Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-007554, 2007 Jan; :1-51
Occupational safety and health issue that was addressed: Extended work schedules-those that vary from the standard eight hours per day, 35 to 40 hours per week-are common and contribute to worker health problems. Because so many nurses work extended schedules, we collected longitudinal data to examine the relationship of such schedules to the incidence of nurse injury. Importance of the problem: Nurses are at high risk for work-related musculoskeletal injury/disorders (MSD) and needlesticks. Because of the movement by health care organizations to reduce costs, generally by downsizing the nursing workforce, the occurrence of unhealthy scheduling practices to address workplace staffing of nurses has been increasing. Therefore, the purpose of this study was to examine the relationship of extended work schedules in nurses to the incidence of MSD and needlesticks. Approach: Using a longitudinal, three wave survey of a probability sample of 2,624 registered nurses, we collected extensive data on nursing work schedules. We then related Wave 1 work schedule data to neck, shoulder and back (MSD) cases occurring in Waves 2 or 3 and to prevalent and incident needlesticks. Key findings: Adverse schedules were significantly related to nurse MSD and needlesticks. Schedule characteristics increasing MSD risk included 13+ hour/days, working many hours per week, working while sick, on days off, or without breaks; on-call hours, and mandatory overtime. Our research was the first to examine the impact of mandatory overtime, being on-call, working while sick or on a day off, and with less than 10 hours off, on nurse health. All of these scheduling practices were related to increased Use of findings to improve workplace safety and health: Based on these findings, preventive efforts should focus on adopting more healthful scheduling practices .Healthier schedules, including workdays less than 12 hours, limiting overtime hours, and reducing work on scheduled days off, would lower MSD risk, needlestick injuries and promote recovery from symptoms. This could allow nurses to remain in their jobs as they age, instead of having to leave jobs due to excessive demands combined with extended schedules. Health care sector implications: Because of the large sample, we were able to examine schedules among important subgroups of the nursing workforce, such as single parents. In addition, we collected new data on the occurrence of other adverse work-schedule factors, such as mandatory overtime, on-call hours, and working on a scheduled day off. Although schedule modifications may initially require additional nursing staff, retention of a stable and healthier workforce has been shown to reduce employer costs, while greatly benefiting nurses and patient care quality. Because there are few major studies in the emerging area of extended work hours and health among nurses, there was a need for more research into the specific schedule characteristics that might have an adverse effect on nurses' health.
Alison Trinkoff, RN, ScD, FAAN, University of Maryland School of Nursing, Baltimore, Maryland 21201-1579