I chose an article from the American Journal of Nursing about how shift work adversely affects mental health. In this article it was found that shift workers, especially women, are at increased risk for poor mental health, particularly regarding symptoms of depression. ” The researchers found that shift workers had an increased risk of adverse mental health outcomes compared with workers who didn’t work such shifts. Specifically, shift work was associated with a 33% greater risk of depressive symptoms. The risk of anxiety and other symptoms of poor mental health were also greater in shift workers, but the differences weren’t statistically significant. Female shift workers were more likely than women who didn’t work such shifts to experience depressive symptoms, a difference that was not seen among men.” I think this information is so important as I think it has a direct correlation to nurse burnout. I think nursing management needs more assessment tools and education tools in place about mental health in the work place.
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Great research! Being a recent graduate, I have found nurse burnout is extremely present. The four phases, honeymoon, shock, recovery and resolution taught in nursing school are extremely valid. Particularly the shock phase, negative feelings may surface, often the expectation of new role is inconsistent of work flow. This phase has increased burnout rate, desire to quit and leads poor self care. The shock phase combined with shift work could have a bigger impact on mental health and performance.“12.5 hours shifts are associated with less effective performance” The article also suggests enough sleep as a step for increasing self care and reducing depressive symptoms. Shift work, disrupts individuals circadian rhythms, characterized by sleep disturbance among other adverse health effects. (Mcdowall, Murphy and Anderson 2017) Taking a quote from your critique “Better mental health for employees, will result in better performance at work”
BoDell
Does your hospital offer any employee incentives for self care? Our hospital has access to counselors for mental health and a residency nurse program that connects us with a mentor but I would like to see an increase in self care activities on campus.
Mcdowall K., Murphy E., Andersen K., (2017). The impact of shift work on sleep quality among nurses. Occupational Medicine. 2017; 67 : 621-625
Hello Johnny,
I do agree with the article suggestion that “getting enough sleep as as step for increasing self care and reducing depressive symptoms”. I have work nights since 1989-by choice I stay on nights now. Sleep is number one priority. I know numerous nurses who think they can get up and do things during the day, i.e, doctors appointments, let their animals in/out for potty breaks, go their children’s activities, have their children at home instead of taking to child care. My advise it always sleep, sleep, sleep. If you are working the day shift you are not able to do not one of these activities so don’t do them while you work the night shift. SLEEP! I have worked with a fair amount of nurses who just cannot sleep during the day and these are the nurses who I find are having mental health problems which frequently leads to them seeking employment elsewhere where they can work days. This is just night shift workers. One cannot ignore the fact that there are many studies that show the harmful effects of night shift work. Eva S. Schernhammer, M.D., DrPH, an associate professor of medicine at Harvard Medical School and an associate epidemiologist at Brigham and Women’s Hospital said, “To derive practical implications for shift workers and their health, the role of during and intensity of rotating night shift work and the interplay of shift schedules with individual traits (e.g., chronotype) warrant further exploration.
Thanks
Gayle
Hello BoDell,
Its interesting that depression is greater among women who shift work vs women who do not but no difference in men who do and do not do shift work. It would be interesting to see if there are studies that can relate why the difference. I looked but not extensively to see if there were any and didn’t find any. Psychology Today’s article “The Night Shift” reports that there are 15 million Americans who work the night shift. Nurse burnout is just one of several issues with shift work listed in this article. Your research article suggest sleep is very important. “The Night Shift” list fragmented sleep as part of this problem as well. I know nurses who go to sleep for a few hours and then up to tend to family and then they try to catch a “nap” before coming into work. This disruption of the circadian rhythms is also likned to cardiovascular disease, obesity, digestive problems, and diabetes. Depressive symptoms could be due to the fact that the world works on a 9-5 schedule and shift workers miss out on family functions and night shift workers can begin to feel like second-class Citizens. ( Psychology Today, 2016).
I have worked nights since 1989- by choice now. I will agree with the research that one does miss out on functions. I do not skip sleep for any cause though or very rare because staying awake at night on little sleep is down right painful and as the research shows not safe patient care.
If you are able to develop anything at your hospital to help the night worker please when you do mandatory education make it conducive to the night work schedule hours. Recently I had a mandatory hand-washing education/simulation skills we had to do. The times were 8-5 for some days, 8-12 for others. When you work 7-7, 8-5 does not work. You can’t come in a little early like 7:30 and or stay a little later like 6-6:30? That prob. does not seem like that big a deal but it is when you are already working 12 hours and have to come in 2 hours early or sit around for an hour after working 12
Thanks for sharing,
Loretta G. Bergman
Hi Loretta,
I found an article in the Journal of Psychiatry and Neuroscience stating that depression is higher in women than men in general, not just in nursing. According to the article, the global prevalence of depression in women is 5.2% compared to 3.2% for men (Albert, 2015). After reading this, it makes sense to me why depression in nurses would be higher in female nurses versus male nurses, especially those who do shift work.
