Working time characteristics and long-term sickness absence among Danish and Finnish nurses: A register-based study

Simulated quick returns in a laboratory context and effects on sleep and pre-sleep arousal between shifts: a crossover controlled trial

This trial presents a laboratory model investigating the effect of quick returns (QRs, <11 h time off between shifts) on sleep and pre-sleep arousal. Using a crossover design, 63 participants worked a simulated QR condition (8 h time off between consecutive evening- and day shifts) and a day-day (DD) condition (16 h time off between consecutive day shifts). Participants slept at home and sleep was measured using a sleep diary and sleep radar. Compared to the DD condition, the QR condition reduced subjective and objective total sleep time by approximately one hour (both p < .001), reduced time in light- (p < .001), deep- (p = .004), rapid eye movement (REM, p < .001), percentage of REM sleep (p = .023), and subjective sleep quality (p < .001). Remaining sleep parameters and subjective pre-sleep arousal showed no differences between conditions. Results corroborate previous field studies, validating the QR model and indicating causal effects of short rest between shifts on common sleep parameters and sleep architecture.

Evaluating quick return restrictions on sickness absence in healthcare employees: A difference-in-differences study

BACKGROUND

Short intervals between shifts, known as quick returns, have been linked to adverse health effects, and increased risk of occupational accidents, particularly among healthcare employees. To safeguard employee health, the 2020 reform of Working Time Act in Finland limited rest periods under 11 h in irregular shift work.

OBJECTIVE

To evaluate the changes in quick returns following the 2020 reform of the Working Time Act in Finland and their association with sickness absence among public healthcare employees.

DESIGN AND METHODS

This observational longitudinal study, analysed as a quasi-experiment used a difference-in-differences regression analysis with unit and time fixed effects and robust standard errors. We assessed changes in sickness absence from 2019 to 2021 across hospital work units. The study compared units mandated to limit quick returns (Treatment group; 416 units, over 20,500 employees, 72 % in nursing) with units that had low levels of quick returns prior the reform and did not need to limit quick returns (Control group; 37 units, over 1700 employees, 70 % in nursing). The analysis considered local agreements permitting quick returns, using both intention-to-treat and per-protocol approaches. Sensitivity analysis included regression models with unit level covariates and inverse probability weighting to adjust for initial differences.

RESULTS

The per-protocol approach and simple regression analysis with fixed effects for unit and time over 2019-2020 showed a less pronounced increase in sickness absence by -0.7 percentage points (95 % confidence interval [CI]: -1.3 to -0.1) for the treatment group compared to the control group, indicating a 13 % lower rate of sickness absence. For the period 2019-2021, the estimate was -0.5 percentage points (95 % CI: -1.0 to 0.0). When incorporating covariates and inverse probability weighting, the estimates were more substantial with narrower confidence intervals: -0.9 percentage points (95 % CI: -1.4 to -0.3) for 2019-2020, and - 0.6 percentage points (95 % CI: -1.2 to -0.1) for 2019-2021. The estimates from the intention-to-treat approach were consistent with the per-protocol results.

CONCLUSION

The Working Time Act reform reduced quick returns, and after the reform, the reduction was associated with a smaller increase in sickness absence among healthcare employees. Policymakers and nursing managers should evaluate and adjust the frequency of quick returns to achieve the potential effects on employee well-being, health, and operational efficiency, which in this study was indicated by the reduction in sickness absence.

Organisational-level risk and health-promoting factors within the healthcare sector-a systematic search and review

Introduction

The healthcare sector is globally experiencing increasing demands and workplace interventions on an organisational level is sought to create healthy workplaces. The aim of this study was to provide an overview of Nordic research on the work environment and health of healthcare professionals, with a focus on identifying organisational-level risk and health-promoting factors.

Methods

This systematic search and review was based on an analysis of studies published in peer-reviewed journals between 1 January 2016 and 3 January 2023. The selected studies investigate the relationships between organisational-level risk and health-promoting factors and measures of health and well-being among healthcare professionals during ordinary operations. To increase applicability, this systematic search and review was limited to the Nordic countries as they share the same context with a publicly-funded widely accessible healthcare system. A total of 2,677 articles were initially identified, with 95 original studies meeting the criteria for relevance and quality.

Results

Identified organisational risk and health-promoting factors were categorised into five categories: work schedule distribution, operations design and work methods, ergonomic conditions, working conditions and personnel policies, and the organisation's ethical environment. In addition, two themes across the categories emerged, providing further insight into the implications for practice. The first theme emphasises risk and health-promoting factors in the actions that employers take to fulfil the organisation's goals. The second theme emphasises risk and health-promoting factors in connection with the ability of employees to do their jobs at a level of quality they deem acceptable.

Conclusion

Several organisational-level risk and health-promoting factors were identified, and the results indicate that the actions that employers take to fulfil the health-care organisation's goals and promote the ability of employees to provide high-quality care are important for the health and wellbeing of healthcare employees.

