Nursing is notoriously known as a profession with erratic scheduling and constant fatigue from a lack of or inconsistent sleep. This is largely due to shifting work which forces nurses to work long hours to meet the staffing needs of a hospital. There is a myriad of negative effects on the health and performance of nurses due to shifting work which results in ineffectiveness, cognitive fatigue, and low job retention rates in the long run.
Context
Nurses commonly work in rotating shifts each week, covering all times of the day, including regular daytime and nighttime shifts. This is in order for a medical professional to be present in case of emergencies with hospitalized patients and any other instances that may arise and require a nurse. Night shifts are traditionally considered the longest, officially lasting 12 hours, but in practice, they can be up to 14 hours by the time a full transition occurs with the next rotation.
Furthermore, the mental stress of the nursing profession and considerable workload add to the impact of such long shifts. Shift work leads to a disrupted circadian cycle and negatively affects the work-life balance (Dall’Ora, Ball, Recio-Saucedo, & Griffiths, 2016). However, there is currently no viable alternative to ensure hospital and patient needs are met consistently without shift rotations.
1st Con-Point
Shift work has been associated with a decreased quality of sleep, lack of alertness, and poor cognitive performance, with both long- and short-term effects. According to Ferri et al. (2016), nurses working rotating shifts, which include night shifts, are more likely to demonstrate low quality and quantity of sleep. Despite being younger in age on average, they statistically experience more common chronic fatigue and physical symptoms of cardiovascular issues. In a study of long hours, Ferri et al. (2016) found that disruptions to the circadian rhythm and sleep cycles induce a drop in cognitive performances towards the end of shift. The physical fatigue experienced by nurses is detrimental and can have severe health consequences as well as impact their professional abilities.
1st Pro-Point
Working in shifts allows nurses to work at their convenience, which improves their life-work balance. According to Mullen (2015), one of the barriers to work-life balance among nurses working in different healthcare setups is the lack of flexible work schedules. Therefore, by having shift work, nurses can plan their lives to balance between work and family and other related needs. Ultimately, such nurses will perform optimally as they are happy on top of being satisfied with life.
On the other side, dissatisfied nurses working regular hours, which at times extended due to excess workload, are likely to perform poorly because they are probably worried about their families. As such, it suffices to argue that shift work nurses are likely to provide better care as compared to their regular work counterparts. The issue of quality of sleep does not arise because such nurses can have enough resting hours when they are not working.
Besides, the human body can adapt to different changes, including the circadian rhythm, which could be modified accordingly. It is true that melatonin levels increase at night, but this argument does not negate the fact that a person can enjoy quality sleep during the daytime.
2nd Con-Point
Sleep deprivation and chronic fatigue caused by shift work will eventually begin to impact the professional competency of a nurse. Kaliyaperumal, Elango, Alagesan, and Santhanakrishanan (2017) conducted a comprehensive study on poor sleep quality in nurses and found decreased cognitive performance on standardized tests. Other aspects such as attention, vigilance, and memory were impaired as well, with night shift nurses demonstrating the lowest scores. As nurses struggle with cognitive performance, this poses a danger to their alertness and competency. There is an increased risk of error or lack of an appropriate reaction to an emergency which could lead to adverse outcomes with a patient.
2nd Pro-Point
Shift work leads to reduced working hours, which increases performance. According to a study by Gyllensten, Andersson, and Muller (2017) exploring the experiences of nurses concerning shift work, it was noted that such workers are unlikely to suffer from burnout. In most cases, the unfinished work could be completed by the incoming shift workers, and thus such nurses do not have to worry about their families or work for long hours.
Ultimately, nurses working in shifts tend to be focused, and they function optimally because they are on the job for shorter hours. As such, the number of reported cases of medication errors goes down as performance increases to facilitate positive patient outcomes. On the contrary, regular work nurses are required to accomplish certain tasks before they leave their workplaces, which may require extra hours; hence fatigue may set in, leading to errors and poor patient outcomes. The sleep deprivation theory does not hold as indicated in the first pro-point above. Similarly, cognitive performance is not a function of when an individual sleeps or works.
