The Health Care Manager Volume 00, Number 0, pp. 1–7 Copyright # 2017 Wolters Kluwer Health, Inc. All rights reserved.

Night Shift Work and Its Health Effects on Nurses Candie Books, RN, BSN; Leon C. Coody, MSN, FNP; Ryan Kauffman, MSNA, CRNA; Sam Abraham, DHA, MS, RN The purpose of this research was to study night shift work and its health effects on nurses. This was a quantitative study using descriptive design; it also incorporated three qualitative open-ended questions to complement the study. The data were collected using Survey Monkey, with an Internetbased confidential data collection tool. The population of relevance to this study was nurses employed in hospital settings in the United States. E-mail addresses and Facebook were used to recruit participants. Results indicated that there is an increased risk of sleep deprivation, family stressors, and mood changes because of working the night shift. Rotating shifts were mentioned as a major concern for night shift nurses. Respondents agreed that complaints about fatigue and fatiguerelated illnesses in night shift workers were ignored. There was also a general perception among nurses working the night shift that sleep deprivation leads to negative health consequences including obesity; however, they were not as high a concern as rotating shifts or fatigue. Key words: health effects and night shift, hospital night shift, night shift nurses, night shift work

ROFESSIONAL NURSES FOCUS on providing care and teaching to promote optimal health of their clients. The personal health of the nurse, however, is often an oversight in this demanding career. Negative health effects and poor health practices seem to be more prevalent with those who regularly work the night shift, compared with their day shift counterparts. Issues that may lead to serious negative health consequences are sleep deprivation, increased levels of stress, family and social disturbances, unhealthy coping mechanisms, limited exercise, and perceived personal health. The purpose of this study was to determine how working the night shift affects the health of nurses.

P

Author Affiliations: Intermediate Care Center (Ms Books) and Palliative Care (Mr Coody), Elkhart General Hospital, IN; Department of Anesthesia, Wentworth Douglas Hospital (Mr Kauffman), Dover, NH; and School of Nursing, Bethel College (Dr Abraham), Mishakawa, IN. The authors have no funding or conflicts of interest to disclose. Correspondence: Sam Abraham, DHA, MS, RN, School of Nursing, Bethel College, 1001 Bethel Cir, Mishawaka, IN 46545 ([email protected]). DOI: 10.1097/HCM.0000000000000177

BACKGROUND Hospitals employ more night shift workers than any other industry.1 Working the night shift can have significant negative impact on many aspects of a worker’s physical, psychological, and psychosocial health and on that worker’s job performance. Nurses working the night shift have an increased risk for breast cancer,2 colorectal cancer,3 diabetes,4 compromised immune function,5 and obesity4 and disruptions in relationships with spouses and children.1 Because of a large number of nursing professionals working the night shift, the issues involved with negative effects of working that shift, and possible means to minimize those effects is an important topic of research. A concerning issue that has been shown by limited studies to be correlated with night shift work by nurses is weight gain and obesity. Obesity in the United States is a serious public health problem. Over the past two decades, obesity rates in the United States have increased by 69% for children and adolescents and 58% for adults.6 Miller et al7 found that the mean body mass index (BMI) of nurses in the six states that 1

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

2

THE HEALTH CARE MANAGER/MONTH–MONTH 2017

they studied were all in the overweight range, with one state bordering on obese. They further found that, although 93% of the nurses reported that being overweight or obese were diagnoses requiring intervention, 76% of them reported that they never addressed this topic with their patients.7 Nurses are on the frontlines of patient care and teaching and should model good health practices for their patients. Average nurses who are overweight or obese are less likely to discuss this topic and offer interventions for their patients. However, Miller et al7 acknowledged that this is just an assumption, and no research was found that had studied this issue. The full spectrum of issues related to obesity among nurses is an important topic of research. Limited studies have demonstrated a correlation between night shift work and the influencing elements. LITERATURE REVIEW The literature on this topic that was accessed from Cumulative Index of Nursing and Allied Health, Ovid, and Medline/PubMed. Minimal research studies have been performed to identify reasons why night-shift-only workers have increased BMI. Some of the literature included information that night-only workers were predisposed to be unhealthy as indicated by increased BMI levels. Pan et al4 conducted the seminal research in the area of night shift nurses and obesity. Two large groups (150 000+) of US female nurses were studied for more than a 20-year time frame. The researchers found that night shift work for a long duration was positively associated with an increased risk of developing obesity and type-2 diabetes. The results concluded that for every 5 years of night shift work, there was an average increase in 0.17 units in the BMI measurement.4 Zhao et al8 conducted another significant investigation of night shift nurses and obesity. This study was a statistical analysis of longitudinal data obtained from a large participant sample of female nurses and midwives. An interactive model created to examine the relationship between day shift, rotating shift, and

