Answer

Impact of Shift Work on Transition of New Nurses to the Professional Nursing Practice

            Shift work in nursing practice is indispensable and necessary to guarantee continuity of care in residential facilities and hospitals. Scheduling and rotating are the key characteristics of shift work and the nursing workforce is largely locked into planned schedules that help to provide around the clock care, including night shift work (Ferri et al., 2016). This is important since midwives and nurses make up approximately 50% of the worldwide healthcare shift-working workforce. Shift work can interfere with sleep and result in fatigue with adverse effects for midwives and nurses’ health. Besides, shift work can also compromise patient safety (Querstret et al., 2020). Querstret et al.’s (2020) study has some limitation though; it relies on secondary sources of evidence. Nursing students normally experience abrupt transition from traditional classes to shift work and clinical rotations (Postma et al., 2017). Regardless, Postma et al. (2017) used a small sample size (n=12); thus, findings cannot be generalized. This review indicates that rapid transition into professional nursing practice characterized by shift work positions new-entry nurses into great risk of experiencing sleep disruptions and poor level of job satisfaction. Strategies for mitigating or prevention the negative mental and physical health impacts of shift work include allow nurses to have a nap while in shift, nurse education and provide counselling services for the nurse population.

Analysis

Theme 1: Shift Work Causes Sleep Disturbances/Problems

            Shift work can lead to sleep disturbances or sleep problems. Shift work have gained more emphasis as the leading cause of circadian rhythm disruptions. In this regard, shift work are known to cause significant changes in the body’s biological functions and sleep alterations, which can lead to negative consequence on psychological and physical well-being as well as poor work performance (Ferri et al., 2016). Ferri and colleagues (2016) add that shift work is associated with gastrointestinal disturbances such as heartburn, peptic ulcer, colitis, dyspepsia, irregular bowel movements, pain, abdominal rumblings, indigestion, gastro-duodenitis and flatulence. There is a syndrome that has been recently described as “shift work disorder” is characterized by disruption of the circadian rhythm of sleep/wake, excessive day sleepiness, insomnia, and fatigue. New nurses transitioning into professional nursing practice are likely to experience “shift work disorder.” Shift work, particularly at night, may induce a state of sleep deprivation, which can alter the level of job performance and daily level of alertness (Ferri et al., 2016). Key limitations in Ferri et al.’s (2016) study included a small sample size and lack of comparison with other residential facilities and/hospitals. Another study by Ganesan et al. (2019), established that shift work is significantly associated with impaired alertness due to circadian misalignment and sleep loss. Similarly, Merchaoui et al. (2017) state that shift work has psychological and physical effects such as disruption of the body circadian rhythmicity, performance, and sleep alertness. It may lead to long term health outcomes such as type 2 diabetes mellitus, obesity, and cardiovascular diseases (Merchaoui et al., 2017). Evidence indicate that shift work can have serious negative effects on psychological and physical health and wellbeing.

            Sleep deprivation is associated with an increased risk of mental and psychological health problems. These include increased risk of obsessive-compulsive disorder, somatization, irritability, anxiety, altered mood, interpersonal sensitivity, and paranoid disorders (Ferri et al., 2016). Similarly, Dehring, von Treuer and Redley (2018) found that lack of adequate sleep associated with shift work may increase the risk of negative physical and psychological outcomes such as gastrointestinal complaints, non-prescription medication use, job-related stress, and cardiovascular diseases. Night staff experience significantly higher risk of having elevated depression scores compared with daytime staff (Dehring et al., 2018). However, Dehring et al.’s (2018) findings cannot be generalized due to a small sample size. Postma et al. (2017) add that lack of sleep due to night shift work can make nurses experience drowsy driving, feel impaired, and feeling of being isolated when they return home after their shifts. Night work leads to negative impacts on family life, emotional health, and social life, job-related stress, and drug use (Merchaoui et al., 2017). In fact, working night shift is associated with increased risk of workplace accidents and road accidents. Impaired driving and excessive sleepiness performance resulting from shift work increases the risk of risks of motor-vehicle crashes by 2– 4 times during the commute to-and-from work (Imes & Chasens, 2019). Shift work is a common practice among nurses and is regarded as a workplace hazard since it may cause poor sleep quality, which can cause adverse effects on the safety and health of nurses and their patients (McDowall, Murphy, & Anderson, 2017). However, McDowall et al. (2017) used a convenient sample; thus, lowering the quality of evidence. Shift work excessively point towards increased risk of being involved in a motor-vehicle accident and adverse effects on mental and physical health.

            Shift work and lack of sleep is associated with a multitude of chronic diseases. It is associated with increased risk of metabolic disturbances, cardiovascular diseases, and possibly some cancers (Buchvold et al., 2019). Similarly, Imes and Chasens (2019) found that shift work can result in disruption of the circadian rhythm, which is associated with cancers, cardio-metabolic diseases, gastrointestinal health issues, depressive symptoms, and the worsening of mood disorders (Imes & Chasens, 2019). In addition, shift work can negatively affect work-life balance and increase familial and social constraints (Buchvold et al., 2019). Use of a sample size in Buchvold et al.’s (2019) study limits generalizability of findings. On the other hand, Postma et al. (2017) adds that shift work is associated with poor personal safety out of the workplace; particularly, when driving home after a long night shift. Lack of sleep may also reduce the quality of life of the affected nurses who are put under rotation and shift work (Postma et al., 2017). Imes and Chasens (2019) found that rotation and shift work is highly correlated with greater fatigue, greater emotional distress, and worse concentration and memory. Gaps in evidence is on lack of effective solutions for managing sleep problems associated with shift work (Sun et al., 2018). Besides Querstret et al. (2020) recommend that future studies should aim to identify comprehensive fatigue risk management strategies. Shit work increases emotional stress, fatigue as well as familial and social constraints.