Artificial Intelligence in Nursing: Technological Benefits to Nurse's Mental Health and Patient Care Quality

Nurses are frontline caregivers who handle heavy workloads and high-stakes activities. They face several mental health issues, including stress, burnout, anxiety, and depression. The welfare of nurses and the standard of patient treatment depends on resolving this problem. Artificial intelligence is revolutionising healthcare, and its integration provides many possibilities in addressing these concerns. This review examines literature published over the past 40 years, concentrating on AI integration in nursing for mental health support, improved patient care, and ethical issues. Using databases such as PubMed and Google Scholar, a thorough search was conducted with Boolean operators, narrowing results for relevance. Critically examined were publications on artificial intelligence applications in patient care ethics, mental health, and nursing and mental health. The literature examination revealed that, by automating repetitive chores and improving workload management, artificial intelligence (AI) can relieve mental health challenges faced by nurses and improve patient care. Practical implications highlight the requirement of using rigorous implementation strategies that address ethical issues, data privacy, and human-centred decision-making. All changes must direct the integration of artificial intelligence in nursing to guarantee its sustained and significant influence on healthcare.

Contextualising the job demands-resources model: a cross-sectional study of the psychosocial work environment across different healthcare professions

BACKGROUND

The deteriorating psychosocial work environment among healthcare workers in Sweden, influenced by demanding working conditions and resource constraints, affects individual well-being and patient care quality. Healthcare workers, including physicians, registered nurses, and nursing assistants, often work interdependently and share workplaces, yet are three completely different professions. Nonetheless, comprehensive studies comparing their psychosocial work environments are scarce; often focusing on healthcare workers either separately or as a homogenous group, but rarely comparative.

AIM

Utilising the job demands-resources model, this study investigated variations in the psychosocial work environment among Swedish healthcare workers. We wanted to identify how the antecedents of individual well-being, in the form of demands and resources, differed between healthcare workers.

METHOD

Data from the 2022 Longitudinal Occupational Health Survey for Health Care in Sweden were analysed; the participants included 7589 physicians, registered nurses, and nursing assistants. The analysis involved descriptive statistics, including measures of means and analysis of covariance (ANCOVA), employing the Bonferroni correction for multiple post hoc comparisons. The ANCOVA was also stratified by working factors, including years of work experience and employment within the private/public sector.

RESULTS

The study revealed significant variations in how healthcare workers perceive their psychosocial work environment. Physicians faced the highest level of Quantitative Demands (mean (x̄) 3.15; 95% CI 3.11-3.19), while registered nurses reported the most Emotional Demands (x̄ 3.37; 95% CI 3.32-3.41). Nursing assistants had the highest grand means for the imbalance between Efforts and Rewards (Effort Reward Imbalance) (x̄ 1.49; 95% CI 1.49-1.49) and an imbalance between Work and Private Life (Work-Life Interference) (x̄ 3.20, 95% CI 3.15-3.25), along with limited resources. The stratified analysis showed that years of experience and the sector affected healthcare workers' perceptions of their psychosocial working environment. For example, registered nurses working in the private sector reported better working conditions than registered nurses working in the public sector. The situation for nursing assistants was reversed.

CONCLUSION

Psychosocial work environments are experienced differently between and within healthcare professions in Sweden. This study provides crucial insights for improving workplace conditions and consequently enhancing healthcare professionals' well-being and quality of patient care.

Concurrent Trajectories of Objectively Measured Insufficient Recovery and Workload Among a Cohort of Shift Working Hospital Employees: Quantitative Empirical Research

AIM

To investigate concurrent changes in short shift intervals (< 11 h) and workload among hospital employees.

DESIGN AND DATA SOURCES

This cohort study of 1904 employees in one hospital district in Finland utilised data on employees' working hours for short shift intervals and workload based on the patient classifications aggregated to a 3-week period level across 2 years, 2018-2019. The data was analysed by group-based trajectory modelling and multinominal regression models.

RESULTS

The seven trajectories model had the best fit to the data-Group 1: very few short shift intervals that are decreasing and low workload (15.0%); Group 2: a low amount of short shift intervals that are decreasing and stable low workload (14.2%); Group 3: moderate amount of short shift intervals that are slightly increasing and low workload (25.1%); Group 4: a low amount of short shift intervals that are slightly decreasing and stable low workload that is slightly increasing (12.1%): Group 5: a moderate amount of both short shift intervals and workload (19.8%): Group 6: short shift intervals that are clearly decreasing, with higher than the average workload decreasing (5.6%); Group 7: moderate amount of short shift intervals and very high workload (8.3%).

CONCLUSIONS

Only a minority of hospital employees were found to have both high workloads and insufficient recovery possibilities, but the time-related increases in objective workload were not compensated by better recovery possibilities in working hours. For shift scheduling, it is noteworthy that older employees might seek to work at units in which the workload is lower, which could be considered to support workability.

REPORTING METHOD

Record.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Effects of a work schedule with abated quick returns on insomnia, sleepiness, and work-related fatigue: results from a large-scale cluster randomized controlled trial

STUDY OBJECTIVES

To investigate the effect of a work schedule with abated quick returns (i.e. > 11 hours between two shifts) on insomnia, daytime sleepiness, and work-related fatigue compared to a shift schedule maintaining the usual number of quick returns.