night-only workers was culminated with a study of 2086 female nurses. Researchers illustrated along with possible confounding factors of diet, exercise, smoking, alcohol consumption, menopausal status, and general health. Results indicated that rotating shift workers were significantly more likely to be overweight or obese than their day shift counterparts and that nightonly workers were significantly more likely to be obese. Specifically, the rotating shift nurses were 1.02 times more apt to be classified as overweight or obese (P = .001; 95% confidence interval, 1.004-1.03) than day-shift-only workers. The night-only workers were found to be 1.02 times more probable to be classified as obese, but not overweight, than day-only shift nurses (P = .031; 95% confidence interval, 1.002-1.04).8 In another more limited study, Marqueze et al9 explored the health status of female staff working the night shift. This study included female nurses and nursing assistants consisting of 548 participants from all hospital nursing departments. The results did not reflect a statistically significant difference in current BMIs. However, when considering an increase in BMI over time, night shift workers had a statistically significant greater increase than day workers. They also found that night shift workers had longer sleep periods than day shift workers.9 Most of the quantitative research studies related to the topic of weight and its relation to working the night shift included female nurses. It was necessary to consider studies outside the nursing profession to find any studies involving male participants. Biggi et al10 studied male night shift workers. Specifically, researchers examined the relationship between permanent night shift work and metabolic and cardiovascular risk factors in a retrospective longitudinal study of 488 males between 22 and 62 years and work experience of 1 to 28 years. As a whole, night workers smoked more and had significantly higher BMI, serum total cholesterol, and triglycerides than the day-shift workers.10 Persson and Martensson11 conducted a qualitative study, using interviews for data collection, of 27 nurses who worked the night shift.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

3

Night Shift Work and Its Health Effects The objective of the study ‘‘was to describe, from the nurses’ account, situations/incident with a significant influence on healthy diet and exercise habits’’ among those nurses.11(p414) The researchers found that the nurses’ diet and exercise were significantly influenced by colleagues, both in positive and negative ways. The other main factor influencing diet and exercise was the disruption in the circadian rhythm of the nurses, which caused them to be fatigued and opt out of exercising. They also ate sugary foods as a coping mechanism to stay awake and opted for fast, convenient foods, because they lacked the time or energy to prepare healthy foods. On the positive side, some nurses reported using exercise to maintain energy and to help them recover after a demanding night shift. In addition, some reported being positively influenced by colleagues, who encouraged each other to diet and exercise together.11

RESULTS

METHODOLOGY

Table 1. Descriptive Statistics for Participant Demographic and Background

This study was a quantitative research using a cross-sectional descriptive design. Three qualitative open-ended questions were used to compliment the quantitative responses. The study included both night and day shift nurses. ‘‘Night shift,’’ as used for this study, is defined as regular working hours between the hours of 7:00 PM and 7:00 AM including those that start at 3:00 PM. ‘‘Day shift’’ is defined as working the hours between 7:00 AM and 7:00 PM including those that start at 3:00 AM. The population of relevance to this study is all nurses employed in hospital settings in the United States. The survey was structured using a 5-point Likert-type scale, where a value of 1 was equated to ‘‘strongly disagree’’ and a value of 5 was equated to ‘‘strongly agree,’’ of which 2.5 was the midpoint. On approval of the proposal by the institutional review board, personal e-mail address and Facebook contacts were used to collect data from 101 nurses. The participants signed an electronic consent before taking the survey. The data were tabulated to find the mean, SD, frequency, and percentages. The final scores were used to depict the responses of nurses.

