NIOSH Training for Nurses on Shift Work and Long Work Hours

Researchers have proposed these guidelines for designing work schedules: (Continued)

• Researchers discourage quick changes. Quick shift changes (for example, evening shift ending at 11:30 p.m. followed by a day shift starting at 7 or 8 a.m.) give nurses little time to sleep. Knauth and Hornberger recommend at least 11 hours between two work shifts.¹²
• If you are using shift rotations remember that forward rotations (day shift to evening shift) are easier to adjust to than backward rotations (evening shift to day shift)^12,13,15
• The most difficult speed of rotation is a weekly rotation – it is best to avoid this.

Concerning shift rotations, some U.S. researchers suggest slow rotations^a that change every 2 or more weeks, because these give the circadian system time to adjust to the new schedule.¹⁶ Some European researchers recommend the opposite: fast-forward rotations^b.¹⁷ They reason that workers spend less time on evening and night shifts and therefore do not experience long periods of isolation from family. Also, fast rotations do not lead to a long series of work days misaligned with the sun’s light/dark cycle. However, fast rotations do not give time for the circadian rhythms to adjust, so performance may be compromised, which is a real concern in healthcare. It is not clear whether fast-forward rotations or slow rotations are best for healthcare workers.

Early start times (6 a.m. or earlier) tend to shorten sleep because the circadian system promotes wakefulness a few hours before usual bedtime. This makes it difficult to go to sleep early. It is best to avoid these if possible.

Working on weekends contributes to the loss of contact with family and friends, which is a major problem for nurses on shift work. Therefore, experts recommend scheduling some weekends off. Many hospitals routinely follow this suggestion.

^a Working a shift for two weeks or more (for example, two weeks of day shift followed by two weeks of the evening shifts).

^b Working different shifts within the same week (for example, day shift for two days, evening shift for the next two days, night shift for one day).