Theme 2: Shift Work Can Lead to Poor Job Satisfaction

            Shift work is associated with poor level of job satisfaction. Ferri and colleagues (2016) compared the impact of night shift versus day shift on nurses and established that nurses on night shift reported lowest mean score in terms of quantity and quality of sleep and job satisfaction, with more frequent psychological symptoms, cardiovascular symptoms, and chronic fatigue compared with nurses on day shift work, in a statistically significant way. Poor job satisfaction can lead to reduced job performance, nurse favoring of absence from the workplace due to sickness, absenteeism, high nurse turnover rate, and job attrition. Besides, poor job satisfaction and other psychological impacts of night shift work can induce one to begin using psychotropic drugs (Ferri et al., 2016). Similarly, Dehring et al. (2018) associated rotating and night shift work with negative effects on job performance, work-related injury, increased sick days, and medical errors. Night shift appears to have more drastic health effects compared to day shift.

            Shift work can impair work performance. According to Ganesan et al. (2019), shift work is associated with impaired work performance as a result of circadian misalignment and sleep loss. Alertness and performance are the most impaired features during night shifts as a result of disruption of the circadian rhythm and lack of adaptation to night time work (Ganesan et al., 2019). Long shifts appear to go beyond decreased reduced job performance, but also include poor nurse well-being as well as reduced opportunities for social support (Dall’Ora & Dahlgren, 2020). However, Dall’Ora and Dahlgren (2020), relied on secondary sources of evidence. Shift work can reduce job performance and reduced job satisfaction.

Recommendations

Strategy 1: Napping

            Napping is one of the effective sleep-related and/or fatigue-management interventions. Napping can be beneficial in nursing practice; however, there is lack of evidence to indicate appropriate nap timing and duration.  Nap durations can range from 30 min to hours; especially during night shifts. Nurses should be given freedom to decide on when it is most appropriate for term to have a nap. However, napping during a shift may increase the level of sleepiness among nurses. Conversely, nurses who take a nap tend to feel less sleepy towards the end of a shift compared to nurses who do not have shift at all. It is important to take into consideration the length of sleep when develop strategic nap programs (Querstret et al., 2020). Naps are helpful approaches for combating fatigue especially in nurses working on shifts. The hospital administration needs to facilitate and allow nurses on shift to have a nap. Naps should be implemented as the constative part of a typical night shift (Querstret et al., 2020). Napping can increase the rate of recovery after work compared to non-nappers (Querstret et al., 2020).

Strategy 2: Education and Counselling of Nurses

Nurses on shift work require special attention, training, and counselling services to help them address mental and physical health issues associated with shift work. Ferri et al. (2016) recommended that nurses with rotating night schedule need special attention since they experience a higher risk of undesirable health effects and job dissatisfaction. In the workplace, supervisors and nurse leaders need to be keen since night shift is associated with increased risk of injuries and human errors, which can negatively affect the quality of patient care (Ferri et al., 2016). Fatigue ranks as one of the top causes of nurses’ errors in administration of medications. According to Postma et al. (2017) night shift nurses may experience reduced ability to make accurate medication calculations and may fail to respond to patients’ needs in a time and effective manner. Therefore, nurses in night shift work should be given adequate time to rest to reduce the risk of medication errors (Ferri et al., 2016). Similarly, Postma et al. (2017) emphasized that nurses on a night shift duty need regular breaks so as to reestablish their mental and physical health equilibrium. Giving nurses the freedom of taking adequate rest is considered as an effective strategy of for self-care given erratic work schedules (Postma et al., 2017). Provision of recovery time and time for rest during tight work shifts can help reduce the risk of negative physical and psychological impacts associated with shift work (Merchaoui et al., 2017). According to Zion and Shochat (2019), allowing nurses on night duty to have a short nap can help reduce the level of sleeplessness. A scheduled nap in a healthcare organization is considered as an effective countermeasure against the negative outcome of night-time shift work; particularly, among female nurses. Changes in policy and attitude are necessary so as to implement scheduled naps, which is cost-effective and beneficial (Zion & Shochat, 2019). However, Zion and Shochat (2019) only tested nurses on two nights.

            According to Dehring et al. (2018), presence or access to supervisor support for the night staff in a healthcare organization helps to reduce social dysfunction, somatic complaints and overall distress associated with night shift work. Enhancement of supervisor support can help counteract the negative physical and psychological outcomes observed among the night shift staff (Dehring et al., 2018). Nurses on rotation and shift work should be advised to adopt personal measures such as such as taking balanced and healthy meals, physical exercises, and smoking cessation (Merchaoui et al., 2017). On the other hand, Sun et al. (2018), recommends setting aside of a low-stimulation sleep environment for the staff, increasing awareness of sleep health of shift nurses, management of sleep disturbances among nurses, establishment of flexible rotating work schedule, social support, suitable working environment, and setting up policies; for example, that allows of provision of a 15 to 30 min nap break (Sun et al., 2018). However, recommendation from Sun et al. (2018) study relies on secondary sources of evidence.

Conclusion

            Rotational and shift work for nurses is associated with negative physical and psychological outcomes. The key themes identified in this essay include the fact that shift work is associated with sleep-associated problems and poor job satisfaction. Intervention strategies include allowing nurses to have a nap during shift work, improved training, education and provision of counseling services for the nurse population. Shift-work cannot be avoided among nurses but more strategies need to be put in place to make it safer with lesser negative physical and psychological consequences.