Daytime Shift Research Articles

Nurses wanted: Is the job too harsh or is the wage too low?

When entering the job market, nurses choose among different kind of jobs. Each of these jobs is characterized by wage, sector (primary care or hospital) and shift (daytime work or shift). This paper estimates a multi-sector-job-type random utility model of labor supply on data for Norwegian registered nurses (RNs) in 2000. The empirical model implies that labor supply is rather inelastic; 10% increase in the wage rates for all nurses is estimated to yield 3.3% increase in overall labor supply. This modest response shadows for much stronger inter-job-type responses. Our approach differs from previous studies in two ways: First, to our knowledge, it is the first time that a model of labor supply for nurses is estimated taking explicitly into account the choices that RN's have regarding work place and type of job. Second, it differs from previous studies with respect to the measurement of the compensations for different types of work. So far, it has been focused on wage differentials. But there are more attributes of a job than the wage. Based on the estimated random utility model we therefore calculate the expected value of compensation that makes a utility maximizing agent indifferent between types of jobs, here between shift work and daytime work. It turns out that Norwegian nurses working shifts may be willing to work shift relative to daytime work for a lower wage than the current one.

Developing a Decision Support Tool for Nighttime Construction in Highway Projects

This paper presents a decision support tool that is intended to help highway agencies in evaluating the suitability of nighttime construction for highway projects. This tool was developed as part of a research project sponsored by the Illinois Department of Transportation. The tool is a simple software package that was developed using a Microsoft Excel spreadsheet and Visual Basic for Applications. The proposed tool utilizes the cost-effectiveness analysis as a basis for comparison between daytime and nighttime operations. The proposed tool is mainly used whenever night shift is thought of as an alternative to the conventional daytime shift. Nonetheless, the tool is also generic in the sense that it can be used to compare different alternative plans such as different lane closure strategies or scheduling alternatives.

Pediatric Hospitalist Medicine: An Overview and a Perspective From Toronto, Canada

spent on inpatient wards, the emergency department, intensive care settings, and primary care clinics; physicians may work at community or academic centers; and models included those with regular daytime hours versus shift work, as well as incorporating house staff versus staff-only models. Communication between hospitalists and referring pediatricians was identified as a priority. A teaching and an educational component were important parts of most models and required support in terms of both faculty development and compensation. Similarly, leadership in administration and research was beginning to emerge as hospitalist fellowships and research priorities began to evolve. Evidence in support of the hospitalist model has been published, most notably by Landrigan et al, who systematically reviewed and reported 20 primary-data studies of pediatric hospitalist systems. Although limited data were available on the quality of patient care provided, length of stay and inpatient hospital costs—factors closely related to one another—were consistently decreased when hospitalist systems were compared with traditional models. Ratings of parental experience and those of house staff ’s educational experiences were also positive. Less clear is the financial impact as hospitalist programs subject to economic analyses have been found overall to lose money. Pilot data, however, indicate adjustable factors that may serve to increase hospitalist program’s profits, namely increasing the daily census and professional and consultative services. Few centers have measured clinical outcomes associated with pediatric hospitalist care, which need to be addressed in future research. The term hospitalist was introduced by Wachter and Goldman in 1996 and was more recently defined by the Society of Hospital Medicine as “physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital care.” Although hospitalists were originally described in the context of adult internal medicine, their prominence in the care of general pediatric inpatients has rapidly emerged. By 1999, 50% of academic pediatric departments in North America had incorporated a hospitalist model, and estimates suggest that 1000 pediatric hospitalists are currently in practice. Growth of the pediatric hospitalist movement is attributed to multiple factors, namely the demand for expertise specific to inpatient medicine; limitations on resident work hours, and financial pressures to decrease both admission rates and length of stay, leading to an increase in patient complexity. Recent literature describing the state of pediatric hospitalists emphasizes the diverse nature of the field. At a 2003 meeting of academic pediatric hospitalists, Lye et al found that the hospitalist role varied widely: inpatient clinical work made up 75% ± 32% of their time, which may be

Assessment of cardiovascular risk in shift healthcare workers

Shift work has been associated with an increased risk of cardiovascular disease (CVD); in particular, night work affects the circadian rhythm. The study examines the effectiveness of three screening methods and plasma hyperhomocysteinemia, an independent risk factor, in assessing the risk of CVD in 147 healthcare providers doing daytime or rotational shift work. The methods applied were: (i) the method proposed by the European Cardiovascular Indicators Surveillance Set (EUROCISS); (ii) the metabolic syndrome (MS) criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) and (iii) the MS criteria of the International Diabetes Federation (IDF). EUROCISS was unable to distinguish between the CVD risk of daytime and rotational shift workers. Both the ATPIII and the IDF detected MS, which is strongly associated with CVD, but only the IDF evidenced a significantly greater prevalence of MS (P<0.05) among shift workers. Hyperhomocysteinemia was unable to discriminate the CVD risk between daytime and shift workers, as it was influenced by multiple confounding factors. The increased risk of CVD associated with shift work is related to the greater incidence of MS among these workers. In our study a high prevalence of MS was detected only with the IDF. The method is useful for CVD prevention and the promotion of health during any medical examination of shift workers.

