Extended Work Hours Research Articles

CE: The potential effects of sleep loss on a nurse's health.

While much has been written about the effects of extended work hours on quality of nursing care, nurse burnout, and job attrition, the potential adverse effects of acute and chronic sleep loss on the overall health and well-being of nurses has received little attention. The author describes the acute and chronic effects of sleep loss on nurses, strategies nurses can use to increase the quantity and quality of their sleep, and institutional policies that can promote adequate rest and recuperation between work shifts for nursing staff.

Abstract No. 386 - Gender specific preferences influencing interventional radiology specialty selection for medical students

In the upcoming years, interventional radiology will be transitioning from a fellowship to a residency program. In 2012-2013, only 15% of interventional radiology fellows were women. The purpose of our study is to evaluate gender specific preferences that may influence medical student specialty selection for residency, in particular interventional radiology. An online survey was distributed via email to assess gender specific preferences that influence specialty selection for medical students. The survey drew parallels to prior investigations looking at similar factors in comparable fields such as interventional cardiology. This survey also inquired about educational exposure to diagnostic radiology and interventional radiology during the medical school. Participation was elicited from medical schools in the Tri-state area on a voluntary basis. Statistical analysis was performed using fisher exact test with p value of < 0.05 set for significance. 106 medical students answered the distributed survey. Of those 58% (n=61) of responders were females and 42% (n=45) were males. 56% of males are considering Interventional Radiology as future specialty, as opposed to 21% of females (p=0.01). The top five deterring factors for females in terms of specialty selection were radiation exposure, extended work hours, call responsibilities, length of career and male predominance. Specifically the two significant deterring factors for females were call responsibilities and male predominance (p=0.02). Interventional radiology exposure was similar between males and females and less than that diagnostic radiology. However, males were also more likely to be part of an IR interest group in their medical school than females (p=0.003). Radiation exposure is still the number one factor that deter medical students from selecting interventional radiology as a career. Interestingly the factors that distinctly deter females rather than males from this field are the call responsibilities and current male dominance in the field.

PATRICK STEVEDORES’ CLIENT-SIDE PROJECT MANAGEMENT AT PORT BOTANY RAMP D

Patrick Stevedores’ Port Botany Container Terminal is located 10km south of the city of Sydney, NSW, Australia. The Terminal is currently undertaking the challenging process of expansion and automation while causing minimal impact to existing operations. This $350 million project includes the automation of the container straddles. As part of the Port Botany Terminal upgrade, a new entrance over the existing rail sidings has been created called Ramp D. Ramp D had to be open to traffic by April 2014 to not delay the commencement of automated straddle operations planned to commence in July 2014. This resulted in a tight construction schedule. With a congested and shared construction site the options for accelerating the programme were limited. As the client’s representative, the role was to facilitate the execution of the project. By careful scheduling, the use of extended working hours to reduce the critical path, and close cooperation by all stakeholders, the target was met.

Physicians' engagement in dual practices and the effects on labor supply in public hospitals: results from a register-based study.

BackgroundPhysician dual practice, a combination of public and private practice, has attracted attention due to fear of reduced work supply and a lack of key personnel in the public system, increase in low priority treatments, and conflicts of interest for physicians who may be competing for their own patients when working for private suppliers. In this article, we analyze both choice of dual practice among hospital physicians and the dual practices’ effect on work supply in public hospitals.MethodsThe sample consisted of 12,399 Norwegian hospital physicians working in public hospitals between 2001 and 2009. We linked hospital registry data on salaries and hospital working hours with data from national income and other registries covering non-hospital income, including income from dual work, cohabiting status, childbirths and socioeconomic characteristics. Our dataset also included hospital variables describing i.e. workload. We estimated odds ratio for choosing dual practice and the effects of dual practice on public working hours using different versions of mixed models.ResultsThe percentage of physicians engaged in dual practice fell from 35.1% for men and 17.6% for women in 2001 to 25.0% and 14.2%, respectively, in 2009. For both genders, financial debt and interest payments were positively correlated and having a newborn baby was negatively correlated with engaging in dual practice. Larger family size and being cohabitating increased the odds ratio of dual practice among men but reduced it for women. The most significant internal hospital factor for choosing dual practice was high wages for extended working hours, which significantly reduced the odds ratio for dual practice. The total working hours in public hospitals were similar for both those who did and did not engage in dual practice; however, dual practice reduced public working hours in some specialties.ConclusionEconomic factors followed by family variables are significant elements influencing dual practice. Although our findings indicate that engagement in dual practice by public hospital physicians in a well-regulated market may increase the total labor supply, this may vary significantly between medical specialties.

