Work hours in healthcare often involve extended work shifts (longer than 8 h per day), long work hours (greater than 40 h per week), on-call work, mandatory overtime, and shift work (work times other than 7:00 A.M. to 6:00 P.M.) to deliver care around the clock. The shortage of nurses and other types of healthcare workers push those available to work longer hours to fill the vacancies. Studies of many types of workers report these demanding work schedules are associated with several health and safety risks including psychological, gastrointestinal, and cardiovascular disturbances, injuries and automobile crashes, cancer, and adverse reproductive outcomes [1][2][3][4][5][6][7][8][9][10][11][12] . In addition, workers may be more prone to poor health behaviors such as smoking, drug and alcohol abuse and less physical activity. Musculoskeletal disorders (MSDs) are a significant cause of morbidity in healthcare workers, and research on the effects of demanding work schedules on MSD risk is an area that needs further exploration. The purpose of this report is to assess research progress to date examining the relationship between demanding work schedules and MSD outcomes and to identify areas for future study.
Theoretical Framework and Possible Mechanisms Linking Demanding Work Schedules and MSDsThe National Academy of Sciences' National Research Council and Institute of Medicine (NRC/IOM) proposed Abstract: Musculoskeletal disorders (MSDs) are a significant cause of morbidity in healthcare workers. The influence of shift work and long work hours on risk for MSDs is an area that needs further exploration. The purpose of this report is to assess research progress and gaps across studies that examined the relationship between demanding work schedules and MSD outcomes. A literature search identified 23 peer-reviewed publications in the English language that examined MSDs and long work hours, shift work, extended work shifts, mandatory overtime, or weekend work. Eight studies that examined long work hours and had some controls for physical job demands reported a significant increase in one or more measures of MSDs. Fourteen studies examining shift work had incomparable methods and types of shift work, and therefore, no clear trends in findings were identified. A small number of studies examined mandatory overtime, work on weekends and days off, and less than 10 h off between shifts. Given the complexity of the work schedule research topic, relatively few studies have adequately examined the relationship of work schedules and musculoskeletal outcomes. The review discusses research gaps including methodological issues and suggests research priorities.