Detrimental Effects of Variable Work Shifts on Quality of Sleep, General Health and Work Performance

Objectives: The aim of this study was to explore the detrimental effects of working a varying pattern of 8-hour shifts on quality of sleep, general health and work performance. Subjects and Methods: The Arabic version of the Pittsburgh Sleep Quality Index (PSQI)and 2 self-administered questionnaires were used to assess quality of sleep, work performance and general health in a sample of 200 males on a schedule of varying 8-hour shifts at the Kuwait Oil Company. A matched sample of an equal number of workers on a fixed daytime shift as a control group was enrolled in the study. Results: Compared with men working on a straight daytime shift schedule, those working on 8-hour variable shifts exhibited higher rates of heavy smoking (p < 0.003), coffee/tea consumption (p < 0.0001), constipation (p < 0.002), job stress (p < 0.0001) and poor sexual performance (p < 0.0001). Variable-shift workers reported persistent sleep disturbances in 3 dimensions of the global score of the PSQI (p < 0.0001). They also had significantly more complaints of fatigue (p < 0.005), poor level of work performance (p < 0.005) and loss of concentration (p < 0.005). Shift workers were significantly more prone to making errors and having accidents at work, and were more likely to report absence from work than the controls (p < 0.0001 and p < 0.005, respectively). Conclusion: These results suggest that the majority of workers on an 8-hour variable-shift schedule experienced various health problems, poor quality of sleep and an increased risk for errors and accidents at work as compared with those workers on a straight daytime shift schedule. There is a need to compare potential benefits of an alternative work shift schedule.

Ionospheric observations made by a time-interleaved Doppler ionosonde

Mid-latitude HF observations of ionospheric Doppler velocity as a function of frequency are reported here as observed over a quiet 24-h period by a KEL IPS71 ionosonde operating at a 5-min sampling rate. The unique time-interleaving technique used in this ionosonde provided a Doppler resolution of 0.04 Hz over a Doppler range of ±2.5 Hz at each sounding frequency via FFT processing and is described here for the first time. The time-interleaving technique can be applied to other types of ionosonde as well as to other applications. The measurements described were made at a middle latitude site (Salisbury, South Australia). Doppler variations (<30 min) were ever present throughout the day and showed short-period TID characteristics. The day-time Doppler shift was found to closely follow the rate-of-change of foF2 as predicted by a simple parabolic layer model. The descending cusp in short-period TIDs is shown to mark an abrupt change with increasing frequency from negative towards positive Doppler shift with the greatest change in Doppler shift being observed below the cusp. The “smilergram” is introduced as observed in both F2 and Sporadic E. The characteristic curve in Doppler versus group height at a single frequency is described and related to changes in reflection symmetry, velocity and depth of moving ionospheric inhomogeneities.

Effect of shift work on body mass index and metabolic parameters

The aim of this cohort study was to investigate the effects of shift work on changes in parameters related to metabolic disturbances. The study population included 1529 male blue-collar workers, aged 19-49 years at baseline, working in a sash and zipper factory in Japan. The participants were divided into four groups according to the work schedule at baseline, the end point being workers doing fixed daytime work in both years (day-day), workers who changed from shift work to fixed daytime work (shift-day), workers who changed from fixed daytime work to shift work (day-shift), and workers doing shift work in both years (shift-shift). The changes in body mass index (BMI), blood pressure, serum cholesterol, and glycosylated hemoglobin A1c over a period of 10 years were compared among the groups by work schedule. The age-adjusted mean increase in BMI was 1.03 kg/m(2) for the day-shift workers, and it was significantly larger than that of the day-day workers and shift-day workers. The shift-shift workers showed a significantly larger increase in BMI than the day-day workers. These tendencies remained after adjustment for age and all other confounding factors, such as BMI, smoking, drinking, and leisure-time physical activity at baseline. The increase in total cholesterol tended to be higher among the shift-shift workers and the day-shift workers, but there were no significant differences. Blood pressure and hemoglobin A1c did not differ among the four groups. Shift work is considered to be a risk factor for excess weight. However, no significant difference in the biomarkers was found between daytime workers and shift workers.

