Comparison of Sleep and Attention Metrics Among Nurses Working Shifts on a Forward- vs Backward-Rotating Schedule

Abstract

IMPORTANCEThe association of fast backward-rotating shift work (ie, anticlockwise sequence of afternoon, morning, and night shifts) with subjective and objective measures of sleep-wake quality, daytime attention, and tiredness of health care workers has not yet been established. OBJECTIVE To investigate the association of shift rotation direction with tiredness, sleepiness, and sustained attention among nurses working forward-and backward-rotating shifts. DESIGN, SETTING, AND PARTICIPANTS Data of this cohort study were collected from nurses working at 5 midsized Italian hospitals. The nurses had either a forward-rotating schedule (ie, morning to afternoon to night) and or a backward-rotating schedule (ie, afternoon to morning to night). The data were collected from July 2017 to February 2020. Data analysis was performed from May to October 2020. EXPOSURES Participants were working either forward-or backward-rotating schedules, in which the sequence of 3 shifts (morning, afternoon, and night) changed in a clockwise or anticlockwise direction. MAIN OUTCOMES AND MEASURES Sleep data were collected using the Karolinska Sleepiness Scale and Pittsburgh Sleep Quality Index. Sustained attention was measured using the Psychomotor Vigilance Task. Tiredness was evaluated using the Tiredness Symptom Scale. RESULTS A total of 144 nurses (mean [SE] age, 41.3 [0.8] years; 92 women [63.9%]) participated in the study; 80 nurses had forward-rotating schedules, and 64 had backward-rotating schedules.Nurses with irregular sleep-wake patterns due to night shift work had poor sleep quality (46 [57.5%] in forward-rotating schedule group; 37 [57.8%] in backward-rotating schedule group). Nurses working backward-rotating shifts exhibited significantly greater sleepiness (F 1,139 = 41.23; P < .001) and cognitive slowing (ie, longer median reaction times; F 1,139 = 42.12; P < .001) than those working forward rotations. Importantly, these differences were not affected by age, years of employment, and quality of sleep. Of nurses working on a backward-rotating schedule, 60 (93.8%) reported elevated sleepiness (Karolinska Sleepiness Scale score Ն7) after the night shift. The median reaction time (F 1,139 = 42.12; P < .001), 10% fastest reaction time (F 1,139 = 97.07; P < .001), minor lapses (F 1,139 = 46.29; P < .001), and reaction time distribution (F 1,139 = 60.13; P < .001) of nurses on backward-rotating schedules indicated a lower level of vigilance, which is negatively associated with neurobehavioral performance. CONCLUSIONS AND RELEVANCEIn this study, both shift rotation models were negatively associated with health and cognitive performance. These findings suggest that forward shift rotation may be more beneficial than backward rotation for several measured performance attentional (continued) Key Points Question Among hospital staff who work day and night shifts, do sleep and attention metrics vary between those who work forward-vs backwardrotating shifts? Findings This cohort study of 144 nurses found that fast forward-rotating shifts...

Shift-Work Schedule Intervention for Extending Restart Breaks after Consecutive Night Shifts: A Non-randomized Controlled Cross-Over Study

“…This may have affected the results for those going from intervention to control. Fifth, as mentioned above, a backward rotation is not an appropriate shift system in terms of the circadian rhythm [ 25 , 26 ]. The shift schedule intervention basically remained as a backward rotation while this intervention study extended restart breaks after consecutive night shifts.…”

“…Two three-shift schedules rotate in a forward direction (day shift to evening shift to night shift) and a backward direction (night shift to evening shift to day shift). Earlier studies have suggested that a backward rotation could be more difficult to adapt to than a forward rotation because the circadian rhythm tends to move forward [ 25 , 26 ]. For example, compared with forward-rotating schedules, backward-rotating shift systems showed a relative risk of 2.9 due to an increased need for recovery and a risk of 3.2 due to poor general health [ 27 ].…”

Mediating effect of circadian rhythm between work stress and sleep quality in Chinese shift‐working nurses: A cross‐sectional survey

“…(Zare et al, 2017); establishing reasonable and flexible shift scheduling by considering the characteristics of the shift system, such as the length of shifts, the direction and speed of shift rotation, and the length of the recovery period in between two consecutive shifts, etc. (Alfonsi et al, 2021;Di Muzio et al, 2021;Sun et al, 2019)).…”

Association between circadian rhythm and sleep quality among nursing interns: A latent profile and moderation analysis

“…Night-shift work was developed in hospitals to ensure high-quality care; however, it leads to circadian misalignment and poor sleep quality among nurses ( Di Muzio et al, 2021 ). The internship period is the duration for interns to acclimate to night-shift work.…”