Shift Work Nurses Research Articles

Patient safety management activities and perceived workload of shift-work nurses, moderated by the perceived importance of patient safety management.

To explore the relationship between patient safety management and each aspect of nurses' workload and to report the moderating effects of the perceived importance of patient safety management on these relationships. As the importance of patient safety is emphasized, nurses' work demands, including patient identification, infection control, and prevention of falls and pressure ulcers, are increasing. However, differences according to hospital type and nurses' increased workload have not been considered when measuring nurses' workload. This study used a cross-sectional research design and an online survey, adhering to the STROBE reporting guidelines. The study population consisted of 215 shift-work nurses employed in tertiary or general hospitals in Korea. Data were collected in January 2024. Patient safety management activities had a positive effect on the pace and amount of work, emotional workload, and mental workload, and a negative effect on work organization (interruption). The perceived importance of patient safety management negatively moderated the effects of perceived patient safety management activities on emotional workload and work organization. This study clarifies the relationship between patient safety activities and each aspect of nurses' workload. The additional demands on nurses due to patient safety management activities should be considered when measuring their workloads and determining adequate nurse staffing levels. To manage the burden of nurses' work demands effectively, it is essential to maintain adequate staffing levels and continuously monitor the patient safety climate. This approach will increase nurses' perception of the importance of patient safety management. Continuous education on patient safety should also be provided.

Development of the Quality of Life Scale for Shift-Working Nurses

Development of the Quality of Life Scale for Shift-Working Nurses

Do shift-working nurses’ work-life quality relate to their physical health and diet quality?

Abstract Background Shift work negatively affects work-related quality of life and this situation causes significant labour force losses and decreased productivity in the society, especially health problems in nurses. This study was conducted to determine the relationship between work-related quality of life, physical health level and nutritional behaviours of nurses working in shifts. Methods This descriptive and relationship-seeking study was conducted with 312 nurses selected by quota sampling in Istanbul. Data were collected between December 2022 to July 2023 using the The Professional Quality of Life Scale (ProQOL), Physical Health Questionnaire and Food Consumption Frequency Questionnaire. Descriptive statistics and Pearson correlation tests were conducted on IBM SPSS 25.0. BeBIS 7.1 software were used for calculation diet index. Results Compassion Satisfaction (CS), Burnout (B) and Compassion Fatigue (CF) scores of nurses was examined, a relationship was found between CS score and B score (r=-0.39 p < 0.05) and between B score and CF score (r = 0.58 p < 0.05). CS score correlated with Cardiovascular Risk Level score (r=-0.15 p < 0.05) and diet index score (r = 0.15 p < 0.05). B score correlated with Gastrointestinal Risk Level score (r = 0.27 p < 0.05) and Cardiovascular Risk Level score (r = 0.38 p < 0.05). There was a correlation between the score of CF and Gastrointestinal Risk Level score (r = 0.25 p < 0.05) and Cardiovascular Risk Level score (r = 0.31 p < 0.05). Daily energy, fibre, vitamin B1 and C, folate, calcium and magnesium intakes of nurses were lower than the recommended. Conclusions Research results support that the gastrointestinal and cardiovascular systems have a direct relationship with stress and emotional states. In the policies to be developed within the scope of occupational health nursing practices, it is recommended to carry out studies to improve the physical health and nutritional behaviours of nurses in order to improve their work-related quality of life. Key messages • Nurses are a risky occupational group in terms of burnout. Protection studies should be prioritised to prevent burnout. • Gastrointestinal and cardiovascular system complaints of nurses should be paid special attention during recruitment and periodic examinations.

Effectiveness of Gamification Intervention Platform on the Work Stress of Shift-Work Nurses in the Post-Pandemic Era.

In the post-pandemic era, the work pressure, trauma, anxiety, and burnout of shift nursing staff has continued to rise in all levels. By introducing Healing Games, turning interactions into game-like situations and using mindfulness as a framework, this will allow the nursing staff to realize their self-healing and help reduce stress.Through the establishment of this healing & stress-relieving game for nursing (HSR game-N) will also have a positive self-control effect on the negative emotions of work pressure. The application of such technology used by shift nurses can help negate and decrease the work pressure of shift nurses.

