A Longitudinal Study of Nursing Staffs’ Shift Schedules during the COVID-19 Pandemic
DOI:
https://doi.org/10.18291/njwls.156659Keywords:
Health, Working Environment & Wellbeing, Work/Life Balance, Organization & ManagementAbstract
Working conditions among healthcare workers became more demanding during the COVID-19 pandemic, and new types of work hour schedules emerged. The aim of the study was to investigate how working hours in the Swedish healthcare sector were affected by the COVID-19 pandemic. Payroll data were extracted from one mid-size Swedish region, including 1,130,391 shifts worked by 3392 individuals between December 2018 and September 2023. Paired t-tests were used to compare working hours before and after the onset of COVID-19. There were few changes to the working hours during COVID-19. A new schedule (4 workdays, 2 days off) increased weekend work and decreased the proportion of quick returns and single free days. Exploratory analyses showed that overtime increased. In conclusion, the pandemic had few and weak effects on the ergonomic qualities of work hour schedules. More research is needed to explore whether the findings are representative of other contexts.
References
Beckers, D. G. J., Van Der Linden, D., Smulders, P. G. W., Kompier, M. A. J., Taris, T. W., & Geurts, S. A. E. (2008). Voluntary or involuntary? Control over overtime and rewards for overtime in relation to fatigue and work satisfaction. Work and Stress, 22(1), 33–50. https://doi.org/10.1080/02678370801984927
Britt, T. W., Shuffler, M. L., Pegram, R. L., Xoxakos, P., Rosopa, P. J., Hirsh, E., & Jackson, W. (2021). Job demands and resources among healthcare professionals during virus pandemics: A review and examination of fluctuations in mental health strain during COVID-19. Applied Psychology, 70(1), 120–149. https://doi.org/10.1111/apps.12304
Carrière, G., Park, J., Deng, Z., & Kohen, D. (2020). StatCan COVID-19: Data to Insights for a Better Canada Overtime work among professional nurses during the COVID-19 pandemic. Statistics Canada, https://epe.lac-bac.gc.ca/100/201/301/weekly_acquisitions_list-ef/2020/20-36/publications.gc.ca/collections/collection_2020/statcan/45-28/CS45-28-1-2020-72-eng.pdf.
Dall’Ora, C., Ball, J., Recio-Saucedo, A., & Griffiths, P. (2016). Characteristics of shift work and their impact on employee performance and wellbeing: A literature review. International Journal of Nursing Studies, 57, 12–27. https://doi.org/10.1016/j.ijnurstu.2016.01.007
Djupedal, I. L. R., Pallesen, S., Harris, A., Waage, S., Bjorvatn, B., & Vedaa, Ø. (2022). Changes in the work schedule of nurses related to the COVID-19 pandemic and its relationship with sleep and turnover intention. International Journal of Environmental Research and Public Health, 19(14), 8682. https://doi.org/10.3390/ijerph19148682
Drach-Zahavy, A., & Marzuq, N. (2013). The weekend matters: Exploring when and how nurses best recover from work stress. Journal of Advanced Nursing, 69(3), 578–589. https://doi.org/10.1111/j.1365-2648.2012.06033.x
Ervasti, J., Pentti, J., Nyberg, S. T., Shipley, M. J., Leineweber, C., Sørensen, J. K., Alfredsson, L., Bjorner, J. B., Borritz, M., Burr, H., Knutsson, A., Madsen, I. E. H., Magnusson Hanson, L. L., Oksanen, T., Pejtersen, J. H., Rugulies, R., Suominen, S., Theorell, T., Westerlund, H., … Kivimäki, M. (2021). Long working hours and risk of 50 health conditions and mortality outcomes: A multicohort study in four European countries. The Lancet Regional Health - Europe, 11. https://doi.org/10.1016/j.lanepe.2021.100212
Escher, C., Nagy, E., Creutzfeldt, J., Dahl, O., Ruiz, M., Ericson, M., Osika, W., & Meurling, L. (2023). Fear of making a mistake: A prominent cause of stress for COVID-19 ICU staff - A mixed-methods study. BMJ Open Quality, 12(1), 1–11. https://doi.org/10.1136/bmjoq-2022-002009
Ferguson, S. A., & Dawson, D. (2012). 12-h or 8-h shifts? It depends. Sleep Medicine Reviews, 16(6), 519–528. https://doi.org/10.1016/j.smrv.2011.11.001
Fischer, D., Lombardi, D. A., Folkard, S., Willetts, J., & Christiani, D. C. (2017). Updating the “Risk Index”: A systematic review and meta-analysis of occupational injuries and work schedule characteristics. Chronobiology International, 34(10), 1423–1438. https://doi.org/10.1080/07420528.2017.1367305