Validity and reliability of bedside nursing assessments of pain, sedation and delirium.

Introduction: Critically ill patients should routinely be evaluated for the presence and intensity of pain, assessed as to their sedation level, and screened for delirium. However, assessing both pain and delirium in intensive care unit (ICU) patients is particularly challenging, given the confounding effect of sedation. The purpose of this study was to describe the validity and reliability of real-time practice-based nursing concurrent assessments of pain, sedation and delirium, in an ICU where these three assessments occur as part of routine nursing care. Methods: Thirty randomly selected nurses were observed by one of two trained adjudicators for documentation and clinical bedside evaluation of pain, sedation level and delirium scoring. The scales were the numeric rating scale,1 the Richmond agitation and sedation scale2 and the intensive care delirium screening checklist3 score for the evaluation of delirium. Each feature was assessed as to documentation in the bedside nursing sheets; accurate use of a scale; and validity of use of the scale with a joint bedside examination of the patient. Results: The reliability between adjudicators for the bedside evaluation of pain and sedation was 100%. The Cronbach’s α score for the evaluation of delirium was 86.3% overall. Except for the agitation/slowing criteria (70.8%), reliability between adjudicators was over 80% for the other seven criteria of the delirium score. A majority of nurses (27/30) documented pain assessments and 20/30 followed recommended standards. Nurses relied on their own evaluation of the patient’s pain 25% of the time, without an objective patient-driven scale. Bedside pain evaluation comparing nurses to adjudicators showed perfect correlation. Sedation was often documented (28/30) correctly (27/30); at bedside assessment of sedation, the correlation (r2) with adjudicators was 0.85 (P < 0.0005, Cronbach’s α of 0.960). A majority of nurses documented delirium scales (28/30); 18 of the 27 available scores showed proper scale use. Bedside assessments showed a r2 of 0.854 (P < 0.0005, Cronbach’s α of 0.957). The daytime shift (mean ICU nursing experience: 11.5 years) had the best overall performance; the night shift was next (mean ICU nursing experience: 2.7 years) and the evening shift (mean ICU nursing experience: 6.3 years) the worst. The highest variability in nursing assessment performance occurred in delirium assessments of psychomotor agitation or slowing. Conclusions: In a single centre ICU with mandated routine assessments, the evaluation of pain, sedation and delirium occurs over 90% of the time. Assessment quality varies based on type of assessment (with sedation being evaluated best, delirium next best, and pain least well). Daytime, night time, and evening nurses’ performance vary significantly, particularly with regard to delirium assessment.

Sleep Parameters among Offshore Workers: An Initial Assessment in the Campos Basin, Rio De Janeiro, Brazil

Shift work has potentially adverse effects on health, particularly on sleep. The purpose of the present study was to assess sleep parameters among personnel working in oil and gas offshore installations in the Campos Basin, Rio de Janeiro, Brazil. One hundred and seventy-nine subjects were asked to complete a sleep questionnaire with multiple-choice answers. Offshore workers were divided into two groups according to their work schedule: (1) fixed daytime workers (n = 86; age: 35.8 ± 9.6 yrs) and (2) shift (n = 87) or night (n = 6) workers (total n = 93; age: 37.7 ± 9.7 yrs). Shift/night workers reported poor sleep more frequently than the daytime workers (20.4% vs. 1.2%, p < 0.01), as well as habitual difficulty in falling asleep (15.1% vs. 4.7%, p < 0.01), long latency of sleep onset (28% vs. 7%, p < 0.01), fragmented sleep (45.2% vs. 16.3%, p < 0.01), short sleep episodes (44.1% vs. 16.3%, p < 0.01), irregular bedtimes (29.0% vs. 12.8%, p < 0.01), and feeling tired upon awakening (15.1% vs. 3.5%, p < 0.01). Habitual napping and loud snoring were reported twice as often in shift/night than in day workers (p < 0.01). Nightmares, somnambulism, and unpleasant feeling in the legs were equality reported by both groups (p > 0.05). Few offshore workers had sought medical help for their sleep problems. A higher number of shift/night workers reported feelings of sadness compared with day workers (26.9% vs. 9.3%, p < 0.01). The findings of this study show that subjective reports of sleep-related problems are quite common among Brazilian offshore shift workers. Reliance on self-reported sleep problems and a cross-sectional design are the main limitations of our study.