Relationship between social jetlag and body mass index in nurses working shift schedules: a cross-sectional study

This study aimed to explore the relationship between shift-working nurses’ social jetlag and body mass index (BMI) and provide a theoretical basis for nursing managers to develop appropriate health interventions. Shift work is unavoidable in nursing and is associated with circadian rhythm disorders. Social jetlag is prevalent in shift-working nurses and is associated with adverse health outcomes (particularly metabolism-related indicators). BMI is a significant metabolic indicator, and research has demonstrated its effectiveness in predicting the formation of metabolic syndrome. The relationship between social jetlag and BMI can be explained by considering physiological, psychological, and behavioral factors. However, most studies on social jetlag and health status are focused on non-shift nurse populations, with fewer studies on shift workers. Five tertiary hospitals located at similar latitudes in Southwest China were selected for the study. We surveyed 429 shift-working nurses using sociodemographic data, the Munich Chronotype Questionnaire for Shift Workers, and BMI. The restricted cubic spline model was used to analyze the relationship between social jetlag and BMI among shift-working nurses, and segmented linear regression was performed around the inflection point using multiple linear regression analysis. The results revealed that social jetlag (82.0 [85.0] min) was experienced by 64.6% of the shift-working nurses. After controlling for confounding variables, the model with seven knots had the lowest accepted Akaike information criterion value, and there was a U-shaped relationship between shift-working nurses’ BMI and social jetlag in this model; its inflection (lowest) point of 20.7 was considered the cut-off point. Segmented regression showed that for BMI < 20.7, BMI was significantly negative with standardized social jetlag; whereas with BMI > 20.7, BMI was significantly positive with standardized social jetlag. BMI has a U-shaped relationship with social jetlag, and attention should be paid to overweight or underweight shift-working nurses to detect early circadian rhythm disorder. Shift-working nurses with high social jetlag tended to have higher/lower BMI, which should be further investigated in the future, to minimize metabolic diseases among them.

간호사의 교대근무 직무만족도 측정 도구 개발

The purpose of this study was to develop and test the measurement for job satisfaction of the shift work nurses. In accordance with the stages of scale development by DeVellis, 10 expert nursing administrators reviewed the content validity. 80 voluntary participants answered the initial instrument. Content, construct, and criterion-related validities were analyzed using exploratory factor analysis and confirmatory factor analysis. Reliability was approved by the Cronbach’s alpha coefficient. As a result of the study, the measuring scale for job satisfaction for the shift work nurses consists of 10 items, with 3 factors. The model fit was good with all indicators (χ2 38.318(p-value .205), RMSEA .050, TLI .955, CFI .974). The Cronbach’s alpha was .775, content validity, criterion-related validity and discriminant validity was all approved but the convergent validity was partially met. A specified measuring scale for job satisfaction of the shift work nurses had been developed and the validity and reliability of the measurement were analyzed. Although the convergent validity was partially not perfectly secured, overall validity and reliability of the measurement had been approved. It may be necessary to repeatedly measure job satisfaction related to shift work using the developed scale among a larger sample of subjects to ensure the validity of the developed measurement. Furthermore, it is expected that by utilizing the developed measurement, the job satisfaction of nurses working shifts can be measured and used as an indicator for organizational performance improvement.

Investigation of the possible effects of night shift on telomere length and mtDNA copy number in nurses

In this study, we aimed to investigate the impacts of altered circadian rhythm on telomere length and mtDNA copy number (mtDNA-CN) in nurses working night shifts. In our study, 52 healthy nurses working in shifts at Ondokuz Mayıs University Hospital and 45 healthy control subjects working during the day were included. qRT-PCR technique was used for the determination of telomere length and mtDNA-CN. It was observed that the shift-work group had poor sleep quality (p = 0.004), feeling tired (p < 0.01) and stressed (p = 0.02) more than control group working during the day. Nurses working in shifts were found to have 1.18 times longer telomeres with respect to the control group working during the day (p = 0.005). When compared among shift workers, poor sleep quality and insufficient sleep duration shortened telomeres (r = 0.32; p = 0.02). There was no statistically significantdisparity regarding mtDNA-CN among the nurses working in shifts and the control group working during the day (p = 0.07). Insufficient sleep was associated with decreased mtDNA-CN when shift-working nurses were compared according to sleep quality (p = 0.006). Furthermore, mtDNA-CN of nurses with poor sleep quality was correlated with lower mtDNA-CN in comparison to nurses with good sleep quality (r = 0.284; p = 0.04). The mtDNA-CN of the nurses was positively associated with the sleep duration the night sleep before the night shift (r = 0.32; p = 0.02). Inadequate sleep duration and quality were observed to cause a reduction in mtDNA-CN of nurses. In conclusion, it has been observed that poor sleep quality and duration are related to shortened telomere length and decreased mtDNA-CN in night shift nurses.