METHODS

A two-armed cluster randomized controlled trial including 66 units was conducted at a university hospital in Norway. Units with healthcare workers on rotating shift schedules were randomly assigned to a shift schedule with abated quick returns (intervention) or to continue with a schedule including quick returns as usual (control) for 6 months. Questionnaires assessed symptoms of insomnia (Bergen Insomnia Scale [BIS]), daytime sleepiness (Epworth Sleepiness Scale [ESS]), and work-related fatigue (Revised Swedish Occupational Fatigue Inventory) at baseline and towards the end of the intervention. Data were analyzed using multilevel linear mixed-effects models, and Cohen's d was used to calculate the effect size between groups.

RESULTS

Overall, 1314 healthcare workers (85.2% female) completed the baseline questionnaire (response rate 49.1%), and 552 completed the follow-up questionnaire. The intervention reduced quick returns from an average of 13.2 (SD = 8.7) to 6.7 (SD = 6.0), while the control group's average remained relatively unchanged from 13.2 (SD = 8.7) to 12.0 (SD = 9.3). Results showed a small improvement in symptoms of insomnia (BIS; d = -0.13, p = .022) and daytime sleepiness (ESS; d = -0.14, p = .013) in favor of the intervention. No effects were observed on work-related fatigue.

CONCLUSIONS

Reducing the number of quick returns in the work schedule resulted in improvements in insomnia and daytime sleepiness. The findings highlight the importance of sufficient daily rest time in the work schedule of healthcare workers.

CLINICAL TRIAL

Health Promoting Work Schedules: The Effect of Abolishing Quick Returns (HeWoS); clinicaltrials.gov/ct2/show/NCT04693182; Registered at ClinicalTrials.gov with the identifier NCT04693182.

Dual trajectories of short-term and long-term sickness absence and their social- and health-related determinants among women in the public sector

BACKGROUND

Short- and long-term sickness absence (SA) vary in their determinants. We examined short- and long-term SA contemporaneously as two interconnected phenomena to characterize their temporal development, and to identify employees with increasing SA at an early stage.

METHODS

We extracted 46- to 55-year-old employed women from the Helsinki Health Study occupational cohort during 2000-17 (N = 3206) and examined the development of short- (1-14 days) and long-term (>14 days) SA using group-based dual trajectory modelling. In addition, we investigated the associations of social-, work- and health-related factors with trajectory group membership.

RESULTS

For short-term SA, we selected a three-group solution: 'no short-term SA' (50%), 'low frequency short-term SA' (40%), and 'high frequency short-term SA' (10%) (7 spells/year). For long-term SA, we also selected three trajectory groups: 'no long-term SA' (65%), 'low long-term SA' (27%), and 'high long-term SA' (8%). No SA in the short-term SA model, indicated a high probability of no SA in the long-term model and vice versa. The developmental pattern was far less certain if participant was assigned to a trajectory of high SA in either one of the models (short- or long-term SA model). Low occupational class and poor health behaviours were associated with the trajectory groups with more SA.

CONCLUSION

SA does not increase with age among most employees. If either SA rate was high, the developmental patterns were heterogenous. Employers' attention to health behaviours might aid in reducing both short- and long-term SA.

Working Hours Associated with the Quality of Nursing Care, Missed Nursing Care, and Nursing Practice Environment in China: A Multicenter Cross-Sectional Study

Aim

The aim of the study was to examine the effect of the length of working hours on missed nursing care, quality of nursing care, and perceptions of the nursing practice environment.

Methods

A multicenter cross-sectional investigation using online questionnaires was conducted from April 2 to May 10, 2022, in twenty nine hospitals (13 Level-III hospitals and 16 Level-II hospitals). We collected data on the working hours of nurses and nurse-reported outcomes, including missed nursing care, quality of nursing care, and nursing practice environment. Restricted cubic spline (RCS) regression models were used to examine relationships between the hours per shift and nurse-reported outcomes.

Results

We investigated 12,703 nurses with a response rate of 97.33%. Nurses worked on average 7.72 (SD = 1.16) hours on the day shift and 8.92 (SD = 2.20) hours on the night shift, respectively. On the day shift, working 7.5 hours shift showed minimal missed nursing care; meanwhile, working 7-7.5 hours were correlated with the highest satisfaction of the nursing practice environment and better quality of nursing care. On the night shift, the highest missed nursing care was found for a working duration of 12 hours to the working 7 hours, with the lowest satisfaction while better quality was observed. The percentage of nurses who reported working overtime was 30.33%. Nurses who worked overtime reported lower satisfaction and poorer quality of nursing care on all shifts; moreover, working overtime showed the positive correlation to missed nursing care on the day shift, while on night shift was not statistically significant.

Conclusion

Positive outcomes were observed for nurses who reported working 7-7.75 hours on the day shift and 12 hours (no more than 15 hours) on the night shift. Implications of Nursing Management. The results reemphasized the need for managers to reduce the working hours, overtime work, and the frequency of the night shift.

Long-term sickness absence trajectories among ageing municipal employees - the contribution of social and health-related factors

BACKGROUND

The ageing work force is heterogeneous, following distinct development in work ability. This study aims to identify trajectories of long-term sickness absence (SA) in later careers and to examine potentially modifiable factors associated with the development of SA.

METHODS

Data comprised of municipal employees of the city of Helsinki aged 50-60 years during 2004-2018 (N = 4729, 80% women). The developmental trajectories of long-term (> 10 working days) SA were examined with Group-based trajectory modelling (GBTM) using SA records of the Social Insurance Institution of Finland during 2004-2018. All-cause and diagnosis-specific (mental disorder- and musculoskeletal disease-related) SA days were analysed. The association of social and health-related factors with trajectory membership was examined using multinomial logistic regression (odds ratios and 95% confidence intervals).

