Shift work - tips and treasures!
Common terms used in shift work
Rotating shifts - Working a pattern of days and nights, this refers to the speed and direction which workers change shifts. Shifts can be forward (from morning to afternoon to night shifts) or backwards rotating (the reverse of forward).
Rotation can be fast; for example changing from early to late shifts every day or so, or doing a week of ‘earlies’ then a week of ‘lates’.
Night shifts - Typically starts anywhere between 8pm and 10pm and runs for 10-12 hours.
Split shifts - This involves the shift being split into two parts; for example, a worker may work the first part of the shift between 6am-10am and the latter part between 4pm-8pm.
12 hour shifts - 12-hour shifts are worked instead of the more traditional eight hour shift arrangement.
‘Earlies’ or morning shift - Typically a 7am-3pm or 8am-4pm shift.
‘Lates’ or evening shift - Typically 2pm-10pm, but in part time work can be 5pm-9pm.
Continental shift - This is a continuous three-shift system that rotates rapidly; for example three mornings, then two afternoons, then two nights.
Three-shift system - The day is divided into three working periods – morning, afternoon and night. This kind of shift work can involve a week of mornings followed by a week on evenings and a week on nights.
Double days/two shift - This is normally two shifts of eight hours each; for example 6am-2pm and 2pm-10pm. Shifts are usually alternated weekly or over longer intervals.
(Direct extraction from ‘A shift in the right direction’ (Royal College of Nursing, 2012)
Below has been extracted from the District Health Boards/NZNO Nursing and Midwifery Multi-Employer Collective Agreement 2012-2015 (New Zealand Nurses Organisation, 2012):
Section 6.0 specifies Agreement on Hours of Work and Section 7.0 on Meal Breaks and Rest Periods.
In particular sub-section 6.6 includes Roster Pattern Divisors (page 12)
The following rosters or combination of rosters will apply during the term of this Agreement:
- 5 days on duty followed by 2 days off duty - 2086 hours p.a. (i.e.: shift length 8 hours)
- 4 days on duty followed by 4 days off duty - 1460 hours p.a. (i.e.: shift length 8 hours)
- 4 days on duty followed by 3 days off duty - 2086 hours p.a. (i.e.: shift length 10 hours)
- 4 days on duty followed by 2 days off duty - 2086 hours pa. (i.e.: shift length 8 hours and 35 minutes) or 1947 hours p.a.(shift length 8 hours)
- 2 days on duty followed by 2 days off duty – 2190 hours p.a.
A part time employee may work within the rosters described above.
Health and Shift Work
Our circadian rhythm naturally tells us to sleep at night. Doing shift work means we need to train our body and mind to perform otherwise. Late sleepers generally find it easier to adapt to night shift and rotating shift compare to early sleepers (Royal College of Nursing, 2012). Nevertheless, sleep deprivation still can be a real issue for many shift workers, no matter if it’s a acute or cumulative issue. The effect of staying awake for 17 hours or more appears similar to be over the drink driving limit in most European countries.
A NZ study conducted by NZNO looked at Nurses over age 50 years old and found that although majority felt shift work has a negative impact on their health, 72.2% have no intention to change their shift working patterns (Clendon & Walker, 2012). Some were able to balance the negatives with the positives of the shift work for their individual circumstances. Interestingly, the perception of their health status was similar to those working regular hours.
Fatigue has been a hot topic in relation to shiftwork; aside from dangerous driving, in healthcare settings, fatigue could potentially lead to medical errors. An Australian article wondered if full-time working nurses with family responsibilities were more susceptible to fatigue, and they found being part of a family structure may actually be protective against the development of maladaptive fatigue (Winwood, Winefield, & Lushington, 2006). They also found the youngest group in their study had the highest fatigue and poorest recovery compared to the oldest group, however this may be due to the young nurses taking up more multiple shift patterns including night duty.
In terms of physical health, overweight and obesity may have a link to shift work from a study conducted among NZ, Australian and UK female nurses and midwives; however, the causal effect still needs to be explored (Zhao, Bogossian, Song, & Turner, 2011).
