Effect of shift work on fatigue, reaction time and accuracy of nurses in the Department of Neurology: A cross‐sectional observational study

Abstract

Aims The purpose of our study was mainly to explore the effect of different shift work on cognitive and executive performance in a real clinical environment among nurses from China. Background Working in shifts can disrupt circadian rhythm, resulting in reduced sleep duration, which can have a detrimental effect on cognitive function. To provide continuous service for patient care, shift work is often a special requirement for nurses. The Stroop test can be used to measure selective attention and reaction time during executive function. However, there have been limited studies about the effect of shift work on the cognitive performance of nurses by Stroop tests. Additionally, no study has been conducted in nurses working in shifts from China. Methods Registered nurses in general ward, Department of Neurology, from West China Hospital of Sichuan University, were eligible and consecutively included if they were simultaneously responsible for the day, evening and night shifts on the shift work schedule. A fatigue questionnaire and Stroop tests were performed for each subject separately before and after three working shifts (morning, evening and night shift) to measure changes in fatigue, reaction time and accuracy. Results Eighteen registered nurses (4 males and 14 females) were included in our study, with a median age of 25 years old. The fatigue degree was significantly increased after day and evening shifts (p = .015 and <.001, respectively). Compared with those in the preshifts, the reaction time in the neutral task and incongruent task was significantly quicker after the day shift (p = .001, p < .001) and night shift (p = .008, .019). In contrast, the reaction time after the evening shift was mildly increased, although without significance. There was no significant difference in accuracy among the three different working shifts. In addition, there was a negative correlation between the fatigue score and reaction time on the incongruent task in the Stroop test before the day shift (r = −.542, p = .020). The fatigue score in the postday shift was found to be inversely related to working hours in the daytime (r = −.500, p = .034). Conclusions Our study showed that increased fatigue was found in nurses after day and evening shifts, and shift work can affect the reaction time after the evening shift. However, there was no significant difference in accuracy and a high level of attention could be maintained among the three working shifts, suggesting a highly developed sense of responsibility in our nurses. Implications for Nursing Management In addition to focusing on the common adverse effects of evening or night shifts on nurses, fatigue in the day shift should be paid special attention to by the leadership in the nursing management. Also, nurse managers can implement specific strategies to reduce fatigue after the day shift by shortening the working hours in the daytime appropriately, setting rest periods in the day shift or dividing nurses into morning and afternoon shifts.

The effects of work on cognitive functions: a systematic review

“…Among 64 studies included in the systematic review, 39 were related to the effect of shift work on cognitive functions ( Table 4 ) ( Deary and Tait, 1987 ; Orton and Gruzelier, 1989 ; Lingenfelser et al, 1994 ; Smith et al, 1995 ; Petru et al, 2005 ; Rouch et al, 2005 ; Saricaoğlu et al, 2005 ; Griffiths et al, 2006 ; Chang et al, 2011 , 2013a , b ; Anderson et al, 2012 ; Shwetha and Sudhakar, 2012 , 2014 ; Niu et al, 2013 ; Özdemir et al, 2013 ; Veddeng et al, 2014 ; Kazemi et al, 2016 , 2018 ; Maltese et al, 2016 ; Titova et al, 2016 ; Vajravelu et al, 2016 ; Haidarimoghadam et al, 2017 ; Soares and de Almondes, 2017 ; Williams et al, 2017 ; Persico et al, 2018 ; Taylor et al, 2019 ; Abdelhamid et al, 2020 ; Adams and Venter, 2020 ; Athar et al, 2020 ; James et al, 2021 ; Prasad et al, 2021 ; Stout et al, 2021 ; Sun et al, 2021 ; Zhao et al, 2021 ; An et al, 2022 ; Benítez-Provedo et al, 2022 ; Esmaily et al, 2022 ; Peng et al, 2022 ).…”

“… Adams and Venter (2020) wanted to quantify the effects of shift work on cognitive functions in anaesthesiology trainees and observed that after 14-h night shift they had a decline in reaction time, psychomotor functions and attention. An et al (2022) explored the effects of different work shifts on cognitive and executive performance in nurses, showing that reported fatigue after the evening shift can negatively affect reaction time. Anderson et al (2012) sought to quantify the cognitive deterioration due to repeated exposure to 24- to 30-h shift and found progressive impairment due to chronic sleep deficiency.…”

“…Many studies focused their attention on the negative effects of shift work on circadian rhythm ( Schettini et al, 2023 ) and consequently on sleep and cognitive functions. Particularly, most studies highlighted detrimental effects: such among healthcare workers, medical professionals, as anaesthesiologists had a decline in reaction time, problem-solving, attention, and mental flexibility after night shift ( Saricaoğlu et al, 2005 ; Griffiths et al, 2006 ; Williams et al, 2017 ; Abdelhamid et al, 2020 ; Adams and Venter, 2020 ; Prasad et al, 2021 ), nurses had affected reaction time, motor ability, attention, cognitive flexibility, working memory, and decision making after work shift ( Chang et al, 2011 , 2013a , b ; Niu et al, 2013 ; James et al, 2021 ; Sun et al, 2021 ; An et al, 2022 ; Esmaily et al, 2022 ; Peng et al, 2022 ), other categories of physicians(intensivists, emergency doctors, gynaecologists, junior doctors, hospital doctors, medical house officers, postgraduate year one physicians) had a deficit in attention, executive function, memory, motor function, and reaction time after night shift ( Deary and Tait, 1987 ; Orton and Gruzelier, 1989 ; Lingenfelser et al, 1994 ; Anderson et al, 2012 ; Özdemir et al, 2013 ; Veddeng et al, 2014 ; Maltese et al, 2016 ; Persico et al, 2018 ; Benítez-Provedo et al, 2022 ). Other workers, such as security staff ( Vajravelu et al, 2016 ; Athar et al, 2020 ), control room operators ( Kazemi et al, 2016 , 2018 ; Haidarimoghadam et al, 2017 ), business process outsourcing employees ( Shwetha and Sudhakar, 2012 , 2014 ), power plant workers ( Smith et al, 1995 ), petrochemical workers ( Soares and de Almondes, 2017 ), firefighters ( Stout et al, 2021 ), police employees ( Taylor et al, 2019 ), miners ( Zhao et al, 2021 ), and generic groups of workers ( Rouch et al, 2005 ; Titova et al, 2016 ) had an impairment in one or more cognitive functions.…”

The Association between Working Hours with Vigilance and Executive Function of Intensive Care Unit Nurses

“…In clinical practice, nurses routinely work 8 or 12 h shifts. Although a 12 h shift may reduce the number of shifts and commuting time while also allowing for more continuous patient care, it is believed that prolonged periods of uninterrupted work are associated with increased fatigue and poor performance [9]. A study demonstrated that nurses working 12.5 h or more had more than three times the risk of errors than those who worked less than 8 h [10].…”

Preventive Effects of a Single Bout of Exercise on Memory and Attention following One Night of Sleep Loss in Sports Students: Results of a Randomized Controlled Study

“…A study in polysomnography technicians showed one 12 h night shift to be already sufficient to increase perceived sleepiness, reaction time and the number of lapses of attention [ 12 ]. Shift work, as investigated in a recent study in nurses, was shown to increase fatigue after day and evening shifts and affect the reaction time after the evening shift [ 13 ]. Nurses did not differ in accuracy and maintained a high level of attention among the three working shifts, suggesting a highly developed sense of responsibility in our nurses.…”