RESULTS

A model with three trajectories was selected for both all-cause and diagnosis-specific SA. Regarding all-cause long-term SA trajectories, 42% had no long-term SA, 46% had low levels of SA, and 12% had a high rate of SA during follow-up. Lower occupational class, reporting smoking, overweight or obesity, moderate or low leisure-time physical activity, and sleep problems were associated with a higher likelihood of belonging to the trajectory with a high rate of SA in both all-cause and diagnosis-specific models.

CONCLUSIONS

Most ageing employees have no or little long-term SA. Modifiable factors associated with trajectories with more SA could be targeted when designing and timing interventions in occupational healthcare.

Identifying labour market pathways after a 30-day-long sickness absence -a three-year sequence analysis study in Finland

BACKGROUND

Return-to-work (RTW) process often includes many phases. Still, multi-state analyses that follow relevant labour market states after a long-term sickness absence (LTSA), and include a comprehensive set of covariates, are scarce. The goal of this study was to follow employment, unemployment, sickness absence, rehabilitation, and disability pension spells using sequence analysis among all-cause LTSA absentees.

METHODS

Register data covered full-time and partial sickness allowance, rehabilitation, employment, unemployment benefits, and permanent and temporary disability pension (DP), retrieved for a 30% representative random sample of Finnish 18-59 years old persons with a LTSA in 2016 (N = 25,194). LTSA was defined as a ≥ 30-day-long full-time sickness absence spell. Eight mutually exclusive states were constructed for each person and for 36 months after the LTSA. Sequence analysis and clustering were used to identify groups with different labour market pathways. In addition, demographic, socioeconomic, and disability-related covariates of these clusters were examined using multinomial regressions.

RESULTS

We identified five clusters with emphases on the different states: (1) rapid RTW cluster (62% of the sample); (2) rapid unemployment cluster (9%); (3) DP after a prolonged sickness absence cluster (11%); (4) immediate or late rehabilitation cluster (6%); (5) other states cluster (6%). Persons with a rapid RTW (cluster 1) had a more advantaged background than other clusters, such as a higher frequency of employment and less chronic diseases before LTSA. Cluster 2 associated especially with pre-LTSA unemployment and lower pre-LTSA earnings. Cluster 3 was associated especially with having a chronic illness before LTSA. Those in cluster 4 were on average younger and had a higher educational level than others. Especially clusters 3 and 4 were associated with a LTSA based on mental disorders.

CONCLUSIONS

Among long-term sickness absentees, clear groups can be identified with both differing labour market pathways after LTSA and differing backgrounds. Lower socioeconomic background, pre-LTSA chronic diseases and LTSA caused by mental disorders increase the likelihood for pathways dominated by long-term unemployment, disability pensioning and rehabilitation rather than rapid RTW. LTSA based on a mental disorder can especially increase the likelihood for entering rehabilitation or disability pension.

Nurses' Short-Term Sickness Absences Before and After the Implementation of a Brief Napping Opportunity During Night Shifts

BACKGROUND

Nurses who work at night have used naps to alleviate their sleepiness and fatigue. Research has shown night shifts, sleepiness, and fatigue predict nurses' missed workdays. Thus, nighttime napping may have a beneficial consequence of reducing nurses' sickness absences. The purpose of this brief report was to describe the difference in rates of short-term sickness absence before and after implementation of a 30-min nap opportunity in one U.S. hospital for 12-hr shift nurses.

METHODS

The study was a retrospective pre-post evaluation design. Eight units provided nap opportunities for the nurses. Full-time nurses were classified into night and rotating shifts based on their 2 years of scheduling patterns. Absence data were extracted from the hospital's timekeeping system and annual absence rates were computed. A single linear mixed model with rank transformed data was conducted for each group. Median estimates, minimum and maximum, and p-values were reported.

FINDINGS

The median absence rates for night shift nurses were 4.3% and 4.0% for the pre-napping and post-napping implementation periods, respectively; however, this difference was not statistically significant (p = .241). The median absence rates for rotating shift nurses were 2.0% and 3.9% for the pre-napping and post-napping implementation periods, respectively; and the difference increase was statistically significant (p < .001).

CONCLUSION/APPLICATION TO PRACTICE

A nap policy which provides nurses with the opportunity to take nighttime naps did not benefit their sickness absence rates. Future research needs to examine the actual napping process on sickness absences, as well as explore other sickness management avenues.

Sickness absence among employees of healthcare organizations in the public sector in Mongolia: A cross-sectional study

OBJECTIVES

This study aimed to understand the rate of sickness absence (SA) among employees of public healthcare organizations in Mongolia, to identify factors associated with long-term SA, and to estimate costs due to SA.

METHODS

This cross-sectional study included employees of public healthcare organizations who had certified SA from 2016 to 2018. Sociodemographic and occupational characteristics of absentees and the data on absences were collected. A logistic regression analysis was performed to identify factors associated with long-term SA (≥15 days) among employees who had SA. Absence parameters and the average costs due to SA were calculated and the total cost due to SA at all public healthcare organizations was estimated.

