EFFECTS OF SHIFT WORK UPON NURSES

(ORIGINAL ARTICLE)

BY

Dr. Nuzhat Huma Akhtar

MBBS; MCPS; DPH; FCPS
Assistant Professor
Department of Community Medicine
Khyber Medical College, Peshawar

POSTAL ADDRESS:

153-Usmania Lane, New Arbab Colony

Jamrud Road, P.O. Tehkal Bala
PESHAWAR
N.W.F.P (Pakistan)
Phone: 92-91-843863

e-mail: [email protected]
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EFFECTS OF SHIFT WORK UPON NURSES

By: Dr Nuzhat Huma Akhtar

Assistant Professor
Department of Community Medicine
Khyber Medical College, Peshawar

Abstract

Nurses are one of the few professional groups who have all done shift work at some time
during their career, whether they wanted to or not. This study was aimed to examine the
impact of different shift schedules on the physical and psychological well being of nurses.
Shift work-related problems were investigated among randomly selected nurses from
Khyber Teaching Hospital, Hayatabad Medical Complex and Lady Reading Hospital,
Peshawar working in 12-h night shift (study group) and 8-h morning/evening shifts (control
group), using a structured questionnaire focussing upon physical health, mental
depression, family relations, informal social participation, job performance and job-related
stress. It was found that the shift work caused significantly more day-time sleepiness,
insomnia, physical fatigue, difficulty in concentration, depression and irritability in the study
group as compared to the control group (p<0.001). Furthermore, it also significantly
disturbed their job performance, family relations, physical health and social participation
(p<0.001).
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INTRODUCTION

Work generally affects workers in terms of both physical and mental health 1. There
have been constant efforts to introduce measures for uninterrupted work in different fields
and these have led to a wider utilization of shift work all over the world. Humans are
designed to sleep at night and work during the day: thus, shift work is inherently non-
physiological2. The circadian rhythms of night shift workers do not usually adjust to their
unusual work and sleep schedules, reducing their quality of life and producing potentially
dangerous health and safety problems3. The shift workers may experience difficulties
associated with the quality and quantity of sleep4, impairment of physical and
psychological health5-6 and social and domestic disruption7. The elevated levels of chronic
fatigue, irritability and lethargy8, psychological ill health, neuroticism and depression9 have
been found among the shift working population.
Certain individuals may be better able to cope with the requirements of shift work
than others. Women may be less able than men to do so because of the demands of
home and family life and psychological differences2. Within health care provision, the
need for 24-hour nursing care requires nurses to work shift system. Nurses are one of the
few professional groups who have all done shift work at some time during their career-
whether they wanted to or not. Nurses working shifts including night shifts have
cumulative symptoms of fatigue, as well as mental and physical symptoms likely to be
attributable to lack of sleep or disturbed circadian rhythms10. When night duty is worked
repeatedly over a long period the influence of these unfavourable symptoms is marked11.
It has been suggested that workers must adapt their life pattern to match shift-work styles
which can result in family problems, increased fatigue level, lower work efficiency, higher
accident rate, illnesses, and lower productivity12. Many nurses who work night shifts have
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found ways to combine work, leisure and family life, despite the fact that they work when
the rest of the world sleeps, and vice versa13.
The present study was based on the assumption that nurses working in night shifts
(study group) are exposed more to physical, psychological and social problems than
those working in morning/evening shifts (control group).
SUBJECTS AND METHODS

Shift work-related problems were investigated among 140 randomly selected

nurses from Khyber Teaching Hospital, Hayatabad Medical Complex and Lady Reading
Hospital, Peshawar working in 12-h night shift (study group) and 6-h morning or evening
shifts (control group). Their age ranged between 21-50 years. The respondents in the
study group (n=90) performed night duty from 8.00 p.m till 8.00 a.m. in small groups of 1-2
alongwith 1-2 helping student nurses in different wards, and each had at least one weekly
night off. Similarly the respondents in the control group (n=50) were placed on morning
( from 8.00 a.m till 2.00 p.m) or evening duty (from 2.00 p.m till 8.00 p.m), in small groups
of at least 2-4, along with 4-6 helping student nurses. The student nurses on morning or
evening shifts were not included in the study because of their different working schedule.
Subjective symptoms and daily behavior were recorded by the nurses before, during and
after their duty, on three alternate days, using a structured questionnaire focussing upon
physical health, mental depression, family relations, informal social participation, job
performance and job-related stress. There was a 100% response rate. A complete clinical
examination of all the respondents was conducted to detect any physical ailment.
Necessary investigations were carried out in suspected cases to confirm the diagnosis.
The results were tabulated and statistically analyzed to confirm the responses.
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RESULTS

