Nurses are well aware that shift work and long hours take a toll on the body. Aching muscles, difficulty staying awake, trouble concentrating, stress, GI problems—all are recognizable effects of fatigue. It may be more surprising, however, that work-related sleep loss may be associated with serious or even deadly long-term health effects.

Reproductive health and health behaviors

Researchers from the National Institute of Occupational Safety and Health (NIOSH), in collaboration with the Harvard Nurses’ Health Study, recently studied the association between shift work and adverse pregnancy outcomes among nurses. Results suggest that nurses, especially those working night shifts, are more likely to experience spontaneous abortions, early preterm births, and menstrual-cycle irregularities.

Studies also have shown that shift work, long hours, and sleep deprivation may have a negative impact on health behaviors. For instance, sleep deprivation is associated with hormonal changes that can cause an increase in appetite. Also, shift work and long hours make it more difficult to find time for exercise. Together, these factors increase the risk of obesity.

The importance of sleep

Long hours and shift work do not allow nurses adequate time to recover from work. Combine professional demands with personal responsibilities and, unfortunately, sleep is sacrificed.

The benefits of sleep are numerous. Sleep affects all organ systems, and disruptions can have serious consequences, including the development of chronic illnesses. For instance, sleep has powerful effects on immune functioning. Research indicates that natural “killer” cells (cells that kill tumors) are much less effective with even modest sleep loss. Other studies have shown that sleep loss is linked to insulin resistance, increased production of cortisol (the “stress hormone”), and increased sympathetic activity.

Solutions and resources

Nurses and employers can work together to prevent adverse health effects related to shift work and long hours. ANA’s long-standing policy positions offer guidance about how to guard against working while fatigued. NIOSH suggests:

Tips for nurses

• Make sure you give yourself enough time to sleep after working your shift.
• Avoid heavy foods and alcohol before sleeping and reduce intake of caffeine and other stimulants several hours before going to sleep.
• Exercise routinely. Keeping physically fit can help you manage stress, stay healthy, and improve your sleep.
• Choose to sleep in a dark, comfortable, quiet, and cool place so you can fall asleep quickly and stay asleep.
• Seek assistance from an appropriate healthcare provider if you are having difficulties sleeping.

Tips for employers

• Regular rest: Establish at least 10 consecutive hours per day of protected time off-duty in order for workers to obtain 7 to 8 hours of sleep.
• Rest breaks: Frequent brief rest breaks (such as every 1 or 2 hours) during demanding work are more effective against fatigue than a few longer breaks. Allow longer breaks for meals.
• Shift lengths: Five 8-hour shifts or four 10-hour shifts per week usually are tolerable. Twelve-hour days may be tolerable with more frequent interspersed rest days. Shorter shifts (such as 8 hours) during the evening and night are better tolerated than longer shifts.
• Workload: Examine work demands with respect to shift length. Twelve-hour shifts are more tolerable for “lighter” tasks (such as desk work).
• Rest days: Plan one or two full days of rest to follow five consecutive 8-hour shifts or four 10-hour shifts. Consider two rest days after three consecutive 12-hour shifts.
• Training: Provide training and resources to create awareness of the ups and downs of shift work.
• Incident analysis: Examine near-misses and incidents to determine the role, if any, of fatigue.

Upcoming resources

ANA’s Center for Health, Safety, and Wellness has collaborated with NIOSH to provide nurses with helpful resources. Later in 2012, NIOSH will launch a free continuing-education program on shift work and long hours. Visit www.cdc.gov/niosh/topics/workschedules and www.nursingworld.org for more information.

Jaime Murphy Dawson is a senior policy analyst at ANA.