Working Hours, Sleep, & Fatigue Forum

Abstract for Healthcare & Social Assistance Sector

Work Hours and Fatigue in the Healthcare and Social Assistance Sector

The Healthcare and Social Assistance Sector (HCSA) is one of the fastest growing industrial sectors in the United States, with over 20 million workers. About 80% of these workers are women, and African American and Asian workers account for a higher percentage of this sector in comparison with other sectors. To provide their services around the clock, 28% of HCSA workers have shift work schedules and 17% work 48 or more hours a week. Twelve-hour shifts are common. HCSA workers also are exposed to many other hazards in the work environment, such as high physical, social, emotional, and cognitive demands (which they often have little control over); fast-paced work; hazardous chemicals and drugs; infectious agents; and workplace violence. HCSA workers often deal with very sick and dying patients and clients in difficult circumstances or with high needs. Compared to those in other sectors, HCSA workers have a significantly higher prevalence of job stress, depression/anxiety, burnout, substance abuse, and non-fatal injuries and illnesses. Sleep deficiency is common; 52% of healthcare workers on night shift report sleeping 6 hours or less per day. Sleeping less than 7 hours on a regular basis is associated with numerous adverse health and safety outcomes.

The research priorities needed to improve work hours, sleep, and fatigue issues in the HCSA sector include nine topics. 1) Develop better work schedule designs for HCSA operations. 2) Improve workplace culture, which historically has given little attention to the impact of shift work, long work hours, and fatigue on worker safety and health. 3) Promote leaders’ application of appropriate evidence-based practices to operations. 4) Promote education/training for all workers and leaders on current scientific evidence to reduce the risks. 5) Further develop countermeasures for fatigue and also implementation strategies that are acceptable to workers and leaders and smoothly maintain healthcare operations. 6) Develop strategies to reduce risks of drowsy driving. 7) Develop methods to test fitness for duty that are easily applied in the work setting. 8) Develop technologies to reduce workload and fatigue. 9) Identify and develop strategies for individual differences that make some more vulnerable to risks associated with shift work and long work hours. Research on these topics will benefit workers, their patients, their employers, and society. Given the insufficient numbers of workers in HCSA, society will benefit from this research because its findings likely will lead to workplace improvements. In turn, these will attract highly skilled HCSA workers in sufficient numbers to meet the growing health care service needs of the aging population and the 60% of the U.S. population with chronic illnesses.

Key Messages

  1. Of all HCSA workers, 28% have shift work schedules and 17% work 48 or more hours a week to provide their vital services around the clock.
  2. Compared to other sectors, HCSA has a significantly higher prevalence of fatigue, job stress, depression/anxiety, burnout, substance abuse, and non-fatal injuries and illnesses.
  3. Sleep deficiency is common; 52% of healthcare workers on night shift report sleeping 6 hours or less per day. Sleeping less than 7 hours on a regular basis is associated with numerous adverse health and safety outcomes.
  4. The highest research priorities are developing better designs for the work schedules and improving the culture, which historically has not given attention to the impact of shift work, long work hours, and fatigue on workers’ safety and health. Additional research priorities are identified to improve work hours, sleep, and fatigue issues in the HCSA sector.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

Page last reviewed: May 22, 2019