Long Working Hours and Emotional Well-Being in Korean Manufacturing Industry Employees

ObjectivesKorea is well known for its long work hours amongst employees. Because workers of the manufacturing industry are constantly exposed to extended work hours, this study was based on how long work hours affect their emotional well-being.MethodsThe analysis was done using the secondary Korean Working Condition Survey (KWCS). Long work hours were defined to be more than 48 hours, and they were subcategorized into units of 52 hours and 60 hours. Based on the WHO (five) well-being index, emotional state was subdivided into three groups - reference group, low-mood group, and possible depression group- where 28 points and 50 points were division points, and two groups were compared at a time. Association between long work hours and emotional state was analyzed using binary and multinomial logistic regression analysis.ResultsWorking for extended working hours in the manufacturing industry showed a statistically significant increase (t test p < 0.001) in trend among the possible depression group when compared to the reference group and the low-mood group. When demographical characteristics, health behaviors, socioeconomic state, and work-related characteristics were fixed as controlled variables, as work hours increased the odds ratio of the possible depression group increased compared to the reference group, and especially the odds ratio was 2.73 times increased for work hours between 48–52 and 4.09 times increased for 60 hours or more and both were statistically significant. In comparing the low-mood group and possible depression group, as work hours increased the odds ratio increased to 1.73, 2.39, and 4.16 times, and all work hours from working 48–52 hours, 53–60 hours, and 60 hours or more were statistically significant. Multinomial logistic regression analysis also showed that among the reference group and possible group, the possible depression group was statistically significant as odds ratio increased to 2.94 times in working 53–60 hours, and 4.35 times in 60 hours or more.ConclusionsLong work hours have an adverse effect on emotional well-being. A more diversified research towards variables that affect long work hours and emotional well-being and how they interact with each other and their relationship to overall health is imperative.

Overweight and Obesity in High Stress Workplaces

Copyright: © 2013 Faghri P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. High stress workplaces, characterized by high job demands and low job control, have been associated with increased risk for cardiovascular disease, high blood pressure, high blood sugar, and high cortisol levels [1]. Increasingly, evidence suggests overweight and obesity risk may be related to high demand, low-control work environments and extended work hours. High-stress employees often report poor eating habits, low level of physical activity, smoking/alcohol use, and weight gain [2-4]. High stress work can also lead to psychological issues including anxiety and depression [ 5].

Sleep Deprivation in Resident Physicians, Work Hour Limitations, and Related Outcomes: A Systematic Review of the Literature

Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well–being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient–related outcomes.

Impact of Layover Length on Sleep, Subjective Fatigue Levels, and Sustained Attention of Long-Haul Airline Pilots

Long-haul airline pilots often experience elevated levels of fatigue due to extended work hours and circadian misalignment of sleep and wake periods. During long-haul trips, pilots are typically given 1–3 d off between flights (i.e., layover) to recover from, and prepare for, duty. Anecdotally, some pilots prefer long layovers because it maximizes the time available for recovery and preparation, but others prefer short layovers because it minimizes both the length of the trip, and the degree to which the body clock changes from “home time” to the layover time zone. The aim of this study was to examine the impact of layover length on the sleep, subjective fatigue levels, and capacity to sustain attention of long-haul pilots. Participants were 19 male pilots (10 Captains, 9 First Officers) working for an international airline. Data were collected during an 11- or 12-d international trip. The trips involved (i) 4 d at home prior to the trip; (ii) an eastward flight of 13.5 h across seven time zones; (iii) a layover of either 39 h (i.e., short, n = 9) or 62 h (i.e., long, n = 10); (iv) a return westward flight of 14.3 h across seven time zones; and (v) 4 d off at home after the trip. Sleep was recorded using a self-report sleep diary and wrist activity monitor; subjective fatigue level was measured using the Samn-Perelli Fatigue Checklist; and sustained attention was assessed using the psychomotor vigilance task for a personal digital assistant (PalmPVT). Mixed-model regression analyses were used to determine the effects of layover length (short, long) on the amount of sleep that pilots obtained during the trip, and on the pilots' subjective fatigue levels and capacity to sustain attention. There was no main effect of layover length on ground-based sleep or in-flight sleep, but pilots who had a short layover at the midpoint of their trip had higher subjective fatigue levels and poorer sustained attention than pilots who had a long layover. The results of this study indicate that a short layover during a long-haul trip does not substantially disrupt pilots' sleep, but it may result in elevated levels of fatigue during and after the trip. If short layovers are used, pilots should have a minimum of 4 d off to recover prior to their next long-haul trip. (Author correspondence: greg.roach@cqu.edu.au)

