![]() ![]() For nurses and doctors in Australia, regulatory guidelines which provide for sufficient rest between shifts, and a limit on the number of consecutive hours worked during a shift is yet to be implemented. In recognition of this risk, the European Working Time Directive introduced the requirement for at least 11 hours of rest between shifts 25 including in healthcare 26, 27 to allow sufficient time to commute to and from work and still provide adequate time for sleep. Shift workers in the healthcare industry rotate between different shift times 23, potentially limiting recovery sleep, particularly when transitioning from shifts that end late and start early the next morning 18, 24. The time available for recovery sleep prior to and between shifts is an important factor influencing performance during subsequent shifts. The combined effect of these circadian and sleep-related factors impair alertness and performance while on duty 16, 19, and often impact on safe driving practices during the commute to and from work 20, 21, 22. Other shift work schedules, which may involve early start or late end times, may also impact sleep duration and increase sleep-wake disturbances 17, 18. The night shift is often associated with extended episodes of wakefulness 14, 15, 16, particularly on the first night in a series when an individual may wake at a normal time in the morning, and remain awake during the day prior to starting the first night 15. Misalignment of the circadian pacemaker with sleep-wake timing is common in shift workers, particularly during nights 10 and results in sleep loss 11, 12 and excessive sleepiness during work shifts 13. These work hours pose a challenge to the healthcare industry as shift work is likely to have major negative implications on patient care and patient safety 5, 6, 7, in addition to its association with significant economic and productivity costs 8, 9. To facilitate the provision of 24 hour emergency healthcare services and hospital care for the critically unwell, shift work comprising irregular work hours outside of traditional diurnal work times is widely adopted 4. ![]() In many countries, healthcare workers make up the single largest proportion of shift workers 1, 2, 3. Although healthcare workers perceive themselves to be less alert on the first night shift compared to subsequent night shifts, objective performance is equally impaired on subsequent nights. Alertness and performance remain most impaired during night shifts given the lack of circadian adaptation to night work. In rotating shift workers, early day shifts can be associated with similar sleep restriction to night shifts, particularly when scheduled immediately following an evening shift. On nights, working during the circadian acrophase of the urinary melatonin rhythm led to poorer outcomes on the KSS and PVT. KSS and PVT mean reaction times were higher at the end of the first and subsequent night shift compared to day shift, with KSS highest at the end of the first night. Sleep was most restricted between consecutive night shifts (5.74 ± 1.30 h), consecutive day shifts (5.83 ± 0.92 h) and between evening and day shifts (5.20 ± 0.90 h). Circadian phase was assessed using urinary 6-sulphatoxymelatonin rhythms. Subjective sleepiness (Karolinska Sleepiness Scale, KSS) and Psychomotor Vigilance Test (PVT) performance were examined during day shift, and on the first and subsequent night shifts (3 rd, 4 th or 5 th). Sleep and wake duration between shifts were evaluated using wrist actigraphs and diaries. ![]() This study examined sleep between shift types (day, evening, night), and alertness and performance during day and night shifts in 52 intensive care workers. Shift work is associated with impaired alertness and performance due to sleep loss and circadian misalignment. ![]()
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