By the very nature of their work, nursing personnel are susceptible to workplace injuries. Nurses have long suspected that the longer hours they work in health care settings, the longer their exposure to physical and psychosocial stressors, and therefore, the higher their risk of suffering injuries and illnesses. Until recently, however, studies on this subject were limited.
Alison Trinkoff, ScD, RN, a professor in family and community health at the University of Maryland, has been conducting the Nurses Worklife and Health Study and researching the effects of long working hours on nurses over the past 10 years.
In a study published last year focusing on the physical demands of nursing work in relation to neck shoulder and back problems in RNs (Am J Prev Med 2003;24: 270), she and her colleagues surveyed 2,000 nurses (1,000 each from Illinois and New York), chosen for the sample from a list of actively licensed nurses.
Of the 1,428 who responded, 80 percent were currently working in nursing and served as the sample for the study. Data were collected between October 1999 and February 2000. The study found that extended work hours are linked to nurse injury. Using a point system, a total work schedule score for each nurse was calculated, and showed that the likelihood of developing a musculoskeletal disorder increased 10 percent to 16 percent with each added point over the normal eight-hour-a-day, 40-hour-a-week schedule.
The prevalence of musculoskeletal disorders in the neck, shoulder, or back was 20 percent, 17 percent, and 29 percent, respectively. Working any shift other than a day shift was associated with shoulder and back disorders. Working more than 40 hours a week and work on two or more weekends a month also were associated with back disorders.
The study is funded by the National Institute of Occupational Safety and Health (NIOSH) and the Agency for Healthcare Research on Quality. The latter is a separate analysis that will examine the connection between worker injury in nursing homes and hospitals and staffing levels by facility.
The adverse schedules that are typical for nurses cause many to leave their workplace for temporary jobs to gain control of work hours and receive better pay. The nursing shortage, further complicated by the exodus of nurses from traditional settings to temporary agencies, creates a continuing cycle of negative effect on nursing schedules, the author noted.
When employees try to address this shortage through mandatory overtime, longer working hours, and requirements such as mandatory on-call, however, the result can be that even more nurses switch to environments where they have more control of their schedules. The early data reveal that schedule modifications are needed to reduce the time of exposure to demanding work conditions.
Dr. Trinkoff hopes that the association between factors related to work schedules and musculoskeletal disorders will lead to schedule modifications that will improve nurses' safety and health.
“Solutions that make work schedules more appealing can motivate nurses to stay on the job, such as treating them like the temporary nurses (allowing them to make their own schedules, flexibility, and so on),” Dr. Trinkoff said.