NIOSH Training for Nurses on Shift Work and Long Work Hours

Researchers have proposed these guidelines for designing work schedules:^12-14

• Nurses will be better able to adjust to work times when they have some ability to control their schedules. Some nurses will select schedules that take their own physical and mental capacity for work into account, as well as their social and family demands. However, others will select schedules that put them at higher risk for fatigue. Therefore, you can use self-scheduling with guidelines or limits to prevent risky scheduling patterns.
• Because most people have difficulty adjusting to night work, experts recommend using permanent/fixed night shifts with caution. Researchers recommend permanent night workers maintain their night activity pattern on days off so their circadian system can adjust to being active at night and sleeping during the daytime. However, because of social interests, most revert to a daytime schedule when off, causing frequent reversals of the sleep/wake schedule, which is very difficult. If it is necessary to have permanent night-shift nurses, create measures to maintain patient safety during their first night back after several days off and during the period of 2 to 6 a.m.
• Keep consecutive night shifts to a minimum for rotating shifts.
• During the evening and night, shorter shifts (8 hours or less) are better tolerated than longer shifts.
• Long stretches of work days tend to build fatigue, particularly with extended work shifts (12 or more hours), so experts recommend avoiding several days of work followed by 4- to 7-day mini-vacations. Plan one or two full days of rest to follow five consecutive 8-hour shifts or four 10-hour shifts. Consider two rest days after three consecutive 12-hour shifts.