The age of participants in this survey was skewed toward younger participants, with 28.6% in the 18- to 30-year and 42.9% in the 31-year to 40-year age groups (see Table 1). Only 14.3% were in the 41-year to 50-year age group, and 16.1% were in the 51-year to 60-year age group, with no participants in the 61+ category. As expected, the majority of the participants (87.5%) were female, with 12.5% of the participants being male. Moreover, as expected, most of the participants (82.4%) had either an associate’s or bachelor’s degree, with 8.9% reporting a diploma, 3.6% reporting a master’s degree, and 5.4% answering ‘‘other’’ to the question on education. In addition, there was a sizable pool of both day shift and night shift workers, of whom 57.1% reported working the day shift, and 42.9% reported working the night shift. Finally, the majority of participants

Variable Age, y 18-30 31-40 41-50 51-60 61+ Sex Male Female Education Diploma Associate Bachelor’s Master’s Other Employment status Full time Part time PRN Shift worked Day Night Smoke Yes No Drink alcohol Yes

f

%

27 43 14 16 0

26.8 42.9 14.3 16.1 0.0

13 88

12.5 87.5

9 54 29 4 5

8.9 53.8 28.6 3.6 5.4

83 14 4

82.1 14.3 3.8

58 43

57.1 42.9

13 88

12.7 87.3

54

53.6

N = 101. Abbreviation: PRN, pro re nata or as needed.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

4

THE HEALTH CARE MANAGER/MONTH–MONTH 2017

(82.1%) were employed full time, with 14.3% working part time and 3.8% working pro re nata or as needed. A significant number of nurses, 88%, claimed that they did not smoke, but 54% did admit to drinking alcohol. RESEARCH QUESTION 1 The first research question was ‘‘What are the health effects of working the night shift for nurses?’’ Data reported by nurses are summarized in Table 2. The majority of nurses agreed that they did not like rotating shift work because of its effect on health (3.17 [SD, 0.94]). They prefer to work straight night shifts than rotate shifts (3.15 [SD, 1.05]). The participants also reported that they used caffeine to aid in staying awake at night (3.15 [SD, 1.25]). There were also a few participants who reported falling asleep at the wheel while driving home from the night shift work (1.74 [SD, 1.32]). Finally, the nurses tended to have a lower level of agreement (1.64 [SD, 1.58]) with the statement ‘‘I use sleep aids, such as overthe-counter or prescribed sleep medications.’’ RESEARCH QUESTION 2 The second research question was ‘‘How do night shift nurses perceive their health?’’ As summarized in Table 3, the participants reported most strongly agreeing with the existence of a high risk of family stressors (3.38 [SD, 0.68]) and a high risk for mood changes (3.36 [SD, 0.74]). The next areas of highest agreement were fatigue and fatigue-related

illness in night shift workers are falling on deaf ears (3.18 [SD, 0.78]), perception of generally increased risk for medical problems (3.12 [SD, 0.86]) and an increased risk for obesity (3.05 [SD, 0.88]). Agreements were low in night shift work interfering with social activities or increased risk of diabetes. QUALITATIVE THEMES The survey also included three questions that gave participants the ability to answer open-ended questions. The first question was ‘‘What health promotion activities do you engage in on a daily basis?’’ The first theme involved exercising, such as running and walking. Some participants reported healthy eating and making good food choices. A few reported not engaging in any health promotion activities on a daily basis, and nearly one-fourth did not mention any health promotion activity. The next question was ‘‘How does working the night shift affect your health?’’ The first theme in the category of the answers involved being tired and a lack of sufficient sleep. The second theme was poor health choices, and the third involved negative effects on mood or depression. Few participants’ expressed a sense of loneliness because of the day-night switch and being asleep while most people were awake and active. Nearly one-fifth of the participants did not respond to this question. The final question was ‘‘How do you perceive your general health?’’ The first theme was ‘‘decent’’ or ‘‘moderate’’ health. One-third trended toward a negative perception of their

Table 2. Health Effects of Working the Night Shift for Nurses Variable

Mean

SD

I do not like rotating shifts because it affects my health. I would rather work straight night shift schedule than rotate shifts. I use caffeine to keep myself awake at night. I fall asleep within the first 2 h of returning home from a shift. I get at least 6 h of sleep each day/night. I have fallen asleep at the wheel while driving home in the morning after a night shift work. I use sleep aids such as over-the-counter or prescribed sleep medications.

