NIOSH Training for Nurses on Shift Work and Long Work Hours

Periodic Assessments

Implementing Improved Work Schedules and Periodic Assessments

• Periodic, systematic assessments can examine the influence of work schedules on factors (on and off the job) such as:
  • performance
  • alertness
  • sleep
  • unintentional injury
  • worker errors and near misses
  • illnesses
  • work/family conflict
• An anonymous, no-blame reporting system can collect information from nurses on their incidents and near misses: the time of the incident, shift details (start time, number of hours into the shift when incident occurred), number of prior consecutive work shifts and time of those shifts, number of hours awake before the incident, number of hours of sleep in each of the previous three days, and normal or unusual circumstances such as overtime because of weather emergency.⁵ Analyses of several incident reports may reveal organizational factors that you can modify to reduce risks.
• For incident investigations, include fatigue-related factors to determine if it was a causal factor: include information about the worker, the work schedule, and any medical conditions or medications. See Lerman and colleagues for two checklists and discussion about the types of data to consider collecting.⁵
• After learning more about designing work schedules, you may start thinking about making modifications to schedules on your unit. Researchers strongly recommend involving workers in any change in scheduling. When planning a schedule change, it is helpful to look at factors both on and off the job to assess whether the new schedule is better. Before and after a schedule change, you can survey nurses to examine how the new schedule is affecting the issues listed above.
• Scientists with expertise in measuring the effect of work schedule changes can be consulted to evaluate the effect of schedule modifications. Scientists with this expertise may come from several disciplines including occupational medicine, nursing, psychology, industrial hygiene, and epidemiology.