Relationship Between Occupational, Industrial, and Sociodemographic Characteristics and Job Start Times: Evidence from Current Population Survey

Alternative work arrangements and unconventional shift schedules are increasingly becoming a part of the economy. Temporal mismatch problems occur when individuals who are traditionally transit dependent do not have access to potential job locations during off-peak times. The Current Population Survey is used to examine the relationships between job start times and a set of Sociodemographic, occupational, and industrial characteristics. A binary response variable, conventional and unconventional start times, gives preliminary insight into the nature of these relationships. A detailed multinomial logit model gives more in-depth insight by analyzing the discrete choice of job start times during unconventional hours, such as the p.m. hours, night hours, or midday, relative to a baseline daytime shift. In addition, probabilities of working in jobs with alternative start times are developed for a set of hypothetical workers with key sociodemographic profiles. It is concluded that workers are self-selected into certain occupations in specific industries by their skills, education, and other workforce factors. The nature of jobs has implications for work schedules and alternative work arrangements. The ability to select certain schedules and the work arrangement of choice therefore is conditional on being employed in those types of jobs. Thus, there appears to be some type of simultaneity between the type of occupation and work schedules. It appears that policies to address the temporal mismatch problem are partly an issue of workforce development (so that workers can seek jobs in more work-arrangement-friendly occupations) and partly a transportation problem.

Noise, stress, and annoyance in a pediatric intensive care unit.

To measure and describe hospital noise and determine whether noise can be correlated with nursing stress measured by questionnaire, salivary amylase, and heart rate. Cohort observational study. Tertiary care center pediatric intensive care unit. Registered nurses working in the unit. None. Eleven nurse volunteers were recruited. An audiogram, questionnaire data, salivary amylase, and heart rate were collected in a quiet room. Each nurse was observed for a 3-hr period during patient care. Heart rate and sound level were recorded continuously; saliva samples and stress/annoyance ratings were collected every 30 mins. Variables assessed as potential confounders were years of nursing experience, caffeine intake, patients' Pediatric Risk of Mortality Score, shift assignment, and room assignment. Data were analyzed by random effects multiple linear regression using Stata 6.0. The average daytime sound level was 61 dB(A), nighttime 59 dB(A). Higher average sound levels significantly predicted higher heart rates (p =.014). Other significant predictors of tachycardia were higher caffeine intake, less nursing experience, and daytime shift. Ninety percent of the variability in heart rate was explained by the regression equation. Amylase measurements showed a large variability and were not significantly affected by noise levels. Higher average sound levels were also predictive of greater subjective stress (p =.021) and annoyance (p =.016). In this small study, noise was shown to correlate with several measures of stress including tachycardia and annoyance ratings. Further studies of interventions to reduce noise are essential.

Effect of dilution of sports drink on water balance and beverage preference of heat-exposed steel workers.

Eight skilled workers engaged in heat-exposed work in front of a blast furnace in a steel factory were asked to drink a sports drink or one of its dilutions of x 2, x 3, or x 5 during a regular daytime shift in the summer of 1999. A regular lunch was taken and the examined beverage was iced and was allowed to be consumed ad libitum. The beverage was changed each day during four days of the experiment without informing the dilution ratio. The non-diluted beverage contained 21 mEq/l of Na+, 5 mEq/l of K+, 6.7 g/dl of carbohydrate. In average, the body temperature measured in the ear canal was elevated by 0.34 degree C, the loss of body weight was 1.77 kg, total beverage intake was 1,875 g, total amount of urine was 291 g, and the total water loss was 3,732 g (1,350-5,810 g) during a single shift. Twenty out of 24 cases experienced more than 1.5% of weight reduction during morning work without noticing any subjective symptoms of dehydration. The amount of weight loss during morning work was significantly smaller when x 2 or x 3 dilution was taken compared to a non-diluted beverage. The mean value of urinary Na+ concentration was decreased after 8 hours of work; however, the difference was not significant. The urinary K+ concentration was significantly increased. When the total amount of urinary sodium excretion in stored urine was calculated, the x 3 dilution recorded the largest amount. Regarding palatability, the x 2 dilution received the best evaluation, whereas all subjects felt the original beverage as too condensed. We did not observe any adverse effect from diluting the sports drink for x 2 or x 3, when supplying them as water and electrolyte replacements for dehydrated steel workers.

Recommendations for the implementation of Neoral C(2) monitoring in clinical practice.

Recommendations for the implementation of Neoral C(2) monitoring in clinical practice.

Can Nurses Be Employed in 12-Hour Shift Systems?

