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. 2019 Feb 7;14(2):e0211715.
doi: 10.1371/journal.pone.0211715. eCollection 2019.

Does Work-Induced Fatigue Accumulate Across Three Compressed 12 Hour Shifts in Hospital Nurses and Aides?

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Does Work-Induced Fatigue Accumulate Across Three Compressed 12 Hour Shifts in Hospital Nurses and Aides?

Brennan J Thompson. PLoS One. .
Free PMC article

Abstract

Fatigue-related impairments in the nursing workforce contribute to a multitude of health, safety, and economic consequences at the individual, organizational and societal levels. Long and compressed work schedules are commonly worked in the healthcare industry, but more research is needed to understand the cumulative effects of multiple work shifts on physiology-based performance outcomes in nurses. The purpose of this study was to compare the effects of a single nursing work shift versus three compressed (one every 24 hours) 12 hour shifts on performance-based fatigue in nurses and aides. Twenty-six fulltime hospital working nurses and aides (age = 36.1 ± 13.3 years) reported to the lab for testing before, immediately after working a single 12 hour shift, and after working three 12 hour shifts in a 72 hour period. Outcome measures included vigilance-based reaction time, lapses of attention, and muscle function assessments (lower and upper body muscle strength, explosive strength and vertical jump performance). All variables except hand grip strength showed a significant decline following the three work shifts. The psychomotor vigilance reaction time and lapses of attention variables also generally showed a significant decline from the end of shift one to the end of shift three, indicting an accumulation of fatigue in these metrics with increasing number of shifts worked. Muscle function variables responded early in the duty cycle, showing a significant decline after a single work shift, but did no further decline by the end of the third shift. These findings use objective measures to substantiate that fatigue impairments occur from working a single 12 hour shift, and in several instances, increase further with more successive work shifts. Caution should be employed by personnel and administrators with work schedules involving multiple compressed 12 hour shifts. Fatigue management strategies may be used to improve risks and consequences from fatigue-related mishaps, and this study reports several variables that appear sensitive to identifying and tracking fatigue in this population.

Conflict of interest statement

The author has declared that no competing interests exist.

Figures

Fig 1
Fig 1
A) Lapses of attention, and B) mean and slowest 10% reaction time (RT) on the psychomotor vigilance task (PVT) before (Pre), after one 12 hour work shift (Mid1), and at the end (Post) of a consecutive three day nursing work shift schedule. Values are mean ± SE. * Significantly different from Pre and † Significantly different from Mid 1 at P < 0.05.
Fig 2
Fig 2. Individual scatter plot showing the relative (%) change scores for mean reaction time (RT) for each participant from baseline (Pre) to after the three consecutive work shifts (Post), and from the end of the first work shift (Mid1) to the end of the third shift (Post).
Note, positive % change indicates poorer RT performance (i.e., an elongated response time versus earlier time trial). Horizontal dashed line represents a 10% reduced performance and is used here as an illustration of a hypothetical threshold where such a performance impairment may begin to negatively impact on-the-job task performance.
Fig 3
Fig 3
A) and B) are composite values (sum of the knee extensors and flexors) for the peak torque (PT) and rate of torque development (RTD) isometric strength variables, respectively, and C) and D) show countermovement jump height (JH) and hand grip (HG) strength, respectively, before (Pre), after one 12 hour work shift (Mid1), and at the end (Post) of a consecutive three day nursing work shift schedule. Values are mean ± SE. * Significantly different from Pre and † Significantly different from Mid1 at P < 0.05.
Fig 4
Fig 4. Cohen’s d effect sizes comparing time trial mean differences on primary outcome measures before (Pre), after one 12 hour work shift (Mid1), and at the end (Post) of the three day work shift schedule.
JH = Jump Height; HG = Hand Grip; Comp = Composite score of knee extensors and flexors muscle groups; PT = Peak Torque; RTD100 = Rate of Torque Development at 100 ms; RT = Reaction Time. Note, positive effect size values indicate poorer performance on each variable when compared to the earlier time trial (e.g., reduced jump height, composite peak torque etc. or increased reaction times, lapses etc.).

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Grant support

The author received no specific funding for this work.
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