It is with selfless intensions that nurses throw themselves into the world of healthcare. It with less eagerness that they take on the rigors of night shift. Although this is a necessary evil (yes evil, you would be hard-pressed to find someone that wouldn’t rather be sleeping), the ethical issues behind this process must be brought to attention. Are nurses who work these shifts aware of the effects of this shift on their health? Are we?
It would be expected that those who take on a night shift deal with an increase in sleep distress, fatigue, and loss of concentration. What is more surprising are the chronic and sometimes fatal diseases that develop in lieu of this practice. In general, night shift has been found to have a negative impact on the psychosocial health of nurses, and increase the probability of developing cardiovascular and gastrointestinal disease, and some cancers (Ferri et al., 2016).
A longitudinal study performed in 2015 on nurses working the night shift found an increase in cardiovascular disease by 2.7% (Lin et al., 2015). This is unsurprising when considering the fact that those who worked on the night shift had an increase in susceptibility for the development of metabolic syndrome. MS is a combination of high blood pressure, cholesterol, blood glucose, all of which can lead to a host of problem, the direst of which include heart attack and stroke. In fact, the researchers who performed this study suggested that those who have developed MS as a result of working night shift switch to a day-time shift in order to delay or reverse progression of the syndrome (Pietroiusti et al., 2010).
Additionally, in terms of mental health, nurses on the night shift were found to have more problems than those on the day shift. Common diagnoses included, “irritability, somatization, OCD, interpersonal sensitivity, anxiety, altered mood, and paranoid disorders,” (Shields 2002).
The documented gastrointestinal issues were most unexpected to me. This culprit of these occurrences has been pointed to alterations in gastric schedules and thus functions, increased stress, and differences in menstrual cycles. Following this train of thought, it was determined that this population was more susceptible to the development of diabetes, again citing the idea of altered circadian rhythm and its effect on the gastric system (Simmons 1988).
Finally, a study in 2007 claimed that alterations to the circadian rhythm were the equivalent of a carcinogen, a thought that was paralleled by researchers in 2015 who determined that nurses who worked night shift increased their risk of developing breast cancer by about 9% (Lin et al., 2015) (Straif et al., 2007).
In conclusion, these studies suggest a need for more resources for nurses who work night shifts. This includes the reconsideration of duration of the shifts on the ethical grounds that the current schedules are having a negative impact on the lives of our healthcare workers. Changing the system in order to provide workers with a more balanced lifestyle could lead to improvement in their health and the optimization of care of their patients.
References
Ferri, P., Guadi, M., Marcheselli, L., Balduzzi, S., Magnani, D., & Di Lorenzo, R. (2016). The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts. Risk management and healthcare policy, 9, 203–211.
Lin X, Chen W, Wei F, Ying M, Wei W, Xie X. Night-shift work increases morbidity of breast cancer and all-cause mortality: a meta-analysis of 16 prospective cohort studies. Sleep Med. 2015;16(11):1381–1387.
Pietroiusti A, Neri A, Somma G, et al Incidence of metabolic syndrome among night-shift healthcare workers. Occupational and Environmental Medicine2010;67:54-57.
Shields M. Shift work and health. Health Rep. 2002;13(4):11–33.
Simmons L, Heitkemper M, Shaver J. Gastrointestinal function during the menstrual cycle. Health Care Women Int. 1988;9(3):201–209.
Straif K, Baan R, Grosse Y, et al. WHO International Agency for Research on Cancer Monograph Working Group Carcinogenicity of shift-work, painting, and fire-fighting. Lancet Oncol. 2007;8(12):1065–1066.
This is a really interesting topic - I also had no idea that nurses working night shift had documented gastrointestinal issues (in addition to the long list of other health problems), but I see now how this makes sense given the disruption of the circadian rhythm. I completely agree that more resources should be given to anyone who works night shifts, including considering completely changing the system.
ReplyDeleteAdditionally, I had no idea that night shift work is a “probable” increased carcinogenic risk (Salamanca-Fernandez et al., 2018), which is very alarming. I decided to look into this more as I was curious as to what the mechanism behind this was. Apparently a major factor that contributes to the carcinogenic risk of night shifts is that exposure to artificial light throughout a night shift decreases production of melanin, which is normally produced in the highest quantities at night due to circadian rhythm (Salamanca-Fernandez et al., 2018). Melanin is believed to have oncostatic properties, and night workers are missing out on the time of day when melanin is produced in the greatest amount (Salamanca-Fernandez et al., 2018). This was especially interesting to me as before I did not understand why it would matter when a person slept, as long as they were sleeping the correct amount.
I was also curious as to whether working in the health care field puts people at an even higher risk of developing some of these diseases when compounded with working overnight shifts (in comparison to individuals working overnight shifts in less stressful positions such as the front desk staff of a hotel). Unfortunately I could not find any studies that have explored this specifically, but I am assuming two combined negative factors cannot have ideal health outcomes.