Fig-1 shows the age distribution in the study and control groups. This is evident
that maximum number of the respondents was between 26-35 years of age. 62.22% of
the respondents from the study group while 74% among the control group were married.
The working environment /behavior of the seniors was described to be satisfactory by
53.33%, and non-satisfactory by 44.77% of the respondents in both the groups. It was
found that due to such environment/behavior, 68.88% of the respondents showed
improved efficiency while in 31.22% of cases, they could not perform their duties properly.
Table-1 gives details of the physical and psychological problems faced by the
respondents in both the groups. It is evident that shift duty caused significantly more
physical and psychological problems like day-time sleepiness, insomnia, physical fatigue,
difficulty in concentration and irritability on the respondents in the study group (P<0.001).
Similarly, as shown in table-2, the shift work-related disturbances in 12-h night shift nurses
were significantly greater than those in 8-h evening/night shift nurses, as for as the job
performance, family relations, physical health and social participation were concerned
(p<0.001). This was interesting to find that according to about 82% of the respondents in
both the groups, there was no strict pre-employment or periodic medical check up, to find
out any significant behaviour change or psychosomatic disorder.
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DISCUSSION

Research in the field of shift work and its influence upon nurses is limited, with
researchers focussing upon different aspects of shiftwork with conflicting findings 14. A
census sample of psychiatric night nurses (n=280) reported significantly higher stress
levels (p<0.05) than the day shift nurses (n=98). In particular, temporary night nurses
(permanent day staff who had to undertake a night duty for 12 weeks every 12-18
months) reported the highest stress levels (p<0.05) 15. Moreover, it has been concluded
that disturbed sleep and sleepiness are common among workers16.
In the present study it was found that due to unsatisfactory working environment /
behavior of the seniors, there was negative effect on the efficiency of the respondents
which is comparable to a previous study by the same author 17, in which it was found hat
non-cooperative attitude of male colleagues made the respondents in its study group,
psychologically upset (p<0.001). Moreover, it is also evident from the present study that
the nurses, working night shifts had more complaints of day-time sleepiness, insomnia,
physical fatigue, difficulty in concentration, depression and irritability as compared to
those, working morning/evening shifts (p<0.001), aggravated by their working conditions
and existing social and family problems. This may be compared with the findings of a
study in which it was revealed that night work resulted in disturbance of sleep, appetite,
energy, concentration and an increase in psychosomatic complaints such as irritability
and feelings of helplessness18. In the present study, it was further found that the job
performance, family relations, physical health and social participation were disturbed more
in the study than in the control group (p<0.001) as compared to another study, in which
nurses working in the night shifts experienced more job-related stress and physical
problems than those working fixed morning/afternoon shifts19.
In conclusion, the study suggests that, there was a significantly higher rate of
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complaints of day-time sleepiness, insomnia, physical fatigue, difficulty in concentration,
depression and irritability in nurses working night shift as compared to those, working
morning/evening shifts. Furthermore, the shift work-related disturbances were significantly
greater in the study than the control group, as for as their job performance, family
relations, physical health and social participation were concerned. However, being a small
sample, the study may not reflect the entire population, and the findings suggest the need
for further research in this area to incorporate the findings in the management policy to
overcome the problems faced by the nurses due to their shift work and to improve their
efficiency and performance.

Acknowledgements:

The author is thankful to all the respondents who took keen interest and offered full
co-operation during the course of this study.
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Table-1

Physical and psychological effects of Shift work

S. No Effects Study Group Control Group

(n=90) (n=50)
1 Day-time sleepiness 10 11.11% 0 0.00%
2 Insomnia 6 6.66% 1 2.00%
3 Physical fatigue 14 15.50% 4 8.00%
4 Difficulty in Concentration 10 11.11% 2 4.00%
5 Irritability 10 11.11% 4 8.00%
6 Depression 14 15.50% 6 12.00%
7 No Effects 26 28.90% 33 66.00%

X2 = p<0.001
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Table-2

Shift work-related disturbances

S. No Effects Study Group Control Group

(n=90) (n=50)
1 Job Performance 12 13.33% 4 8.00%
2 Family Relations 14 15.55% 3 8.00%
3 Physical Health 20 22.22% 4 8.00%
4 Social Participation 18 20.00% 6 12.00%
5 No Effects 26 28.88% 33 66.00%

X2 = p<0.001
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