3.17 3.15 3.15 2.48 1.85 1.74 1.64

0.94 1.05 1.25 1.43 1.29 1.32 1.58

N = 101. Items were rated on a 5-point Likert-type scale: 1 (strongly disagree) to 5 (strongly agree).

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

5

Night Shift Work and Its Health Effects Table 3. Night Shift Nurses’ Perception of Their Health Variable

Mean

SD

There is increased risk of family stressors because of working night shift. There is high risk of mood changes because of working night shift. Fatigue and fatigue-related illnesses in night shift workers are falling on deaf ears. There are increased risks of medical problems for a nurse working the night shift. There is an increased likelihood of obesity because of working night shift. My working night shift interferes with being socially active and healthy. There is an increased risk of diabetes because of working night shift.

3.38 3.36 3.18 3.12 3.05 2.88 2.60

0.68 0.74 0.78 0.86 0.88 1.23 0.94

N = 101. Items were rated on a 5-point Likert-type scale: 1 (strongly disagree) to 5 (strongly agree).

health. One-fifth responded with ‘‘very good’’ or ‘‘healthy.’’ SUMMARY OF RESULTS The focus of the study was the health effects of working the night shift and nurses’ perception of their health. The participants apparently reported dislike for rotating shifts and lack of sleep contributing to increased fatigue. They also reported unhealthy coping mechanisms such as caffeine use, but surprisingly, few reported using over-the-counter or prescription sleep aids. They also reported depressed moods, family stressors, and a general perception that night shift work had a negative effect upon their health. DISCUSSION There was fairly strong agreement that nurses preferred to work a straight night shift rather than rotating shifts and that working rotating shifts has a negative impact on health. Another area of significance was the report of stimulant use to stay awake at night. The majority of participants agreed to be using caffeine to stay awake during the night shift. Given the health effects that regular use of stimulants may have, this is a negative health effect of working the night shift. One of the most significant results revealed by the study was the level of sleep deprivation of night shift workers. The majority of night shift workers showed fairly strong disagreement with the statement ‘‘I get at least 6 hours of sleep each day/night.’’ Most night nurses

getting less than 6 hours of sleep is of great concern. According to Matthews,12 chronic sleep deprivation can have serious results, including depression, anxiety, cognitive impairment, suppression of the immune system, and metabolic disturbances. This result was further supported by the qualitative open-ended questions asked of the participants. One of the questions was ‘‘How does working the night shift affect your health?’’ In answering that question, 41% of the participants indicated that they experienced tiredness or a lack of sufficient sleep. In the open-ended response, 30% of participants agreed that they have a negative perception of their health, which is a cause for concern. Related to the perception of health, the participants strongly agreed that there was a high risk of family stressors resulting from working the night shift including the risk for mood changes. Mood change, irritability, and depression are common results of frequent or chronic lack of sleep.12 It is likely that this lack of sleep is the causal factor for reported mood change. Problems with fatigue and fatigue-related illnesses were also a concern. This result is likely associated with the previous discussion wherein most night shift participants regularly reported sleeping less than 6 hours in a 24-hour period. The participants also agreed on the perception of a somewhat increased risk for obesity and an increased risk for medical problems; however, they were not as high a concern as rotating shifts or fatigue. The reported perception of an increased risk of diabetes was only slightly higher than the midpoint of 2.5.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

6

THE HEALTH CARE MANAGER/MONTH–MONTH 2017

IMPLICATIONS Hospitals will always require 24-hour staffing, and thus, having a significant portion of the nursing staff working the night shift is inevitable. Previous research has shown, and this study supports, that night shift work poses an increased risk in multiple areas of health of those workers. Because there is no way to eliminate this risk factor, providing education and resources to counter the risk is necessary for leadership. Nurses may not be aware of these issues and risk. Hospital leaders need to ensure that their nursing team is educated about the possible risks associated from working the night shift. People will not engage in health-promoting behavior without being aware of the seriousness of the risk that they are facing. In addition, it often takes a trigger or outside stimulus to prompt a person to take action. This and other research in this area may act as the trigger for night shift nurses to engage in better health-promoting behavior themselves, rather than just advocating for the behaviors for their patients. Finally, there was strong perception that rotating-shift work, instead of straight-night shift or straight day-shift work, lead to health impacts. There was also a strong preference expressed by nurses against working rotating shifts. This is an area in which leadership can solve the perceived problem by eliminating rotating-shift scheduling to the greatest extent possible.