Nurses are often obliged to work in a 12-hr shift work system. We have decided to check whether such a working system constitutes an excessive load for nurses. On the basis of a questionnaire survey among nurses working in an 8-hr daytime shift system (169 nurses) and in a 12-hr shift (536 nurses), the amount of physical workload, work stress, and after-work activities were compared. Data analysis has shown that a 12-hr shift system is characterized by less significant physical workload but greater mental load. The nurses working in a 2-shift system were more tired after work, but they could spend more time on leisure activities and do housework. The data suggest that there are no significant contraindications for nurses to work in a 2-shift system.

Characterization of the triage process in neonatal intensive care.

Despite intense interest in allocation of resources to neonatal intensive care, no description exists of resource use by the large numbers of newborns admitted for triage, the process of short-term evaluation and management of infants after delivery. This study characterized the triage phase of neonatal care with respect to infant demographics, risk factors for illness, and the course of the hospital admission. We hypothesized that triage infants were responsible for a significant fraction of total intensive care resource utilization, and that patterns of use were predictable. Cross-sectional cost analysis of prospectively collected data. Data were collected prospectively on 2486 inborn infants admitted to two neonatal intensive care units (NICUs) for <24 hours and subsequently discharged to routine care. Over the 11-month study period, these two hospitals delivered 15 097 live births and admitted a further 1837 infants for nontriage NICU care. On a 50% random subsample, we calculated severity of illness using the Score for Neonatal Acute Physiology (SNAP) and applied a NICU resource checklist. Daily NICU workload was estimated according to the number and labor intensity of NICU admissions using Medicus and SNAP. Charges were obtained from patient-level item charge records and converted to costs using Medicare ratios of costs to charges. Length of stay (LOS) and costs for triage were correlated with diagnoses, perinatal descriptors, severity of illness, and markers of concurrent NICU workload using stepwise regression. Mean birth weight for triage infants was 3367 g (standard deviation, 600 g) and mean gestational age 39.1 weeks (standard deviation, 1.8 weeks). The predominant reasons for evaluation were exclusion of sepsis (34%), birth complications including meconium aspiration, perinatal depression and trauma (24%), and transitional respiratory distress (23%). Severity illness, as measured by SNAP, was minimal, with 70% having scores of 0, indicating no derangement. Only 6% experienced depressed 5-minute Apgar scores (<7), and 80% required no delivery room resuscitation. The most frequent forms of resource use were antibiotic administration (34%), placement of a peripheral intravenous line (40%), cardiac monitoring (53%) and external warming (26%). Median LOS was 102 minutes, corresponding over the study period to 2% of total NICU hours but 7% of NICU days charged. Median cost was $870, with aggregate costs accounting for a total of 9.5% of total NICU costs. In the multivariate model, LOS was increased by respiratory diagnosis or hypoglycemia, severity of illness, lower gestational age, the need for intravenous placement, daytime shift, hospital, and lower acuity of concurrent NICU admissions (R2 = 0.24). Neonatal triage is a low-acuity but time-intensive process that contributes significantly to total resource use by newborns because of the large numbers of infants involved. Both LOS and costs are affected not only by infant medical characteristics but also by nonmedical markers of unit structure, which may be amenable to change. This source of resource consumption should be recognized in future assessments of costs associated with neonatal intensive care.

Nurses Who NURSE

MARTIN, NETHA M.; HOULIHAN, HARRIET F.; KOERBER, VIRGINIA R.; MACY, D. LAVONNE Author Information

高温作業と身体機能の逐時的ならびに季節的変動に関する研究

1. Body functions as revealed by body temperature, pulse rate, blood pressure, body weight and grip strength were observed in two to four days every month throughout a year in a team of seven workers working in a hot environment. Measurements were made six times in a shift, beginning just before the commencement of work and ending just after the finish. 2. In the case of daytime shift, body temperature showed two maxima at about 9.30 a.m. and 3 p.m., pulse rate and blood pressures (systolic and pulse) showed S-shaped change, concave in the morning and convex in the afternoon. In the case of night shift, body temperature, pulse rate, as well as blood pressures showed skew V-shape, lowering in the early morning. In this case, exact phase displacement of body functions by 12 hours could not be seen, although disturbances of the natural physiological wave were detected in body temperature and systolic blood pressure after the midnight. 3. Besides work, rest, food-intake and psychic influences, environmental temperature was found to have difinite effects on physiological manifestations. 4. Monthly changes of physiological functions were relatively closely related to temperature conditions of the working place and those of the room for measurement. Body temperature, pulse rate, or decrease of body weight (apparent as well as net) had a peak in summer and a bottom in winter, while systolic blood pressure or pulse pressure showed just the reverse. In the case of night shift, such differences in body functions in summer as against in winter were not so clear as in the daytime shift.