What might help you to cope
There are many practical guides out there to help people cope with shift work, focusing on balancing diet, activities and sleep. UK Royal College of Nursing (2012)’s publication ‘A shift in the right direction’ has provided some great tips that may help people cope with shift work. Some sleep hygiene strategies include: turning off phones, sleeping in a dark and quiet room or use an eye mask or ear plugs or white music, develop a bedtime ritual such as taking a bath, eat a light meal to avoid hunger. Other ways to cope with night shift include: sleeping extra before the first night shift, healthy snacks or lunch during the shift, and a power nap of 20-45 minutes if possible (please seek your local policy and manager or supervisor’s approval prior to doing this!).
The following table has been extracted from the same publication mentioned above regarding “Sleep dos and don’ts” on page 18:
- Keep your bedroom as cool as possible – people sleep better in cooler environments (around 18 degrees C).
- Develop a bedtime ritual that you follow before you got to sleep - relax with a book, listen to music or take a bath. This can help serve as a signal that your body is ready for sleep.
- Eat a light meal before going to bed to avoid hunger.
- Regular exercise during the day helps sleep patterns but try to avoid exercise about three hours before bedtime.
- Keep the bedroom dark – use an eye mask, blackout blinds or heavy curtains (or even a thick blanket) on your bedroom window. Even if you don’t work nights it can get very bright in the early mornings during daylight saving period.
- Keep the bedroom quiet – use ear plugs if necessary.
- Write a ‘to do’ list before you go into the bedroom so you don’t lie awake worrying that you will forget important things the next day (a pen and paper by the bed can also help).
- Use a relaxation tape to help you sleep.
- Invest in a good mattress or at least some decent pillows – seek manufacturer’s advice on the best type of pillow for you and your usual sleeping position.
- Avoid stressful or stimulating activity before you go to bed.
- Avoid alcohol or nicotine in the hour or two before sleep. Alcohol might make you feel sleepy, but it will wake you up too quickly after falling asleep. Nicotine is a stimulant and may affect the time it takes you to get to sleep. Don't drink caffeine for up to four hours before going to bed.
- Avoid a heavy or fatty meal before bedtime as they are harder to digest.
- Avoid watching TV, video games, studying, playing or working on a computer in the bedroom. If you can’t avoid this as you live in a bed sit or shared accommodation – think about having distinct areas in your room such as a desk which you can close off and a cupboard to store study material.
- Don’t use another person’s sleeping pills.
- Don’t try and force yourself to sleep – sleep is a passive process. If you can’t sleep, after 30 minutes in bed get up and do something to distract yourself.
- Avoid falling to sleep on the sofa.
- Avoid clock watching – watching the clock can increase anxiety about length of sleep. Set your alarm if necessary and turn your clock away from your sight line.
- Avoid difficult conversations with loved ones or confrontational discussions before bedtime wherever possible.
(Royal College of Nursing, 2012)
Every shift worker eventually develops their own routine and strategies to help them sleep and relax. Here are some YouTube videos suggesting ways that might help you sleep. They are American instead of Kiwi-made videos. http://www.youtube.com/watch?v=zf4_grBxPnE and http://www.youtube.com/watch?v=O8GgyiTTgqM non-Nurse specific http://www.youtube.com/watch?v=lsDbEdMG8-Q&list=PL1E18364674A7A64F&index=7
Eating is very important for our bodies to cope with the stress of shift work. As we recommend our client/patient to have a healthy life style, it is a good idea to remind ourselves how to live with it. http://www.youtube.com/watch?v=maPkwzmQ8XY
In terms of social life, described as “social rhythm” in some studies, are important in promoting psychosocial wellbeing of the shift worker (Royal College of Nursing, 2012). Proactive in planning your calendar, and reserve credit for swapping shifts, e.g. try not to turn down people when they ask to swap shift with you, are some personal suggestions from your fellow young nurse here. Also you get to enjoy the leisure of avoiding peak hour traffic and enjoy a movie when the cinema isn’t so packed.