How shifts, night work affect hospital workers

Recent findings about the ill effects of shift work and lack of sleep might be worrisome for hospital workers based on that lifestyle. For instance, residents now work regulated hours under duty-hour limits to improve patient safety. But few may have considered what shift work, particularly at night, can do to hospital workers.

A study online yesterday in BMJ that didn't specifically look at healthcare jobs found shift work (evening, irregular or unspecified shifts, mixed schedules, night shifts and rotating shifts) is linked to more heart attacks and strokes.

Shift work can disrupt the body clock (circadian rhythm), linked to higher risk of high blood pressure, high cholesterol and diabetes, and according to the study, associated with major vascular problems.
 
Night shifts, in particular, were associated with the steepest increase in risk for coronary events (41 percent), according to the authors, who recommend educating shift workers on heart symptoms.

In a separate study, Brigham and Women's Hospital (BWH) researchers not surprisingly found that the longer workers are awake, the slower they are in performing complex visual tasks in safety-sensitive jobs, according to a study published online yesterday in The Journal of Vision. During the biological night time (12 a.m. - 6 a.m.), studied participants also performed tasks more slowly than during the daytime. 

"This research provides valuable information for workers, and their employers, who perform these types of visual search tasks during the night shift, because they will do it much more slowly than when they are working during the day," senior study author and BWH associate neuroscientist Jeanne F. Duffy said in a statement.

In addition, BWH found that as time went on (over the second and third week of being "jet lagged"), participants' self-ratings only slightly worsen when their performance got significantly slower, suggesting that workers don't think they are as tired as they actually are.

The Joint Commission last year issued a Sentinel Event about the dangers of extended hours and excessive workloads. The accrediting body suggested organizations assess their fatigue-related risks, including limiting off-shift hours and consecutive shift work; examining the hand-off process; inviting staff to offer input in their own work schedules; implementing a fatigue management plan; and educating staff about the effects of fatigue on patient safety.

For more information:
- see the BMJ study announcement and study
- read the Journal of Vision announcement and study

Related Articles:
Wake up your zombie workforce to patient safety risks
Handoff program cuts medical errors by 40%
Long work hours linked to adverse events, Joint Commission warns
AHRQ: Less than half of hospitals have nonpunitive culture, safe handoffs
Physician residents have shorter hours, doubts about care
Patient safety is unaffected by reduced working hours

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