ABSTRACT

There is conflicting evidence on the effect of night work on sickness absence. Most previous studies used self-reporting to identify shift patterns and measure levels of sickness absence. In contrast, this study used objective data from electronic rosters to explore the association of nurses’ patterns of night work and sickness absence. This was a retrospective longitudinal study of nurse roster data from 32 general medical and surgical wards in a large acute hospital in England. We used data from 3 years and included both registered nurses and unregistered nursing assistants. We used generalized linear-mixed models to explore the association between night work and the subsequent occurrence of sickness absence. Of 601,282 shifts worked by 1944 nursing staff, 38,051 shifts were lost due to sickness absence. After controlling for potential confounders including proportion of long (≥12 h) shifts worked, proportion of overtime shifts, proportion of shifts worked in the past 7 days, and staff grade, we found that staff working more than 75% of their shifts in the past 7 days as night shifts were more likely to experience sickness absence (aOR = 1.12; 95% CI: 1.03–1.21), compared to staff working on day only schedules. Sub-group analysis found that an association between a high proportion of night shifts worked and long-term sickness (aOR = 1.31; 95% CI: 1.15–1.50), but not short-term sickness. Working high proportions of night shifts, likely representing permanent night work schedules, is associated with a higher risk of long-term sickness absence for nurses working in inpatient adult wards in acute hospitals. The higher sickness absence rates associated with permanent night shifts could result in additional costs or loss of productivity for hospitals. This study challenges the assumption that permanent night schedules maximize circadian adjustment and, therefore, reduce health problems.

摘要

关于夜班工作对疾病缺席的影响有相互矛盾的证据。以前的大多数研究都使用自我报告来确定轮班模式并测量疾病缺席程度。相反，本研究使用电子花名册中的客观数据来探索护士夜间工作模式与疾病缺席之间的关系。这是对英格兰一家大型急诊医院32个普通内科和外科病房护士名册数据的回顾性纵向研究。我们使用了3年的数据，包括注册护士和未注册护理助理。我们使用广义线性混合模型来探索夜班工作与随后发生的疾病缺席之间的关联。1944年护理人员工作的601282个班次中，有38,051个班次因缺病而丢失。在控制了可能的混杂因素后，包括长期轮班（≥12小时）的比例，加班率的比例，过去7天的轮班比例和员工职等，我们发现员工在轮班中工作的比例超过75％与仅按日程安排的工作人员相比，前7天的夜班更容易出现疾病缺席（aOR = 1.12； 95％CI：1.03-1.21）。小组分析发现，夜班工作的高比例与长期疾病（aOR = 1.31； 95％CI：1.15-1.50）之间存在关联，而与短期疾病无关。夜班工作比例很高，可能代表了永久性的夜班时间表，这会使在急诊医院住院的成人病房工作的护士长期缺席病的风险更高。永久性夜班会导致更高的疾病缺勤率，可能会导致额外费用或医院生产力下降。这项研究挑战了以下假设：永久性的夜间时间表可以最大程度地调节昼夜节律，从而减少健康问题。