I worked nights for 8 years, switching to days just several years ago. I loved working the night shift and had no problems sleeping, however, dayshift works better with my social life. I did feel a little bit isolated as a night shift worker, because all of my friends and family operated on a dayshift schedule. I can see how those who already tend towards having depression could have it exacerbated by having to work nights. I agree with the original poster that this research is very important in nursing.
Albert, P. (2015). Why is depression more prevalent in women? Journal of Psychiatry & Neuroscience, 40(4), 219–221. doi: 10.1503/jpn.150205
I can very well relate to the topic of shift work and its adverse effects on health and wellbeing, especially when combined with extended hours of work. I was a victim at a psychiatric hospital where nurses and mental health workers had to work 16-hour shifts back to back, leading to burnout and high turnover rates. Caruso (2013), corroborates the resulting multifaceted problems with the findings that shift work and long work hours increase the risk for reduced performance on the job, obesity, injuries, a wide range of chronic diseases, and fatigue-related errors that could harm the patients. Also, fatigued nurses endanger others during their commute to and from work.
Truth be told, while the night shift allows us to tend to various needs or activities, it is imperative to draw a limit and give our bodies the rest it deserves. My concern, however, stems from the question jlcarter7 asked about provisions for self-care incentives at your facility. Are employees aware of these provisions, and if so, do they avail themselves of it?
Reference
Caruso, C. C. (2013). Negative impacts of shiftwork and long work hours. Rehabilitation Nursing, 39(1), 16–25. doi: 10.1002/rnj.107
There is a residency program as well and new employees are hooked with a “buddy” but I’m not sure how well this works. I’m thinking it may work well through orientation which is about 6 months on days and then they come to nights. I think whey they fly solo this is the toughtest time. Other RNs on the floor can be helpful but often everybody is too busy to really step in. I am not aware of any other self-care incentives for the night shift and I do not know of one person ever on nights who has said that they took advantage of anything that was available to help them. There was one nurse who was fairly new and was having trouble sleeping. She went to the managers to discuss her concerns and wanted to change to prn days. She discussed with me that there were some other health concerns involved but she did not share those with me. The managers let her move to days full time out of turn. This caused a big stink amongst the staff waiting to go to days and were skipped over. Most nurses I know of that cannot take nights any longer either quit to travel, quit to take other jobs to go to day shift (ususally out of OB), or go to prn days. I’ve seen nursing facebook groups that ask about sleeping/night shift. There are often some good suggestions there. Nursing can be very rewarding but it is hard as well. Nurses truely do go through the four phases of honeymoon, shock, recovery and resolution mentioned in JlCarter7 post. My best advice is uninteruppted sleep. Nurse-life/safe care, and safety of travelling by the nurse, requires it as well as the mental health/wellbeing/happiness of the nurse.
Gayle
Thank you all for your well thought out input. There is not a self-care incentive program at the rural hospital I am currently working at. It possibly has never been brought to anyone’s attention. I know a current nurse who has her own mental health issues that I believe would truly benefit from a self-care program. Our manager is very thoughtful of the night shift when it comes to staff meetings. There are always 3 different times and days scheduled for staff meetings so you can go to a meeting before your shift starts, right after your shift ends, or on your day off. I do agree uninterrupted sleep is so important! This has all been great information that I can bring up to my manager so these resources can be in place for those that need them.
Shift work, including the night shift, is common for hospital nurses because patients need to be cared for twenty‐four hours a day. I worked nights for 4 years and remember when I switched to days how much better I felt. Working 12 hour days can be very exhausting not just physically but mentally as well. According to Giorgi, Mattei, Notarnicola, Petrucci, & Lancia ( 2018), “Nurses are more susceptible to burnout than some other healthcare professionals due to their close interpersonal relationship with patients”. Shift work places nurses under stress and can cause their health, well‐being and lifestyle to deteriorate. Nurses who feel strained are more likely to burnout. The aim of this study was to investigate any possible relationship between sleep disorders, burnout and job performance in a shift‐work population of nurses. . The results were that on shift‐work nurses’ sleep quality and burnout correlated positively. The female gender and personal burnout were significantly associated with impaired sleep quality, while working in the psychiatric setting, working a long cycle shift pattern and experiencing daytime dysfunction were significantly associated with burnout. A significant negative association between patient‐related burnout and job performance was observed. Specific characteristics of shift‐work nurses can directly affect sleep quality and burnout and indirectly job performance.
Giorgi, F., Mattei, A., Notarnicola, I., Petrucci, C., & Lancia, L. (2018, March). Can sleep quality and burnout affect the job performance of shift-work nurses? A hospital cross-sectional study. Retrieved February 26, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/29164
I think you struck a nerve with this research topic! I agree with you that this is likely corelated to the nurse burnout that goes on in this country. My unit has over 80% turnover rate and there are many factors that go into that, but the shift work is one of them. When I started on night shift I couldn’t function and begged to go to day shift. I would say that I felt depressed, I started taking Lexapro and cried all the time. Some people love night shift though and their bodies and minds get used to it. In general, hospital turnover rates are increasing in this country (NSI Nursing Solutions, 2019). Although shift work is hard on employees, I found an article that claimed nurses were twice as likely to experience depression for multiple reasons (Minority Nurse, 2016). I am encouraged that your article supports a problem with nurse depression, but I am not really sure how soon the schedule will change for nursing staff. I appreciate your research topic very much.