RESULTS

From 2016 to 2018, there were 13 653 absentees and 21 043 SA, and the absence rate was 0.9%. The average absence length per absence and absentee were 9.63 days and 14.85 days, respectively. Factors associated with long-term SA were age ≥40 years, 10-19 years in employment, working at the second and tertiary levels, and night shift. The average cost per absentee was 295.5 USD, and the estimated total cost for all health organizations was 1 796 993 USD per year.

CONCLUSIONS

The absence rate was 0.9% and older age, longer work experience, higher organizational level, and night shift were associated with taking a long-term SA. To reduce the costs of absenteeism and promote the health of employees in healthcare organizations, policymakers should review the policies related to SA and develop national guidelines on SA for employers, healthcare managers, and employees.

Sequence analysis of the combinations of work shifts and absences in health care - comparison of two years of administrative data

BACKGROUND

In health care, the shift work is arranged as irregular work shifts to provide operational hours for 24/7 care. We aimed to investigate working hour trends and turnover in health care via identification of time-related sequences of work shifts and absences among health care employees. The transitions between the work shifts (i.e., morning, day, evening, and night shifts), and absences (days off and other leaves) over time were analyzed and the predictors of change in irregular shift work were quantified.

METHODS

A longitudinal cohort study was conducted using employer-owned payroll-based register data of objective and day-to-day working hours and absences of one hospital district in Finland from 2014 to 2019 (n = 4931 employees). The working hour data included start and end of work shifts, any kind of absence from work (days off, sickness absence, parental leave), and employee's age, and sex. Daily work shifts and absences in 2014 and 2019 were used in sequence analysis. Generalized linear model was used to estimate how each identified sequence cluster was associated with sex and age.

RESULTS

We identified four sequence clusters: "Morning" (60% in 2014 and 56% in 2019), "Varying shift types" (22% both in 2014 and 2019), "Employee turnover" (13% in 2014 and 3% in 2019), and "Unstable employment (5% in 2014 and 19% in 2019). The analysis of transitions from one cluster to another between 2014 and 2019 indicated that most employees stayed in the same clusters, and most often in the "Varying shift types" (60%) and "Morning" (72%) clusters. The majority of those who moved, moved to the cluster "Morning" in 2019 from "Employee turnover" (43%), "Unstable employment" (46%) or "Varying shift types" (21%). Women were more often than men in the clusters "Employee turnover" and "Unstable employment", whereas older employees were more often in "Morning" and less often in the other cluster groups.

CONCLUSION

Four clusters with different combinations of work shifts and absences were identified. The transition rates between work shifts and absences with five years in between indicated that most employees stayed in the same clusters. The likelihood of a working hour pattern characterized by "Morning" seems to increase with age.

Utilizing a Nordic Crosswalk for Occupational Coding in an Analysis on Occupation-Specific Prolonged Sickness Absence among 7 Million Employees in Denmark, Finland, Norway and Sweden

We identified occupations with a high incidence of prolonged sickness absence (SA) in Nordic employees and explored similarities and differences between the countries. Utilizing data from national registers on 25-59-year-old wage-earners from Denmark, Finland, Norway and Sweden, we estimated the gender- and occupation-specific age-adjusted cumulative incidence of SA due to any cause, musculoskeletal diseases and mental disorders. To increase the comparability of occupations between the countries, we developed a Nordic crosswalk for occupational codes. We ranked occupational groups with the incidence of SA being statistically significantly higher than the population average of the country in question and calculated excess fractions with the employee population being the reference group. We observed considerable occupational differences in SA within and between the countries. Few occupational groups had a high incidence in all countries, particularly for mental disorders among men. In each country, manual occupations typically had a high incidence of SA due to any cause and musculoskeletal diseases, while service occupations had a high incidence due to mental disorders. Preventive measures targeted at specific occupational groups have a high potential to reduce work disability, especially due to musculoskeletal diseases. Particularly groups with excess SA in all Nordic countries could be at focus.

Working Time Control and Variability in Europe Revisited: Correlations with Health, Sleep, and Well-Being

Working time control (WTC) and working time variability (WTV) are two important dimensions of working times, especially with regard to the dynamics of irregular working hours in a changing world of work. Both dimensions are closely related, and the terms are sometimes used synonymously. However, a high degree of WTC does not automatically lead to variable or irregular working hours. On the contrary, WTV is often imposed by the employer and does not necessarily occur in conjunction with high WTC. This article gives an overview of different European WTC and WTV regimes using a typological approach. Based on the European Working Conditions Survey 2015 (EWCS, n = 27,607), four employee groups are compared: those with (1) high WTC and high WTV, (2) high WTC and low WTV, (3) low WTC and high WTV, and (4) low WTC and low WTV. Firstly, the analyses aim to assess whether WTC and WTV vary across European countries due to different working time regimes and in different occupational sectors, i.e., hospitality, retail, and health and social work. Secondly, multi-level analyses are used to describe correlations with health (self-rated health, psychosomatic complaints), sleep (sleep problems), and well-being (WHO-5-Scale). The analyses suggest that WTC and WTV differ between European countries: in the northern countries, high WTC/high WTV is most prevalent, whereas low WTV/low WTC is more common in the other countries. As far as employee health and sleep are concerned, high WTV is associated with poor health, i.e., a greater number of psychosomatic health complaints, worse self-rated health status, and more sleep problems. However, the correlation appears to be weaker for psychosomatic health complaints when employees have high WTC. Significant correlations could not be found for WTC. Low WTC and high WTV is more common in occupational sectors in hospitality, retail, and health and social care; however, these occupational sectors show the same correlations regarding health, sleep, and well-being. The analyses indicate that it is crucial to consider WTV and WTC together in order to understand the dynamics of irregular working hours and health.