3rd Con-Point
Shift work on a continuous basis leads to widespread job dissatisfaction and severely decreases retention rates among the nursing staff. The impact of long hours on health and work-life balance results in negative attitudes towards the job and its scheduling. A comprehensive multinational study by Dall’ora, Griffiths, and Ball (2015) found the effects of nurse shift work to be exemplified by increased burnout, severe job dissatisfaction, and a possible intention to leave.
Particularly, 12-hour shifts which have profoundly negative psychological effects which accumulate and eventually erupt into nurses quitting their jobs. This suggests the long-term effects of shift work and the impact it may have on administrative aspects of healthcare delivery since nurse retention is a critical issue in light of the shortness of nursing staff.
3rd Pro-Point
Working in shifts allows nurses to create time for personal and career development by furthering their studies. Night shift nurses would attend classes during the day, rest, and work without affecting their performance. Ultimately, such nurses will be better placed to offer quality service and perform exemplary as opposed to their counterparts who have not furthered their learning. In a study by Atefi, Abdullah, Wong, and Mazlom (2014), the interviewed nurses argued that flexible work environments are the leading causes of job satisfaction and high-performance inpatient care. These evidence-based findings contradict the third con-point above, which states that job dissatisfaction is associated with shift work.
Additionally, shift work reduces chances of burnout and fatigue as opposed to the claims that it is a major contributor to the same. As established earlier, working in shifts leads to fewer hours on the job, which reduces the possibility of having burnout. Fatigue is normally caused by long working hours, which is not synonymous with shift work. Therefore, it is clear that working in shifts has several benefits, which have been overlooked due to inherent stereotypes associated with this work schedules.
Conclusion
Shift work is demonstrated to have a number of negative effects on nurses, ranging from psychological and physical health to their job satisfaction and employment. Over the long term, nurses experience burnout on all levels, physical and emotional, which severely hinders them in their professional and personal lives. Unfortunately, shift work is ultimately a necessity in current healthcare realities, but strategies such as shorter shifts and staff rotations for breaks could be introduced to mitigate the effects.
References
Atefi, N., Abdullah, K. L., Wong, L. P., & Mazlom, R. (2014). Factors influencing registered nurses perception of their overall job satisfaction: A qualitative study. International Nursing Review, 61(3), 352-360.
Dall’Ora, C., Ball, J., Recio-Saucedo, A., & Griffiths, P. (2016). Characteristics of shift work and their impact on employee performance and wellbeing: A literature review. International Journal of Nursing Studies, 57, 12-27. Web.
Dall’ora, C., Griffiths, P., & Ball, J. (2015) 12 hour shifts: Nurse burnout, job satisfaction & intention to leave. Evidence Brief, 3, 1-2. Web.
Ferri, P., Guadi, M., Marcheselli, L., Balduzzi, S., Magnani, D., & Di Lorenzo, R. (2016). 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. Risk Management and Healthcare Policy, 9, 203-211.
Gyllensten, K., Andersson, G., & Muller, H. (2017). Experiences of reduced work hours for nurses and assistant nurses at a surgical department: A qualitative study. BMC Nursing, 16(16), 1-12. Web.
Kaliyaperumal, D., Elango, Y., Alagesan, M., & Santhanakrishanan, I. (2017). Effects of sleep deprivation on the cognitive performance of nurses working in shift. Journal of Clinical and Diagnostic Research, 11(8), 1-3.
Kazemi, R., Haidarimoghadam, R., Motamedzadeh, M., Golmohamadi, R., Soltanian, A., & Zoghipaydar, M. R. (2016). Effects of shift work on cognitive performance, sleep quality, and sleepiness among petrochemical control room operators. Journal of Circadian Rhythms, 14. Web.
Mullen, K. (2015). Barriers to work-life balance for hospital nurses. Workplace Health & Safety, 63(3), 96-99