Pain complaints after consecutive nights and quick returns in Norwegian nurses working three-shift rotation: an observational study

Abstract

ObjectivesTo determine whether nurses working consecutive night shifts, or short transitions between shifts (quick returns (QRs)), yielded higher risk for pain complaints when compared with regular morning shifts. Sleep duration was tested as a potential mediator.DesignObservational diary study.SettingRandom hospitals.ParticipantsNurses with three-shift rotation (morning, evening and night), n=679, 22–63 years old.Outcomes measuresDaily ratings of working hours, sleep and subjective pain complaints in six anatomical regions (head, neck/shoulder/upper back, upper extremity, low back, lower extremity and abdomen) for 28 days. In addition, we assessed demographics, habitual sleep and pain complaints, work and lifestyle factors. It was tested (1) whether the risk for pain complaints was higher after workday 3 versus after workday 2, and whether the difference was larger for consecutive night shifts versus consecutive morning shifts, and (2) whether the risk for pain complaints was higher after QRs versus after two morning shifts. Risk for pain complaints refers to combined increased risk for any pain and risk for increased intensity.ResultsAdjusted analyses showed no shift type by workday interaction for pain complaints in the neck/shoulder/upper back, upper extremities, low back, lower extremities or abdomen. For headache, a strong trend indicated that the risk was higher on workday 3 compared with workday 2 for night shifts (OR 1.13, 95% CI 0.99 to 1.28). The risk was lowered if sleep duration was taken into account (OR 0.37, 95% CI 0.17 to 0.81). No conclusive support was found for the risk for pain complaints being higher after QRs, compared with after morning shifts.ConclusionsFor five of six pain complaints, the hypotheses were not supported by the current data. For headache, we found potential support for a sleep-relieving effect on headache after working several nights in a row. Pain complaints were not instigated or exacerbated by an evening-to-morning transition between shifts.

An updated review of the effect of work hours and shift work on musculoskeletal disorders (MSD) in the healthcare sector

“…A total of 6 studies examined the association between long weekly or daily work hours and MSD (Cameron et al 2008;Clari et al 2019;Dong et al 2020;Mekonnen 2019;Park et al 2014;Yan et al 2017), while a total of 12 studies examined shift and night work as exposure of interest (Attarchi et al 2014;Bazazan et al 2019;Bjorvatn et al 2018;Cameron et al 2008;Chang/Peng 2021;Katsifaraki et al 2019Katsifaraki et al , 2020Kim et al 2012;Matre et al 2020;Mekonnen 2019;Yan et al 2017;Zhao, Bogossian and Turner 2012). Note that some studies examined multiple dimensions of work schedules, and thus are used with regards to duration and timing of work hours.…”

“…We identified a total of six manuscripts on night work and MSD risk published after 2008. A high-quality study conducted in Finland followed 679 shiftworking nurses over 28 days, where participants were asked to log daily pain levels (Katsifaraki et al 2020). Night work, as compared to early morning shifts, was associated with a significantly higher level of lower back (OR 1.73, 95% CI 1.02-2.92) and abdominal pain (OR 3.17, 95%CI 1.80-5.60).…”

Extended Work Shifts Increase Subjective Pain Complaints Among Cabin Crewmembers, but Not Among Airline Pilots or Healthcare Workers

“…The prevalence of subjective pain complaints assessed by diary was comparable to a previous study among nurses. 21 Whether extended workdays are associated with increased risk of subjective pain complaints, has received limited attention in the literature. The few studies that exist, support a positive association.…”

“…If the main effect was significant at P < 0.05, paired comparisons were made between occupations. To test the primary hypothesis, pain complaints were treated as ordinal variables 20,21 . The proportional odds assumption was tested and met for all dependent variables (Brant test).…”

“…To test the primary hypothesis, pain complaints were treated as ordinal variables. 20,21 The proportional odds assumption was tested and met for all dependent variables (Brant test). The effect of time was analyzed using Stata's meologitfunction (mixed effects ordered logistic regression), for each occupation.…”