Implementing ward-based practice books to increase the amount of practice completed during inpatient stroke rehabilitation: a mixed-methods process evaluation

Purpose Stroke survivors must complete large amounts of practice to achieve functional improvements but spend many hours inactive during their rehabilitation. We conducted a mixed methods process evaluation exploring factors affecting the success of a 6-month behaviour change intervention to increase use of ward-based practice books. Methods Audits of the presence, quality and use of ward based-practice books were conducted, alongside focus groups with staff (n = 19), and interviews with stroke survivors (n = 3) and family members (n = 4). Quantitative data were analysed descriptively. Focus group and interview transcripts were analysed using qualitative analysis. Results Personal (patient-related) factors (including severe weakness, cognitive and communication deficits of stroke survivors), staff coaching skills, understanding and beliefs about their role, affected practice book use. Staff turnover, nursing shift work and a lack of action planning reduced success of the behaviour change intervention. Conclusions Staff with the necessary skills and understanding of their role in implementing ward practice overcame personal (patient-related) factors and assisted stroke survivors to successfully practice on the ward. To improve success of the intervention, repeated training of new staff is required. In addition to audit and feedback, team action planning is needed around the presence, quality, and use of ward practice books.

Effects of working conditions on the perception of night work safety and health effects on nurses.

To examine night working conditions by shift work type and identify the effects of night working conditions on nurses' perceptions of shift work safety and health effects. Night work is the main factor affecting nurses' health. However, the safety of night working conditions has not been sufficiently examined in previous studies. This study used a cross-sectional research design and an online survey using a tool released by the Australian Manufacturing Workers' Union, and the responses of 348 shift work nurses in Korea were analyzed. Logistic regression analysis was used to examine the effects of shift work conditions on the perceived safety of night work and health effects. The STROBE reporting guidelines were utilized, and data were collected from December 1 to December 31, 2021. The adjusted logistic regression analysis showed that perceived threat to safety and the health effects of shift work were not significant according to shift type. However, night-shift-work nurses who worked alone (P=0.003), lacked an emergency recovery system (P=0.026), and had difficulty commuting perceived a threat to their health (P=0.007). Additionally, nurses who experienced loss of concentration (P=0.006) and inadequate rest time (P<0.001) perceived the health effects of shift work. Urgent monitoring of night work conditions is necessary for the 2-shift work type. Nurses must work night shifts together and an emergency system should be established for their safety. Night work conditions should be improved to prevent the hazards of night work and its negative health effects on nurses. This study suggests the necessity of a policy to enhance night work safety, including emergency coping systems and sufficient inter-shift rest time.

Relationships among meal time, break time and workplace characteristics of nurses who work day, evening and night shifts: a cross-sectional study

ABSTRACT Objectives. This study aimed to examine the relationships among shift-working nurses’ meal time, break time and workplace characteristics. Methods. The cross-sectional study analyzed 351 questionnaires from 117 nurses who worked three shifts, drawn from eight nursing units in two tertiary hospitals located in South Korea. Meal time and break time during work were investigated through a questionnaire that participants completed immediately after the end of each shift. Regression analysis was conducted to investigate the associations between nurses’ work characteristics and meal time and break time. Results. Meal time and break time were less than 30 min on all shifts and significantly longer on the night shift than on the other shifts. As patients’ average length of stay increased, meal time increased on day and night shifts, while break time decreased on evening shifts. Overall, a higher nursing staff-to-patient ratio was associated with shorter meal and break times. Conclusions. It was found that nurses were not able to take proper time for meals and breaks while working. A realistic and specific strategy should be prepared to address this issue, with appropriate consideration of the specific characteristics of nurse staffing, patients’ conditions and shifts.

가정간호 업무 관리를 돕는 캘린더 앱 디자인 연구

The purpose of this study is to propose a calendar app that can help manage schedules and work for Home Care Nurses who feel difficulty due to heavy workload. First, as a result of case analysis of related apps, it was found that various services other than calendar functions were provided, and that there was no app for nurses performing visiting schedules because all cases were produced for shift-working nurses. After conducting an in-depth interview, we were able to derive six key requirements by building and classifying them as an Affinity Diagram. Behavior pattern analysis was conducted using the data, and after grouping into two representative groups, a Persona and Circumstantial Scenario were produced to confirm the requirements of each aspect. Based on this, it was confirmed that effective services can be provided as a result of conducting usability evaluation after creating a prototype app. Finally, it concludes with conclusions and suggestions, and look forward to further research in the future.