Gao, X., Jiang, L., Hu, Y., Li, L., & Hou, L. (2020). Nurses’ experiences regarding shift patterns in isolation wards during the COVID-19 pandemic in China: A qualitative study. Journal of Clinical Nursing, 29(21–22), 4270–4280. https://doi.org/10.1111/jocn.15464
Garde, A. H., Hansen, J., Kolstad, H. A., Larsen, A. D., Pedersen, J., Petersen, J. D., & Hansen, Å. M. (2018). Payroll data based description of working hours in the Danish regions. Chronobiology International, 35(6), 795–800. https://doi.org/10.1080/07420528.2018.1466797
Geurts, S. A. E., & Sonnentag, S. (2006). Recovery as an explanatory mechanism in the relation between acute stress reactions and chronic health impairment. Scandinavian Journal of Work, Environment and Health, 32(6), 482–492. https://doi.org/10.5271/sjweh.1053
Giusti, E. M., Veronesi, G., Gianfagna, F., Magnavita, N., Campana, F., Borchini, R., Iacoviello, L., & Ferrario, M. M. (2024). The independent and interactive effects of changes in overtime and night shifts during the COVID-19 pandemic on burnout among nurses: a longitudinal study. Scandinavian Journal of Work, Environment & Health, 50(6), 475–484. https://doi.org/10.5271/sjweh.4176
Härmä, M., Kecklund, G., & Tucker, P. (2024). Working hours and health – key research topics in the past and future. Scandinavian Journal of Work, Environment and Health, 50(4), 233–243. https://doi.org/10.5271/sjweh.4157
Härmä, M., Koskinen, A., Sallinen, M., Kubo, T., Ropponen, A., & Lombardi, D. A. (2020). Characteristics of working hours and the risk of occupational injuries among hospital employees: A case-crossover study. Scandinavian Journal of Work, Environment and Health, 46(6), 570–578. https://doi.org/10.5271/sjweh.3905
Härmä, M., Ropponen, A., Hakola, T., Koskinen, A., Vanttola, P., Puttonen, S., Sallinen, M., Salo, P., Oksanen, T., Pentti, J., Vahtera, J., & Kivimäki, M. (2015). Developing register-based measures for assessment of working time patterns for epidemiologic Studies. Scandinavian Journal of Work, Environment and Health, 41(3), 268–279. https://doi.org/10.5271/sjweh.3492
Hernandez, I., Arakelian, E., Rudman, A., & Dahlgren, A. (2024a). An organizational recovery paradox in managing working hours, staffing, and recovery during the COVID-19 pandemic - A qualitative study. Scandinavian Journal of Work and Organizational Psychology, 9(1), 6. https://doi.org/10.16993/sjwop.286
Hernandez, I., Söderström, M., Rudman, A., & Dahlgren, A. (2024b). Under pressure - Nursing staff’s perspectives on working hours and recovery during the COVID-19 pandemic: A qualitative study. International Journal of Nursing Studies Advances, 7. https://doi.org/10.1016/j.ijnsa.2024.100225
Jarrar, M., Ali, N. B., Shahruddin, R., Al-, K., Aldhmadi, B. K., Al-bsheish, M., Alsyouf, A., & Alumran, A. (2023). The impact of the working hours among Malaysian nurses on their ill-being, intention to leave, and the perceived quality of care: A cross- sectional study during the COVID-19 pandemic. Journal of Multidisciplinary Healthcare, 119–131. https://doi.org/10.2147/JMDH.S394583
Karhula, K., Puttonen, S., Ropponen, A., Koskinen, A., Ojajärvi, A., Kivimäki, M., & Härmä, M. (2017). Objective working hour characteristics and work–life conflict among hospital employees in the Finnish public sector study. Chronobiology International, 34(7), 876–885. https://doi.org/10.1080/07420528.2017.1329206
Kivimäki, M., Jokela, M., Nyberg, S. T., Singh-Manoux, A., Fransson, E. I., Alfredsson, L., Bjorner, J. B., Borritz, M., Burr, H., Casini, A., Clays, E., De Bacquer, D., Dragano, N., Erbel, R., Geuskens, G. A., Hamer, M., Hooftman, W. E., Houtman, I. L., Jöckel, K. H., … Virtanen, M. (2015). Long working hours and risk of coronary heart disease and stroke: A systematic review and meta-analysis of published and unpublished data for 603 838 individuals. The Lancet, 386(10005), 1739–1746. https://doi.org/10.1016/S0140-6736(15)60295-1
Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4(NOV). https://doi.org/10.3389/fpsyg.2013.00863