The Effect of Shift Structure on Performance

The effect of shift structure on worker performance and productivity is of increasing interest to firms and regulatory bodies. Using approximately 743,000 emergency medical incidents attended by 2,381 paramedics in Mississippi, we evaluate the extent that paramedics' performance toward the end of shifts is impacted by shift length. We find evidence that performance deteriorates toward the end of long shifts, and argue that fatigue is the mediating factor. Our calculations imply that such deterioration may result in a 0.76 percent increase in 30-day mortality. These findings have implications for workforce organization, calling attention to regulation designed to limit extended work hours. (JEL J22, J24, J28, J45, M12)

Time Poverty, Work Status and Gender: The Case of Pakistan

The present study measures time poverty and its incidence across gender, occupational groups, industries, regions, and income levels using Time Use Survey (TUS) 2007, the first nationwide time use survey for Pakistan. In the entire TUS sample, the incidence of time poverty is 14 percent. Women are found to be more time poor than men whether employed or not. This is because of certain women-specific activities that they have to perform irrespective of their employment status. Working women are far more time poor than those not working.. Women accepting a job have to make a major trade-off between time poverty and monetary poverty. People working in professions and industries that generally require extended work hours and offer low wage rates are more time poor. This entails a situation of double jeopardy for workers who tend to be money and time poor at the same time. The close association of time poverty with low income found in this study corroborates this conclusion. Government can help reduce time poverty by enforcing minimum wage laws and mandatory ceiling on work hours in industries with high concentration of time poverty. Eradication of monetary poverty can also eliminate the need to work long hours at low wages just to survive. A fair distribution of responsibilities between men and women.is also needed. Keywords: Time Poverty, Gender Disparities, Time Use, SNA Activities, Time Use Survey, Pakistan

Chapter 21 - Managing neurobehavioral capability when social expediency trumps biological imperatives

Sleep, which is evolutionarily conserved across species, is a biological imperative that cannot be ignored or replaced. However, the percentage of habitually sleep-restricted adults has increased in recent decades. Extended work hours and commutes, shift work schedules, and television viewing are particularly potent social factors that influence sleep duration. Chronic partial sleep restriction, a product of these social expediencies, leads to the accumulation of sleep debt over time and consequently increases sleep propensity, decreases alertness, and impairs critical aspects of cognitive functioning. Significant interindividual variability in the neurobehavioral responses to sleep restriction exists-this variability is stable and phenotypic-suggesting a genetic basis. Identifying vulnerability to sleep loss is essential as many adults cannot accurately judge their level of impairment in response to sleep restriction. Indeed, the consequences of impaired performance and the lack of insight due to sleep loss can be catastrophic. In order to cope with the effects of social expediencies on biological imperatives, identification of biological (including genetic) and behavioral markers of sleep loss vulnerability as well as development of technological approaches for fatigue management are critical.

As Accessible as a Book on a Library Shelf: The Imperative of Routine Simulation in Modern Health Care

As Accessible as a Book on a Library Shelf: The Imperative of Routine Simulation in Modern Health Care

