Employmentweb_low

EmploymEnt, Work, And hEAlth InEquAlItIEs - a global perspective
selected case studies
at risk of exposure to chemical and biological agents, such as
pesticides or dust, heat and harsh weather, repetitive work,
hazardous equipment, excessive work hours, demanding physical
work and noise (ilo, 2006).
Case study 61. The link between employment relations and working conditions: Work schedule and work hours in
relation to nurse injury. - alison trinkoff
nursing jobs increasingly involve extended work schedules and heavy job demands, with recent studies showing the
detrimental effects on the health of nurses (caruso, hitchcock, dick, russo, & schmit, 2004; trinkoff, geiger-brown, brady,
lipscomb, & Muntaner, 2006; trinkoff, le, geiger-brown, lipscomb, & lang, 2006). increased hours in a work environment
with high physical and psychosocial demands can adversely affect nurses’ health. in fact, chronic stress over time is known
to affect the nerve, immune, and cardiovascular systems (Mcewen, 1998). research has found that physical and
psychological job demands and extended work schedules increase risk of work-related injuries such as musculoskeletal
disorders (van der hulst, 2003).
currently, the u.s. institute of Medicine recommends that nurses work no more than 12 hours in a 24-hour period and
no more than 60 hours in a seven-day period, in order to reduce error-producing fatigue [institute of Medicine (ioM) 2004].
their report entitled "Keeping patients safe: transforming the work environment of nurses" also incorporated baseline
findings from our longitudinal study of nurse scheduling. in our study, over one-third of staff nurses reported that they
typically worked 12+ hours a day. among those working 12+ hours, 37 per cent rotated shifts (trinkoff et al., 2006). on-call
requirements were also very common (41%). despite the long hours, few nurses took breaks; two-thirds typically took one
or no breaks during their shifts. although current evidence indicates that extended schedules can adversely affect nurses
and patients, research on nurse scheduling has been limited, usually to certain work settings (such as hospitals), or certain
schedule components (such as shift work or mandatory overtime only). More research is needed.
because nurses are at high risk of Msd, especially neck and back injuries, and have the highest number of needlestick
injuries, we therefore examined the relation of work schedules to Msd and needlestick incidence in nurses (trinkoff et al.,
2006; trinkoff, le, geiger-brown, & lipscomb, 2007). we contacted 5,000 randomly selected actively licensed nurses from
two u.s. states. of these nurses, 4,229 were sent questionnaires (138 had invalid addresses, and 633 declined to enroll).
returned surveys were received from 2,624 nurses, for a 62 per cent enrollment rate, with follow-up rates for waves 2 and
3 of 85 per cent and 86 per cent, respectively. we found that onset of both injury types was independently related to work
schedule, with long work hours significantly increasing the risk of injury. this was partly explained by workplace exposure
to physical demands. in addition, time spent away from work was also related to injury, suggesting that inadequate rest and
recovery was also an important risk factor for injury.
although our study asked whether nurses were required to work extra hours, many of the nurses also worked long
hours voluntarily. studies of health effects of extended hours found that the health impact is comparable regardless of this
distinction (ioM, 2004). encouraging or requiring already tired nurses to work extra hours exacerbates a cycle of fatigue, and
often leads to exit from the profession. this compounds staffing problems by creating nurse shortages, further increasing
the pressure to work extended hours. conversely, improving working conditions has been shown to decrease nurse
vacancies and shortages (luther et al., 2002).
because workplace injuries to nurses incur extensive economic, psychological, and physical costs, it is extremely
important to prevent them. despite advances in protecting nurses, extended work schedules and related job demands are
contributing to nurse injuries. these conditions, if modified, could lead to further injury reductions.
References
caruso, c., hitchcock, e., dick, r., russo, J., & schmit, J. (2004). Overtime and extended work shifts: Recent findings on
illnesses, injuries, and health behaviours. retrieved september 22, 2009, from http://cdc.gov/niosh/docs/2004-
143/pdfs/2004-143.pdf
institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. washington, dc: national
academies press.
luther, K. M., Maguire, l., Mazabob, J., sexton, J. b., helmreich, r. l., & thomas, e. (2002). engaging nurses in patient
safety. Critical care nursing clinics of North America, 14(4), 341-346.
Mcewen, b. s. (1998). stress, adaptation, and disease. allostasis and allostatic load. Annals of New York Academy of Science,
840, 33-44.
trinkoff, a., geiger-brown, J., brady, b., lipscomb, J., & Muntaner, c. (2006). how long and how much are nurses now
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