Laß, I., & Wooden, M. (2022). Weekend work and work–family conflict: Evidence from Australian panel data. Journal of Marriage and Family, 84(1), 250–272. https://doi.org/10.1111/jomf.12779
Lehmann, M., Bruenahl, C. A., Löwe, B., Addo, M. M., Schmiedel, S., Lohse, A. W., & Schramm, C. (2015). Ebola and psychological stress of health care professionals. Emerging Infectious Diseases, 21(5), 913–914. https://doi.org/10.3201/eid2105.141988
Matre, D., Skogstad, M., Sterud, T., Nordby, K. C., Knardahl, S., Christensen, J. O., & Lie, J. A. S. (2021). Safety incidents associated with extended working hours. A systematic review and meta-analysis. Scandinavian Journal of Work, Environment and Health, 47(6), 415–424). Nordic Association of Occupational Safety and Health. https://doi.org/10.5271/sjweh.3958
Nijp, H. H., Beckers, D. G. J., Geurts, S. A. E., Tucker, P., & Kompier, M. A. J. (2012). Systematic review on the association between employee worktime control and work-non-work balance, health and well-being, and job-related outcomes. Scandinavian Journal of Work, Environment and Health, 38(4), 299–313. https://doi.org/10.5271/sjweh.3307
Nymark, C., von Vogelsang, A. C., Falk, A. C., & Göransson, K. E. (2022). Patient safety, quality of care and missed nursing care at a cardiology department during the COVID-19 outbreak. Nursing Open, 9(1), 385–393. https://doi.org/10.1002/nop2.1076
Olds, D. M., & Clarke, S. P. (2010). The effect of work hours on adverse events and errors in health care. Journal of Safety Research, 41(2), 53–162. https://doi.org/10.1016/j.jsr.2010.02.002
Öster, K., Tucker, P., Söderström, M., & Dahlgren, A. (2024). Quick returns, sleep, sleepiness and stress - An intra-individual field study on objective sleep and diary data. Scandinavian Journal of Work, Environment & Health, 50(6), 466–474. https://doi.org/10.5271/sjweh.4175
Rosenström, T., Härmä, M., Kivimäki, M., Ervasti, J., Virtanen, M., Hakola, T., Koskinen, A., & Ropponen, A. (2021). Patterns of working hour characteristics and risk of sickness absence among shift-working hospital employees: A data-mining cohort study. Scandinavian Journal of Work, Environment and Health, 47(5), 395–403. https://doi.org/10.5271/sjweh.3957
Sagherian, K., Steege, L. M., Cobb, S. J., & Cho, H. (2023). Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States. Journal of Clinical Nursing, 32(15–16), 5382–5395. https://doi.org/10.1111/jocn.15566
Swedish Association of Local Authorities and Regions. (2024). Allmänna bestämmelser. https://skr.se/skr/arbetsgivarekollektivavtal/kollektivavtal/allmannabestammelserab.145.html
Totterdell, P., Spelten, E., Smith, L., Barton, J., & Folkard, S. (1995). Recovery from work shifts: How long does it take? Journal of Applied Psychology, 80(1), 43–57. https://doi.org/https://doi.org/10.1037/0021-9010.80.1.43
Vanttola, P., Puttonen, S., Karhula, K., Oksanen, T., & Härmä, M. (2020). Prevalence of shift work disorder among hospital personnel: A cross-sectional study using objective working hour data. Journal of Sleep Research, 29(3). https://doi.org/10.1111/jsr.12906
Vedaa, Ø., Harris, A., Bjorvatn, B., Waage, S., Sivertsen, B., Tucker, P., & Pallesen, S. (2016). Systematic review of the relationship between quick returns in rotating shift work and health-related outcomes. Ergonomics, 59(1),1–14. https://doi.org/10.1080/00140139.2015.1052020
Watanabe, M., & Yamauchi, K. (2018). The effect of quality of overtime work on nurses’ mental health and work engagement. Journal of Nursing Management, 26(6),679–688. https://doi.org/10.1111/jonm.12595
Wong, K., Chan, A. H. S., & Ngan, S. C. (2019). The effect of long working hours and overtime on occupational health: A meta-analysis of evidence from 1998 to 2018. Environmental Research and Publiv Health, 16(12), 2102. https://doi.org/https://doi.org/10.3390/ijerph16122102
Zhang, X., Jiang, Z., Yuan, X., Wang, Y., Huang, D., & Hu, R. (2021). Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (COVID-19) epidemic: A cross-sectional survey. International Journal of Nursing Studies Advances, 3, 100026. https://doi.org/10.1016/j.ijnsa.2021.100026
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