Commentary on: Fatigue and extended work hours among perfusionists: 2010 Survey

Commentary on: Fatigue and extended work hours among perfusionists: 2010 Survey

Fatigue and extended work hours among cardiovascular perfusionists: 2010 Survey

Due to the emergent unpredictable nature of cardiac surgery, perfusionists, potentially, are susceptible to extended work hours and acute sleep deprivation. While fatigue among other healthcare clinicians has been studied, there has been no research on this topic specifically in the perfusion community. Therefore, the purpose of this study was to: (1) collect preliminary data on the prevalence of fatigue in perfusion and (2) identify if there were concerns regarding fatigue, performance and perfusion safety. In May 2010, a link to a 50-question survey (surveymonkey.com) was posted on Perflist and Perfmail. The survey was closed in July 2010. There were 445 respondents and data were analyzed and expressed as a response percent. Participants included 27% chief perfusionists/managers, 67% staff perfusionists, and 6.0% other (perfusion education faculty, retired perfusionists, locum tenens). Regarding extended work hours, 68.9% of surveyed perfusionists have worked at the hospital for greater than 23 hours straight and 17.5% have worked continuously for over 36 hours. Actual performance of cardiopulmonary bypass (CPB) after 17, 23, and 36 hours of wakefulness was reported by 82.9%, 63% and 14.8% respondents, respectively. Regarding bathroom requirements while on CPB, 87.5% have felt extremely uncomfortable at least once, 19.9% have relieved themselves in the operating room at least once, and 22.3% have left the pump attended by a non-perfusionist to use the restroom at least once. Microsleep during CPB was reported by 49.5% of respondents. Automobile accidents attributed to an extended period of work and fatigue was reported by 6.9% and another 44.4% reported a near-miss auto accident. A fatigue-related minor error was reported by 66% and 6.7% admit to having a serious perfusion accident believed to be due to fatigue. Concerning critical phases of bypass, 51.5% believe that they perform less effectively when fatigued. Additionally, 75.9% indicate that they have been concerned about their ability to perform their job adequately due to fatigue-related acute sleep deprivation. Opinions regarding workplace management were as follows; 48% believe that fatigue can play a role in our profession and managers should do what they can to provide a rested staff, but, unfortunately, it is impractical to set work limits; 32.2% believe fatigue issues should be taken more seriously and specific guidelines should be stated by our professional organizations and 13.4% believe that limits should be established, legislated, and enforced by state or federal authorities. Based upon this preliminary survey data, it appears that fatigue and acute sleep deprivation is a significant safety concern in the perfusion community. Further research must be performed to understand actual performance degradation that may occur in fatigued perfusionists performing CPB.

Work Hours and Self rated Health of Hospital Doctors in Norway and Germany. A comparative study on national samples

BackgroundThe relationship between extended work hours and health is well documented among hospital doctors, but the effect of national differences in work hours on health is unexplored. The study examines the relationship between work hours and self rated health in two national samples of hospital doctors.MethodsThe study population consisted of representative samples of 1,260 German and 562 Norwegian hospital doctors aged 25-65 years (N = 1,822) who received postal questionnaires in 2006 (Germany) and 2008 (Norway). The questionnaires contained items on demography, work hours (number of hours per workday and on-call per month) and self rated subjective health on a five point scale - dichotomized into "good" (above average) and "average or below".ResultsCompared to Norway, a significantly higher proportion of German doctors exceeded a 9 hour work day (58.8% vs. 26.7%) and 60 hours on-call per month (63.4% vs. 18.3%). Every third (32.2%) hospital doctor in Germany worked more than this, while this pattern was rare in Norway (2.9%). In a logistic regression model, working in Norway (OR 4.17; 95% CI 3.02-5.73), age 25-44 years (OR 1.66; 95% CI 1.29-2.14) and not exceeding 9 hour work day and 60 hours on-call per month (OR 1.35; 95% CI 1.03-1.77) were all independent significant predictors of good self reported health.ConclusionA lower percentage of German hospital doctors reported self rated health as "good", which is partly explained by the differences in work time pattern. Initiatives to increase doctors' control over their work time are recommended.

Cultural Encounters in the Banking Sector of Serbia: The Case of Raiffeisenbank

Тhis paper aims to examine the existence of cultural shock, differences and conflicts inside Raiffeisenbank, between personnel belonging to two national cultures (Austrian and Serbian), which could, conditionally, be regarded as representatives of ’’Western’’ and ’’Eastern’’ cultural models. The focus of the research was on elements of organizational culture, such as horizontal and vertical relationships, the type of leadership, the extent of formalization of procedures and work tasks, the types of motivations for different parties, but also on certain elements of work cultures (e.g., the respect of time limits, attitude toward extended working hours, etc.). Specific focus was placed on the role of cultural mediators, whose function was to mediate in the process of adaptation by the representatives of local national culture to novelties in the organizational culture imported from the outside, but also in the process of adaptation by foreigners to the local culture. The case study comprises a short history of Raiffeisenbank, analysis of written documents, and in depth interviews with individuals who could be regarded as “typical” in the examined cultural encounters.