Depressive Symptoms and Missed Nursing Care among Clinical Nurses: A Cross-Sectional Survey

Purpose: This study aimed to compare missed nursing care between nurses with and without depressive symptoms. Methods: A cross-sectional survey was conducted with shift-working nurses at a general hospital in South Korea. Data from 184 nurses were analyzed using the independent t-test, the &lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; test and the Fisher’s exact test. Results: The most frequently missed nursing care items reported by hospital nurses were, in descending order, monitoring intake/output, assessing the effectiveness of medications, bathing and skin care, washing hands. The order of missed nursing care items was similar between groups with and without depressive symptoms, but there were statistically significant differences between the two groups in the mean scores for vital signs, bedside glucose monitoring, turning patients every 2 hours, providing emotional support to patients, skin/wound care, patient discharge planning, response to the call light, and pro re nata (PRN) medication requests acted on. Conclusion: Nurses’ mental health needs to be monitored and managed more closely, as it is correlated to missed nursing care. Health institutions and nursing departments should support nurses through strategies that can quickly detect and manage nurses’ depressive symptoms. Systematic resources incorporating social support among nurse colleagues could also be used as strategies to reduce depressive symptoms and missed nursing care.

Occupational and Psychological Factors Associated With Burnout in Night Shift Nurses.

Providing inpatient nursing care inevitably involves night shift work. However, night shift work nurses often face psychiatric health problems such as burnout. If night shift work is an essential work type for nurses, it is necessary to select personnel suitable for night shift work or establish improvement measures such as psychiatric intervention through psychiatric evaluation. The objective of this study was to identify factors that could be interventional among factors affecting burnout in shift-working nurses. A total of 231 night shift female nurses participated in this study. A questionnaire survey was given to assess their general characteristics. To assess burnout, the Maslach Burnout Inventory-General Survey Korean version was adopted. In addition, several mental health scales were used to identify individual psychological characteristics. To identify variables associated with the presence of burnout, odds ratios were calculated using a logistic regression model taking three dimensions of burnout as a dependent variable after adjusting for psychological and occupational factors. High resilience was a significant preventive factor in the three dimensions of burnout. Regarding occupational factor, the longer the duration of employment, the higher depersonalization, but the professional efficacy was good. Our results indicate that resilience and social support could be prevention factors for burnout. This study is meaningful in examining items that require active intervention and support for burnout targeting night shift nurses who are indispensable for patient care.

Relationship between shift assignments, organizational justice, and turnover intention: A cross-sectional survey of Japanese shift-work nurses in hospitals.

Shift management and planning processes for shift-working nurses are important for their continued work. This study aimed to determine the association between shift assignments, organizational justice, and their interaction with turnover intention among shift-work nurses. This cross-sectional study used an online questionnaire administered to Japanese nurses between January and February 2020. Enquiries pertaining to their daily start and end times for each shift type, the shift assignments, organizational justice, and their turnover intention were made. To examine the association with turnover intention, logistic regression analysis was performed with shift assignments, organizational justice, and their interaction terms as independent variables. A total of 386 nurses participated in the final analysis. Of these, 161 nurses (41.7%) had turnover intention. Unequal work assignments and procedural justice were significantly associated with turnover intention. However, the interaction between these factors was not significant. The results suggest that procedural justice in the workplace and turnover intention are related, but in shift planning, even procedural justice cannot buffer unequal work from leading to turnover intention. This study provides valuable insights for nursing managers who manage the schedules of shift-working nurses.

