a common issue in later studies points to further implications for nurses' psychosocial well-being. Job satisfaction problems in nursing might be co-responsive to stress management intervention. Improving the buffering effectiveness of increased resilience and of prominent perceived job resource issues are urgently required. Participatory, psychosocial methods have the potential to raise job resources but will require high-level collaboration by stakeholders, and participative leadership and facilitation by managers to enable better decision-latitude, support for action planning and responsive changes. © 2015 John Wiley & Sons Ltd.
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Background: Registered nurses across the globe bear a heavy injury burden. Every shift, nurses are exposed to a variety of hazards that can jeopardize their health, which negatively impacts their ability to provide high-quality patient care. Previous research suggests that inexperienced, or newly licensed nurses, may have an increased risk for certain occupational injuries. However, the current knowledge base is insufficient to fully understand how work hours influence newly licensed nurses' occupational injury, given the significant variation in hospital organization and work characteristics. Objective: To describe newly licensed nurses' shift work characteristics and determine the association between shift type and scheduling characteristics and nurse injury, before and after adjusting for individual and combined effects of demographics, external context, organizational context, and work context, following the Organization of Work model. Design: This study is a secondary analysis of a nationally representative survey of newly licensed registered nurses using a cross-sectional design. Participants: The analytic sample includes 1744 newly licensed registered nurses from 34 states and the District of Columbia who reported working in a hospital and were within 6-18 months of passing their state licensure exam at the time of survey administration. Methods: Descriptive statistics were calculated, followed by bivariate and multivariate Poisson regression models to assess the relationship between shift type and scheduling characteristics and nurse injury. Lastly, full models with the addition of demographics, external context, organizational context, and work context variables were calculated. Results: The majority (79%) of newly licensed nurses worked 12-h shifts, a near majority worked night shift (44%), and over half (61%) worked overtime (mandatory or voluntary) weekly. Nurses working weekly overtime were associated with a 32% [incidence rate ratio (IRR) 1.32, CI 1.07-1.62] increase in the risk of a needle stick and nurses working night shift were associated with a 16% [IRR 1.16, CI 1.02-1.33] increase in the risk of a sprain or strain injury. Conclusions: Overtime and night shift work were significantly associated with increased injury risk in newly licensed nurses independent of other work factors and demographic characteristics. The findings warrant further study given the long-term consequences of these injuries, costs associated with treatment, and loss of worker productivity.
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Night-shift work (NSW) has previously been related to incidents of breast cancer and all-cause mortality, but many published studies have reported inconclusive results. The aim of the present study was to quantify a potential dose–effect relationship between NSW and morbidity of breast cancer, and to evaluate the association between NSW and risk of all-cause mortality. The outcomes included NSW, morbidity of breast cancer, cardiovascular mortality, cancer-related mortality, and all-cause mortality. Sixteen investigations were included, involving 2,020,641 participants, 10,004 incident breast cancer cases, 7185 cancer-related deaths, 4820 cardiovascular end points, and 2480 all-cause mortalities. The summary risk ratio (RR) of incident breast cancer for an increase of NSW was 1.057 [95% confidence interval (CI) 1.014–1.102; test for heterogeneity p = 0.358, I² = 9.2%]. The combined RR (95% CI) of breast cancer risk for NSW vs daytime work was: 1.029 (0.969–1.093) in the <5-year subgroup, 1.019 (1.001–1.038) for 5-year incremental risk, 1.025 (1.006–1.044) for 5- to 10-year exposure times, 1.074 (1.010–1.142) in the 10- to 20-year subgroup, and 1.088 (1.012–1.169) for >20-year exposure lengths. The overall RR was 1.089 (95% CI 1.016–1.166) in a fixed-effects model (test for heterogeneity p = 0.838, I² = 0%) comparing rotating NSW and day work. Night-shift work was associated with an increased risk of cardiovascular death (RR 1.027, 95% CI 1.001–1.053), and all-cause death 1.253 (95% CI 0.786–1.997). In summary, NSW increased the risk of breast cancer morbidity by: 1.9% for 5 years, 2.5% for 5–10 years, 7.4% for 10–20 years, and 8.8% for >20-years of NSW. Additionally, rotating NSW enhanced the morbidity of breast cancer by 8.9%. Moreover, NSW was associated with a 2.7% increase in cardiovascular death.
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Rotating night shift work imposes circadian strain and is linked to the risk of several chronic diseases. To examine associations between rotating night shift work and all-cause; cardiovascular disease (CVD); and cancer mortality in a prospective cohort study of 74,862 registered U.S. nurses from the Nurses' Health Study. Lifetime rotating night shift work (defined as ≥3 nights/month) information was collected in 1988. During 22 years (1988-2010) of follow-up, 14,181 deaths were documented, including 3,062 CVD and 5,413 cancer deaths. Cox proportional hazards models estimated multivariable-adjusted hazard ratios (HRs) and 95% CIs. All-cause and CVD mortality were significantly increased among women with ≥5 years of rotating night shift work, compared to women who never worked night shifts. Specifically, for women with 6-14 and ≥15 years of rotating night shift work, the HRs were 1.11 (95% CI=1.06, 1.17) and 1.11 (95% CI=1.05, 1.18) for all-cause mortality and 1.19 (95% CI=1.07, 1.33) and 1.23 (95% CI=1.09, 1.38) for CVD mortality. There was no significant association between rotating night shift work and all-cancer mortality (HR≥15years=1.08, 95% CI=0.98, 1.19) or mortality of any individual cancer, with the exception of lung cancer (HR≥15years=1.25, 95% CI=1.04, 1.51). Women working rotating night shifts for ≥5 years have a modest increase in all-cause and CVD mortality; those working ≥15 years of rotating night shift work have a modest increase in lung cancer mortality. These results add to prior evidence of a potentially detrimental effect of rotating night shift work on health and longevity. Copyright © 2014 American Journal of Preventive Medicine. All rights reserved.