The Joint Association of Daily Rest Periods and Sleep Duration with Worker Health and Productivity: A Cross-Sectional Web Survey of Japanese Daytime Workers

A daily rest period (DRP) is a daily inter-work interval that contains sleep opportunity. This study investigates the joint association of DRP and sleep duration with worker health and productivity. A total of 13,306 Japanese daytime workers participated in this web-based cross-sectional survey. Participants reported on their DRPs and sleep duration; moreover, sleep difficulties, mental health, and presenteeism were assessed by the standardized questionnaires. The participants were divided into 10 groups based on their DRPs and sleep duration. Logistic regression analyses showed that the combination of quick return (QR: DRP of <11 h) and short sleep duration (<6 h) was found to be significantly associated with sleep difficulties (odds ratio [OR] = 4.45, 95% confidence interval [CI] = 2.83-7.01), poor mental health (OR = 3.04, 95% CI = 1.79-5.15), and presenteeism (OR = 2.35, 95% CI = 1.47-3.77) compared with the reference group (the combination of adequate DRP [15 h] and a normal sleep duration [≥6 h]). The combination of QR and normal sleep duration or adequate DRP and short sleep duration was significantly associated with high ORs for the outcomes. QR, short sleep duration, or both negatively affect worker health and productivity.

Night Work and Sustainable Working Life-A Prospective Trajectory Analysis of Swedish Twins

The aim was to investigate the changes in sustainable working life over 10-13 years of follow-up and the effect of baseline night work. Data from the Swedish national registers were used to define sustainable working life. Survey data in the 1998-2003 "SALT" with 34,680 twins or in the 2004-2006 "STAGE" with 19,637 twins were utilized to assess night work at baseline. Group-based trajectory and multinomial regression models were applied. The results of the SALT cohort yielded five trajectory solutions: stable sustainable working life (40%), stable lack of sustainable working life (25%), later decreasingly sustainable working life (15%), increasingly sustainable working life (14%), and early decreasingly sustainable working life (7%). In the STAGE cohort, four trajectories were detected: stable sustainable working life (83%), decreasingly sustainable working life (7%), stable lack of sustainable working life (5%), and increasing sustainable working life (5%). Night work was associated with the decreasing or increasing sustainable working life in the trajectory groups. To conclude, the largest parts of both cohorts followed trajectories of stable sustainable working lives. Night work was associated with both the trajectories of decreasing and increasing sustainable working lives.

Protocol for a systematic review and meta-analysis on the associations between shift work and sickness absence

BACKGROUND

Shift work, i.e., non-standard work hours, has been associated with both short- and long-term sickness absence. However, findings are inconsistent and inconclusive. Thus far, no comprehensive meta-analytic synthesis on the relationship between shift work and sickness absence has been published. The aims of the planned systematic review and meta-analysis are (1) to establish whether shift work is associated with sickness absence, (2) to determine if specific shift work characteristics relate to sickness absence (e.g., length and frequency of spells), and (3) to identify moderating factors affecting the relationship between shift work and sickness absence.

METHODS

Eligible studies will be identified using a predefined search strategy in several electronic databases (MEDLINE, Web of Science, PsychInfo, EMBASE, and ProQuest) and comprise peer-reviewed papers reporting original empirical findings on the association between shift work and sickness absence. Mainly observational studies with cross-sectional, prospective, or retrospective research design and case-control studies will be included. Risk of bias will be assessed using an adapted checklist previously employed to evaluate studies on sickness absence. To carry out the meta-analytic synthesis, a random effects meta-analysis will be conducted using the Comprehensive Meta-Analysis software. The review and meta-analysis will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Heterogeneity will be evaluated by Cochran's Q test and the I² statistics.

DISCUSSION

The review and meta-analysis will be the first to conduct a meta-analytic synthesis of the evidence on the association between exposure to shift work and sickness absence, as well as identify relevant moderators affecting the relationship between shift work and sickness absence. Aggregation of the existing evidence will improve the knowledge on the association between shift work and sickness absence. Such knowledge can be used to guide scheduling of shift work to promote work schedules that are less detrimental to health and contribute to reduced sickness absence and higher work- and leisure-time productivity.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022301200.

A Longitudinal Study on Trajectories of Night Work and Sickness Absence among Hospital Employees

This study aimed to investigate trajectories of night shift work in irregular shift work across a 12-year follow-up among hospital employees with and without sickness absence (SA). The payroll-based register data of one hospital district in Finland included objective working hours and SA from 2008 to 2019. The number of night shifts per year was used in group-based trajectory modeling (GBTM). The results indicate that, among those who had any sickness absence episodes, the amount of night work decreased prior to the first SA. In general, trajectories of night shift work varied from stably high to low-but-increasing trajectories in terms of the number of shifts. However, a group with decreasing pattern of night work was identified only among those with sickness absence episodes but not among those without such episodes. To conclude, the identified trajectories of night work with or without sickness absences may indicate that, among those with sickness absence episodes, night work was reduced due to increasing health problems. Hence, the hospital employees working night shifts are likely a selected population because the employees who work at night are supposed to be healthier than those not opting for night work.