2019 NSI National Health Care Retention & RN Staffing Report. (2019, March). Retrieved February 28, 2020, from https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report
Lampert. (2016, March 01). Depression in nurses: The unspoken epidemic. Retrieved February 28, 2020, from https://minoritynurse.com/depression-in-nurses-the-unspoken-epidemic/
Shift work, in addition to contributing to mental health concerns, can potentiate cardiovascular, hematological, immunological, endocrine, and gastroenterological issues. A 2015 review of studies on the health impact of shift work summarized that shift work was a potential contributory factor to the development of metabolic syndrome and diabetes (Shariat, A. et al., 2015). The review, however, did conclude that causal links are difficult to study and isolate.
Having worked night shift for a number of years, I have found that there were nurses who were suited for living a reverse schedule and there were those who had immense difficulty in adjusting. If I were to design a research project regarding the adaptability versus lack of ability to adapt to shift work, I would want it to be a longitudinal study that established a baseline of an individual’s circadian rhythm and health status prior to entering shift work and then follow the individual for a period of years to reassess whether his or her natural biological sleep-wake cycle had adapted to shift work and where his or her health status had varied from baseline. Great topic and thank you for posting.
Shariat, A., Bahri, M.T., Daneshjoo, A. & Sadeghi, H. (2015). The Adverse Health Effects of Shift Work in Relation to Risk of Illness/Disease: A Review. Acta Medica Bulgarica, 42(1), 63-72.
This is a very interesting article! I think nurses who work nights are superheros! I literally turn into an idiot at 0200. I cannot speak or function, let alone take care of an ill or injured human. I can barely function enough to be a mom in the middle of the night, let alone a nurse.
I had never really thought of the effects of working nights on depression and anxiety. I had only really considered it in terms of the effect it can have on family life and sleep schedules. I’ve watched my sister work nights for years. She can barely sit down without nodding off. We’ve spent many holidays with her asleep on the couch while we all have fun around her.
A longitudinal study of night shift nurses found that switching to day shift decreased their symptoms of depression and anxiety (Thun et al., 2014). This makes a lot of sense to me, because sleep deprivation can have such a negative affect on mood. If I’m tired I cannot focus and the lack of focus makes me anxious. I also get so emotional if I don’t get good sleep for several days in a row.
This reminds me why it’s so important to make every effort to get night shift nurses involved. They have so many different struggles than day shift nurses do and their voice is so important. I’ve heard of hospitals doing a special forum/council just for night shift. In one hospital it was called Nights of the Round Table. It gave them a chance to be involved, speak to the unique struggles of being a night shift employee, and still get the shift differential that they deserve. I know that this wouldn’t cure anyone’s depression, but maybe feeling heard could help decrease problems on the shift, which could lead to better sleep.
Resource:
Thun, E., Bjorvatn, B., Torsheim, T., Moen, B., Magerøy, N., & Pallesen, S. (2014). Night work and symptoms of anxiety and depression among nurses: A longitudinal study. Work & Stress, 28(4), 376-386.
I wonder if there is a baseline difference in people who choose to work day shift vs those who choose to work the night shift. One study I found from 2014 stated that night shift workers didn’t differ from day workers in terms of baseline anxiety and depression symptoms but, interestingly, night shift workers who changed to day shift had a decrease in symptoms. It seems to support the argument that day shift is in some way better for people who may already deal with these symptoms. I worked night shift for over a decade. I’m naturally a night person and stayed up most of the night even as a child, reading under the blankets with a flashlight. I am currently in my third year of faking being a day-dweller and still occasionally have trouble sleeping at night. The transition was rough but I only changed from one shift permanently to another. I don’t work “shift work” with changing or rotating shifts. On the other hand, the local power company still uses rotating shifts. The company provides information to its employees on decreased lifespan associated with rotating shift work. Anecdotally, my father was a foreman for them and he and nearly all his people had had at least one MI.
Thun, E., Bjorvatn, B., Torsheim, T., Moen, B.E., Mageroy, N., & Pallesen, S. (2014). Night work and symptoms of anxiety and depression among nurses: A longitudinal study. Work & Stress, 28(4), 376-386.
doi:10.1080/02678373.2014.969362
This has all been such great input! Thank you! I have enjoyed reading everyone’s posts!
This is a very interesting topic. I think we all feel the affects of shift work. The study I looked at, examined the rotating shift work. It to found a high incidence of depression and anxiety.
The present study demonstrated high sleep reactivity to be an important premorbid vulnerability to incident SWD and elevations in depression and anxiety in response to desynchrony between endogenous circadian timing and exogenous sleep patterns among rotating shift workers.
Kalmbach, D. A., Pillai, V., Cheng, P., Arnedt, J. T., & Drake, C. L. (2015). Shift work disorder, depression, and anxiety in the transition to rotating shifts: the role of sleep reactivity. Sleep medicine, 16(12), 1532–1538. https://doi.org/10.1016/j.sleep.2015.09.007