Cited Literature
Salamanca-Fernandez, E., Rodriguez-Barranco, M., Guevara, M., Ardanaz, E., Olry de Labry Lima, A., & Sanchez, M. J. (2018). Night-shift work and breast and prostate cancer risk: updating the evidence from epidemiological studies. An Sist Sanit Navar, 41(2), 211-226. doi:10.23938/ASSN.0307
I find it ironic that people who work in the healthcare system are more susceptible to illness than the general population. It seems that the stress of working in healthcare setting has a negative impact on health for all healthcare providers, I can see how this could be especially true for those working night shifts. I would imagine the extreme stress of taking of others, compounded with disrupted sleep cycle is a leaves people vulnerable to stress related diseases, and weaker immune systems. A study conducted on healthcare providers in Taiwan found that half of hospital staff had either a minor psychiatric disorder or depressive disorder (Su). I think this further demonstrates a need for more resources and better care available.
ReplyDeleteSu, J. (2009 June 12). Mental health and quality of life among doctors, nurses and other hospital staff. Stress and Health.
I find it ironic that people who work in the healthcare system are more susceptible to illness than the general population. It seems that the stress of working in healthcare setting has a negative impact on health for all healthcare providers, I can see how this could be especially true for those working night shifts. I would imagine the extreme stress of taking of others, compounded with disrupted sleep cycle is a leaves people vulnerable to stress related diseases, and weaker immune systems. A study conducted on healthcare providers in Taiwan found that half of hospital staff had either a minor psychiatric disorder or depressive disorder (Su). I think this further demonstrates a need for more resources and better care available.
ReplyDeleteSu, J. (2009 June 12). Mental health and quality of life among doctors, nurses and other hospital staff. Stress and Health.
This is a pretty hot topic for me since I am among the ranks of health care night shift workers. I have worked the night shift for about 4 years now so of course I have looked into the health concerns that arise from the lifestyle, and (surprise) none of the information was very reassuring and your post only bolsters my previous findings. What I find most surprising is that there is a clear and obvious solution to the woes of the night shift worker... taking a nap! I am very fortunate to work for an organization that allows on-shift napping and I think without it I would have started looking for a new job or different position within my organization by now.
ReplyDeleteIn addition to the issues that you listed I found some information in a study by Silva-Costa, A., Griep, R. H., & Rotenberg, L. that also lists increased BMI and hypertension to the myriad of issues that can arise from night work (2017). However, they also noted in their study that even small naps taken at work have been shown to decrease this risk as well as improve alertness and performance, restore circadian rhythms, and restore normal melatonin production even though they do not quite make up for the accumulating sleep debt (Silva-Costa, et al., 2017).
The problem with napping at work is that it usually requires that there is a low workload which may not happen often, especially at larger hospitals. So this begs the question, do you think that we have a ethical obligation to both patients and staff to require hospitals to implement a "nap time" for night workers to prevent the health impacts that come with the job? Should we pay people to sleep? Or do night shift workers sign an unspoken contract agreeing to the risks when they accept the job they applied for?
Cited Literature
Silva-Costa, A., Griep, R. H., & Rotenberg, L. (2017). Night work and BMI: is it related to on-shift napping?. Revista de saude publica, 51, 97. doi:10.11606/S1518-8787.2017051007094
Celeste I really enjoyed your post. I can absolutely relate to the negative effects of working the night shift. I worked graveyard shifts for two summers at a cherry orchard processing plant. During those summers, I would be exhausted, sick, and found myself constantly miserable. It absolutely took a tool on my body and mental health. However, I needed a job and I did not have any other job options at the time.
ReplyDeleteI agree we should find better resources for those that often work night shift. Also, we should require companies to find solutions to better their workers over all health.
There have been a few studies including a melatonin regiment and taking naps during the night shift, but neither of those showed significant affects (Folkard et al., 1993 ; Charmane et al., 1994). However, there was an effective study correlating brighter lights during night shift and dimming light goggles for the day that did help night shift workers adjust their circadian rhythm (Sallinen et al., 1998). I hope companies’ keep pushing research for improved solutions because I don’t think I could live my life wearing dimming goggles in the daytime.
References:
Charmane I. Eastman, Karen T. Stewart, Michael P. Mahoney, Liwen Liu, Louis F. Fogg, Dark Goggles and Bright Light Improve Circadian Rhythm Adaptation to Night-Shift Work, Sleep, Volume 17, Issue 6, September 1994, Pages 535–543, https://doi.org/10.1093/sleep/17.6.535
Folkard, S., Arendt, J., & Clark, M. (1993). Can Melatonin Improve Shift Workers Tolerance of the Night Shift? Some Preliminary Findings. Chronobiology International, 10(5), 315–320. doi: 10.3109/07420529309064485
Sallinen, M., Harma, M., Akerstedt, T., Rosa, R., & Lillqvist, O. (1998). Promoting alertness with a short nap during a night shift. Journal of Sleep Research, 7(4), 240–247. doi: 10.1046/j.1365-2869.1998.00121.x