Because they're worth it? A discussion paper on the value of 12-h shifts for hospital nursing

The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses' wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses.

Health-promoting work schedules: protocol for a large-scale cluster randomised controlled trial on the effects of a work schedule without quick returns on sickness absence among healthcare workers

INTRODUCTION

In shift work, quick returns refer to transitions between two shifts with less than 11 hours available rest time. Twenty-three per cent of employees in European countries reported having quick returns. Quick returns are related to short sleep duration, fatigue, sleepiness, work-related accidents and sickness absence. The present study is the first randomised controlled trial (RCT) to investigate the effect of a work schedule without quick returns for 6 months, compared with a work schedule that maintains quick returns during the same time frame.

METHODS AND ANALYSIS

A parallel-group cluster RCT in a target sample of more than 4000 healthcare workers at Haukeland University Hospital in Norway will be conducted. More than 70 hospital units will be assessed for eligibility and randomised to a work schedule without quick returns for 6 months or continue with a schedule that maintains quick returns. The primary outcome is objective records of sickness absence; secondary outcomes are questionnaire data (n≈4000 invited) on sleep and functioning, physical and psychological health, work-related accidents and turnover intention. For a subsample, sleep diaries and objective sleep registrations with radar technology (n≈ 50) will be collected.

ETHICS AND DISSEMINATION

The study protocol was approved by the Regional Committee for Medical and Health Research Ethics in Western Norway (2020/200386). Findings from the trial will be disseminated in peer-reviewed journals and presented at national and international conferences. Exploratory analyses of potential mediators and moderators will be reported. User-friendly outputs will be disseminated to relevant stakeholders, unions and other relevant societal groups.

TRIAL REGISTRATION NUMBER

NCT04693182.

Length of exposure to long working hours and night work and risk of sickness absence: a register-based cohort study

Background

There is inconsistent evidence that long working hours and night work are risk factors for sickness absence, but few studies have considered variation in the length of exposure time window as a potential source of mixed findings. We examined whether the association of long working hours and night work with sickness absence is dependent on the length of exposure to the working hour characteristics.

Methods

We analysed records of working hours, night work and sickness absence for a cohort of 9226 employees in one hospital district in Finland between 2008 and 2019. The exposure time windows ranged from 10 to 180 days, and we used Cox’s proportional hazards models with time-dependent exposures to analyse the associations between working-hour characteristics and subsequent sickness absence.

Results

Longer working hours for a period of 10 to 30 days was not associated with the risk of sickness absence whereas longer working hours for a period of 40 to 180 days was associated with a lower risk of sickness absence. Irrespective of exposure time window, night work was not associated with sickness absence.

Conclusions

It is important to consider the length of exposure time window when examining associations between long working hours and sickness absence, whereas the association between night work and sickness absence is not similarly sensitive to exposure times.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07231-4.

Metabolic syndrome and the increased risk of medically-certified long-term sickness absence: a prospective analysis among Japanese workers

BACKGROUND

Metabolic syndrome (MetS) has been associated with various chronic diseases which may lead to long-term sickness absence (LTSA), but there is lacking information on the direct association between MetS and LTSA. The present study aimed to investigate the all-cause and cause-specific associations between MetS and the risk of medically-certified LTSA among Japanese workers.

METHOD

We recruited 67,403 workers (57,276 men and 10,127 women), aged 20-59 years, of 13 companies in Japan, during their health check-ups in 2011 (11 companies) and 2014 (2 companies), and followed them up for LTSA events (≥ 30 consecutive days) until March 31, 2020. MetS was defined according to the Joint Interim Statement. A Cox proportional hazards regression model was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) for LTSA associated with MetS and its components.

RESULTS

During 408,324 person-years of follow-up, 2,915 workers experienced LTSA. The adjusted HR for all-cause LTSA was 1.54 (95% CI, 1.41-1.68) among those with vs without MetS. In cause-specific analysis, HRs associated with MetS significantly increased for LTSA due to overall physical disorders (1.76), cardiovascular diseases (3.16), diseases of the musculoskeletal system and connective tissue (2.01), cancers (1.24), obesity-related cancers (1.35), mental, behavioral and neurodevelopmental disorders (1.28), reaction to severe stress and adjustment disorders (1.46) and external causes (1.46). The number of MetS components were also significantly associated with increased LTSA risk.

CONCLUSION

MetS was associated with an increase in the risk of LTSA due to various diseases among Japanese workers.