Lack of sufficient sleep seems to be one of the most significant complaints of nurses working the night shift. Lack of sleep can lead to fatigue, irritability, lack of focus, and diminished cognitive abilities.12 The results from nurses chronically getting too little sleep may have an impact on their ability to provide proper patient care, to assess critically their patients, and to respond quickly to emergency situations. Thus, not only the nurses’ health but also their patients’ health may be at risk. CONCLUSION Night-shift workers may be at an increased risk for health problems related to the lack of sufficient sleep, obesity, familial stresses, and general increased risk of health-related effects. Because a significant proportion of nursing staff works the night shift greater than workers in any other industry, this issue is significant. Rotating shifts were mentioned as a major concern for night shift nurses. Another finding of this study was that chronic lack of sleep may be a significant health effect of nurses working the night shift. This result is aligned with previous research in this area. Not only can chronic lack of sleep impact a nurse’s health, but also the serious results from the lack of sleep could lead to impairment of the nurse’s ability to provide appropriate care. Night shift work can never be eliminated in a hospital setting; thus, nurses’ awareness and education are needed to counter the risk factor.

REFERENCES 1. Rathore HH, Shukla KK, SinghSS, Tiwari GG. Shift work—problems and its impact on female nurses in Udaipur, Rajasthan India. Work. 2012;41:4302-4314. 2. Schernhammer ES, Laden F, Speizer FE, Willett WC, Hunter DJ, Kawachi I, Colditz GA, Rotating night shifts and risk of breast cancer in women participating in the nurses’ health study. J Natl Canc Inst. 2001; 93(20):1563-1568. 3. Schernhammer ES, Laden F, Speizer FE, et al. Nightshift work and risk of colorectal cancer in the nurses’ health study. J Natl Canc Inst. 2003;95(11): 825-828. 4. Pan A, Schernhammer ES, Sun Q, Hu FB. Rotating night-shift work and risk of type 2 diabetes: two

prospective cohort studies in women. Plos Medicine. 2011;8(12):e1001141. 5. Nagai M, Morikawa Y, Kitaoka K, Nakamura K, Sakurai M, Nishijo M, Nakagawa H. Effects of fatigue on immune function in nurses performing shift work. J Occup Health. 2011;53(5):312-319. 6. US Department of Health and Human Services, Healthy People 2020. Nutrition, physical activity, and obesity. US Department of Health and Human Services, Healthy People 2020 Web site. http://www.healthypeople. gov/2020/LHI/nutrition.aspx?tab=data. 7. Miller S, Alpert P, Cross C. Overweight and obesity in nurses, advanced practice nurses, and nurse educators. J Am Acad Nurse Pract. 2008;20(5):259-265.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Night Shift Work and Its Health Effects 8. Zhao I, Bogossian F, Turner C. A cross-sectional analysis of the association between night-only or rotating shift work and overweight/obesity among female nurses and midwives. J Occup Environ Med. 2012;54(7):834-840. 9. Marquezea EC, Lemosa LC, Soaresa N, Lorenzi-Filhob G, Morenoa CR. Weight gain in relation to night work among nurses. Work. 2012;41(suppl 1):2043-2048.

7

10. Biggi N, Consonni D, Galluzzo V, Sogliani M, Costa G. Metabolic syndrome in permanent night workers. Chronobiol Int. 2008;25(2):443-454. 11. Persson M, Martensson J. Situations influencing habits in diet and exercise among nurses working night shift. J Nurs Manag. 2006;14(5):414-423. 12. Matthews EC. Sleep disturbances and fatigue in critically ill patients. AACN Adv Crit Care. 2011;22(3):204-224.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Night Shift Work and Its Health Effects on Nurses.

The purpose of this research was to study night shift work and its health effects on nurses. This was a quantitative study using descriptive design; i...
84KB Sizes 11 Downloads 151 Views