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Patient Safety/Quality

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Shift work affects the health and work performance of nurses and other health care workers

Among the Nation's full-time health care workers, 30 percent are shift workers, with about 11 percent of them working evening shifts (3 to 11 pm), 9 percent working night shifts (between 11 pm and 7 am), 3 percent working rotating shifts (for example, days to evenings or nights), and the remaining working split shifts and other arranged shifts. Shift work can result in fatigue, irritability, reduced performance, and decreased mental agility, notes Ronda Hughes, Ph.D., M.H.S., R.N., of the Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality. Dr. Hughes and her colleague Patricia Stone, Ph.D., M.P.H., R.N., at Columbia University, coauthored a recent review of the topic.

Studies show that while some workers prefer the shorter work week offered by 12-hour shifts, they become fatigued and less alert toward the end of the shift. On the positive side, 12-hour shifts reduce the number of nursing "hand-offs" from one shift to another, during which mistakes are known to occur. Compared with nurses working permanent day or evening shifts, night shift workers are not as alert and are more likely to struggle to stay awake during the second half of the shift. Performance lapses and procedural and medication errors are more likely to occur at night, especially between 4 am and 8 am.

People who work rotating shifts are more likely to suffer from sleep problems and reduced alertness and performance. One study of 635 nurses found that the odds of making or almost making a medication error, as well as the odds of having an accident or a near miss while commuting, doubled among rotating shift workers. Another Nurses' Health Study found that working a rotating night shift at least three nights per month for 15 or more years may increase the risk of colorectal cancer in women.

Permanent evening or night shifts offer the best health and productivity benefits. To avoid fatigue, nurses should take short breaks throughout a shift or take naps, when patients are covered; work the shift they physically tolerate best; establish support networks; and avoid leaving the most tedious tasks to the end of a shift when one is apt to feel most drowsy.

See "The perils of shift work," by Dr. Hughes, in the September 2004 American Journal of Nursing 104(9), pp. 60-63.

Reprints (AHRQ Publication No. 04-R070) are available from the AHRQ Publications Clearinghouse.

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