Junior doctors' extended work hours and the effects on their performance: the Irish case

To explore the relationship between junior doctors' long working hours and their performance in a variety of cognitive and clinical decision-making tests. Also, to consider the implications of performance decrements in such tests for healthcare quality. A within-subject design was used to eliminate variation related to individual differences. Each participant was tested twice, once post call and once rested. At each session, participants were tested on cognitive functioning and clinical decision-making. The study was based on six acute Irish hospitals during 2008. Thirty junior hospital doctors, ages ranged from 23 to 30 years; of them, 17 of the participants were female and 13 were male. Measures Cognitive functioning was measured by the MindStreams Global Assessment Battery (NeuroTrax Corp., NY, USA). This is a set of computerized tests, designed for use in medical settings, that assesses performance in memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills. Clinical decision-making was tested using Key Features Problems. Each Key Features Problem consists of a case scenario and then three to four questions about this scenario. In an effort to make it more realistic, the speed with which participants completed the three problems was also recorded. Participants' global cognitive scores, attention, information processing speed and motor skills were significantly worse post call than when rested. They also took longer to complete clinical decision-making questions in the post-call condition and obtained lower scores than when rested. There are significant negative changes in doctors' cognitive functioning and clinical decision-making performance that appear to be attributable to long working hours. This therefore raises the important question of whether working long hours decreases healthcare quality and compromises patient safety.

Impacts of solar home systems on social development in rural Bangladesh

This study was carried out to find the impacts of solar home systems (SHSs) application at selected villages in Gazipur district, Bangladesh. A questionnaire-based survey method was used to collect primary data from the period of October 2004 to January 2005. The research reveals that solar electrification provided direct and indirect benefits to the users of the system, with many implications of a permanent nature. Reduction of kerosene usage was the main impact of SHSs. It resulted in less pollution, higher quality light and more hours of light in the evening, as well as less work for cleaning kerosene lamps. Very few income generation activities were created after acquiring SHSs in the studied villages. But the people who were engaged with business using traditional fuel, switched to solar light that added a little bit more income due to extended working hours in the evening. Women and children were found to benefit from the quality of light for household work and studying in the evening. Users became accustomed to the better quality of light and could not perceive returning back to kerosene lamps. Solar electrification also added to the overall comfort and satisfaction of the consumers.

Regulation of Medical Student Work Hours: A National Survey of Deans

Because of the impact of resident duty hours on resident and medical student education, it is important to determine curriculum deans' opinions toward and current status of student work hours regulations. In 2008, the authors electronically surveyed the curriculum deans at the 126 U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME) regarding student work hours at their schools. Sixty-six respondents (82%) had a written policy restricting their students' work hours, and in 63% of these, the policy also extended to students visiting their institution. Policies applied to mandatory and elective (84%) or only mandatory (16%) rotations. About half the respondents supported a universal policy across medical schools, but of those who supported a policy, there was an equal split between whether individual schools or the LCME should create the policy. Deans felt strongly (>80%) that student well-being would be improved by work hours regulation, yet 48% noted that it would negatively affect scheduling required clerkship activities. Fifty-four percent supported the Accreditation Council for Graduate Medical Education work hours policy for students, and most (82%) felt that students should work no more than 80 hours/week. Students are always supervised, yet extended work hours can affect learning and patient and team interactions. Without a mandate, many schools have created policies to restrict student work hours. This study describes the current status and offers an opportunity for consensus building around this important issue.

The Health Care Work Environment and Adverse Health and Safety Consequences for Nurses

Nurses' working conditions are inextricably linked to the quality of care that is provided to patients and patients' safety. These same working conditions are associated with health and safety outcomes for nurses and other health care providers. This chapter describes aspects of the nursing work environment that have been linked to hazards and adverse exposures for nurses, as well as the most common health and safety outcomes of nursing work. We include studies from 2000 to the present by nurse researchers, studies of nurses as subjects, and studies of workers under similar working conditions that could translate to nurses' work environment. We explore a number of work organization factors including shift work and extended work hours, safety climate and culture, teamwork, and communication. We also describe environmental hazards, including chemical hazards (e.g., waste anesthetics, hazardous drugs, cleaning compounds) and airborne and bloodborne pathogen exposure. Nurses' health and safety outcomes include physical (e.g., musculoskeletal disorders, gastrointestinal, slips, trips and falls, physical assault) and psychosocial outcomes (e.g., burnout, work-family conflict). Finally, we present recommendations for future research to further protect nurses and all health care workers from a range of hazardous working conditions.