The Effect of Night Duty of Pharmacists on Sleepiness and Concentration at Daytime

Background: The changing responsibilities of pharmacists contribute to a lack of qualified pharmacists to fill vacant positions, particularly in rural areas. Consequently, pharmacy managers cover various duties, including an increasing number of nights being on duty that can impair daytime concentration and performance. The objective of the study was to assess the effect of night duties on daytime sleepiness, sleep quality, and concentration abilities of pharmacists. Methods: 22 pharmacists, both sexes, aged 27 to 60 years, were recruited and their sleep time, sleep efficiency, and mobility (actigraphy) were assessed during a night on duty and a control night using an actimetry. Daytime sleepiness and concentration were assessed using standardized questionnaires (ESS, KSS, d2-R). Results: Significant differences were observed between the night shift and control nights with respect to sleep time, sleep efficiency, and mobility. Daytime sleepiness was significantly increased after night shifts (ESS: 11.64 vs. 2.09; KSS: 6.77 vs. 2.41 after a night shift and control night, respectively; p < 0.001) and concentration diminished compared to control nights (d2-R KL: 220.95 vs. 260.36 after a night shift and control night, respectively; p < 0.001). Conclusions: The results provide evidence that night duties lead to high daytime sleepiness in pharmacists, which in turn may negatively affect their ability to concentrate and their error rate. Existing regulations on emergency pharmacy services should be reconsidered regarding the safety of the pharmaceutical supply.

The associations of working hour characteristics with short sickness absence among part- and full-time retail workers

Objective:

This study aimed to determine the associations of working hour characteristics with short (1–3 days) sickness absence (SA) among retail workers.

Methods:

As part of “RetailHours-project”, 4046 employees of 338 Finnish retail stores were included. Registry-based data on working hour characteristics and short SA were utilized. A case-crossover design was used and the odds ratios (OR) were controlled for the clustering effect and working hour characteristics.

Results:

There were strong dose–response relationships between percent of short (<11 hours) shift intervals and short SA among part- and full-time workers, men and women, and younger and older workers. Compared to workers without short shift intervals, the risk of SA was 1.47 times [95% confidence interval (CI) 1.29–1.68] higher among workers who had short shift intervals <10% of work times, 2.39 times (95% CI 2.03–2.82) higher among workers who had 10–25% of work times, and 4.03 times (CI 2.34–6.93) higher among workers who had short shift intervals >25% of work times. Weekly working hours >40 hours were associated with SA among part-time workers [odds ratio (OR) 2.22, CI 1.65–2.98], women (OR 1.62, CI 1.27–2.07) and among workers <30 years of age (OR 1.68, CI 1.20–2.35) as well as among workers aged ≥30 years (OR 1.43, CI 1.07–1.92). Furthermore, working mainly night shifts was associated with SA among full-time workers (OR 2.41, 95% CI 0.99–5.86) and women (OR 1.72, CI 1.02–2.89).

Conclusions:

A short shift interval is an important risk factor for short SA. Improving intervals between shifts and shortening long weekly working hours could reduce the risk of short SA among retail workers.

Patterns of working hour characteristics and risk of sickness absence among shift-working hospital employees: a data-mining cohort study

OBJECTIVES

Data mining can complement traditional hypothesis-based approaches in characterizing unhealthy work exposures. We used it to derive a hypothesis-free characterization of working hour patterns in shift work and their associations with sickness absence (SA).

METHODS

In this prospective cohort study, complete payroll-based work hours and SA dates were extracted from a shift-scheduling register from 2008 to 2019 on 6029 employees from a hospital district in Southwestern Finland. We applied permutation distribution clustering to time series of successive shift lengths, between-shift rest periods, and shift starting times to identify clusters of similar working hour patterns over time. We examined associations of clusters spanning on average 23 months with SA during the following 23 months.

RESULTS

We identified eight distinct working hour patterns in shift work: (i) regular morning (M)/evening (E) work, weekends off; (ii) irregular M work; (iii) irregular M/E/night (N) work; (iv) regular M work, weekends off; (v) irregular, interrupted M/E/N work; (vi) variable M work, weekends off; (vii) quickly rotating M/E work, non-standard weeks; and (viii) slowly rotating M/E work, non-standard weeks. The associations of these eight working-hour clusters with risk of future SA varied. The cluster of irregular, interrupted M/E/N work was the strongest predictor of increased SA (days per year) with an incidence rate ratio of 1.77 (95% confidence interval 1.74-1.80) compared to regular M/E work, weekends off.

CONCLUSIONS

This data-mining suggests that hypothesis-free approaches can contribute to scientific understanding of healthy working hour characteristics and complement traditional hypothesis-driven approaches.

Sleep-Related Problems in Night Shift Nurses: Towards an Individualized Interventional Practice

Rotating shifts (mostly 8- or 12-h) are common among nurses to ensure continuity of care. This scheduling system encompasses several adverse health and performance consequences. One of the most injurious effects of night-time shift work is the deterioration of sleep patterns due to both circadian rhythm disruption and increased sleep homeostatic pressure. Sleep problems lead to secondary effects on other aspects of wellbeing and cognitive functioning, increasing the risk of errors and workplace accidents. A wide range of interventions has been proposed to improve the sleep quality of nurses and promote an increase in attention levels. In recent years, particular attention has been paid to individual and environmental factors mediating the subjective ability to cope with sleep deprivation during the night shift. Given the predictive role of these factors on the negative impact of a night shift, an individualized intervention could represent an effective countermeasure by ensuring suitable management of shift schedules. Therefore, the aims of this mini-review are to: (a) provide an updated overview of the literature on sleep problems in night shift nurses and their adverse consequences; and (b) critically analyze the psychosocial factors that mediate the negative impact of shift work with the ultimate goal of defining an effective countermeasure based on an individualized approach.