Occupational and leisure-time physical activity and associated factors among shift-working registered nurses: A cross-sectional study

BackgroundLifestyle behaviors, including physical activity, may help to mitigate the chronic disease and mental health consequences of shift work in nurses at the individual level. The physical activity levels of shift-working nurses and factors that predict physical activity in this population are unclear. ObjectiveThe primary aim of this study was to describe work and leisure-time physical activity behaviors in shift-working hospital nurses and determine behavioral, biological, or work-related factors that influence physical activity. DesignObservational; cross-sectional. Setting(s)Acute care hospital system. ParticipantsCurrent registered nurses (N = 112) with a shift work schedule (rotating, mixed, or permanent night shift) MethodsOnline validated questionnaires were used to assess work and leisure physical activity levels (International Physical Activity Questionnaire); Theory of Planned Behavior constructs (attitudes, subjective norms, perceived behavioral control, and intention) related to physical activity; and morningness-eveningness. Work-related characteristics were also assessed. Structural equation models were examined for the Theory of Planned Behavior constructs. ResultsShift-working nurses reported 227 (±265) minutes/week of leisure-time and 566 (±868) minutes/week of occupational moderate-to-vigorous physical activity. Attitude (standardized coefficient = 0.63; p < 0.05) was the strongest predictor of physical activity intention, and intention (standardized coefficient = 0.40; p < 0.05) was a significant predictor of leisure-time physical activity behavior. There were no statistically significant differences in physical activity type and amount between those who identified as “morning”, “intermediate”, or “evening” types. Clinical nurse leaders engaged in statistically significantly less leisure-time physical activity than direct care nurses (703 ± 1142 vs. 1202 ± 1372 MET-minutes/week) (p = 0.013). ConclusionsOur findings suggest that on average, shift-working registered nurses report meeting national physical activity guidelines for leisure and occupational physical activity; however, there is considerable interindividual variability. Theory of Planned Behavior constructs, especially attitude and intention, were significantly associated with leisure-time physical activity but not occupational physical activity, emphasizing the importance of targeting them in interventions to increase physical activity levels among shift-working nurses.

Pilot feasibility testing of biomathematical model recommendations for personalising sleep timing in shift workers.

Sleep disturbances and circadian disruption play a central role in adverse health, safety, and performance outcomes in shift workers. While biomathematicalmodels of sleep and alertness can be used to personalise interventions for shift workers, their practical implementation of is undertested. This study tested the feasibility of implementing two biomathematical models-the Phillips-Robinson Model and the Model for Arousal Dynamics-in 28 shift-working nurses, 14 in each group. The study examined the overlap and adherence between model recommendations and sleep behaviours, and changes in sleep following the implementation of recommendations. For both groups combined, the mean (SD) percentage overlap between when a model recommended an individual to sleep and when sleep was obtained was 73.62% (10.24%). Adherence between model recommendations and sleep onset and offset times was significantly higher with the Model of Arousal Dynamics compared to the Phillips-Robinson Model. For the Phillips-Robinson model, 27% of sleep onset and 35% of sleep offset times were within ± 30 min of model recommendations. For the Model of Arousal Dynamics, 49% of sleep onset, and 35% of sleep offset times were within ± 30 min of model recommendations. Compared to pre-study, significant improvements were observed post-study for sleep disturbance (Phillips-Robinson Model), and insomnia severity and sleep-related impairments (Model of Arousal Dynamics). Participants reported that using a digital, automated format for the delivery of sleep recommendations would enable greater uptake. These findings provide a positive proof-of-concept for using biomathematical models to recommend sleep in operational contexts.

Does daily energy and macronutrient intake differ between work and non-workdays in shift workers? A mixed methods study

ABSTRACT Shift workers are at increased risk of obesity and metabolic diseases, but their eating patterns on work and non-workdays are understudied. We aimed to examine whether energy intake and macronutrient intake of day and night shift nurses were different during work and non-workdays. We used a mixed-methods approach to study food intake of shift working nurses from two hospitals during day and night shifts. Participants completed baseline questionnaires about eating behaviour, sleep, chronotype, mood and shift work disorder. Participants then completed a 4-d food diary which included a non-workday prior to the first shift, the first and last shift (either day or night) and the following non-workday. After completion of the food diaries, we used semi-structured interviews to explore the qualitative aspects of eating behaviours. Seventy-nine shift-working nurses participated in the study. Daily energy intake was not significantly different on work and non-workdays in day or night shift workers (p > 0.05). Whilst macronutrient consumption was also not different between day and night shift workers (p > 0.05), sugar intake was higher in day compared to night shift workers (p = 0.02) on the non-workday prior to the first workday. In qualitative interviews, participants reported their eating to be different on day and night shifts as well as work and non-workdays. Eating behaviour in day and night shift workers was highly influenced by food availability, convenience, peers, and family members. Nurses qualitatively report that night and day shifts result in them eating differently despite no statistically discernible difference in energy intake.

Impact of sleep-wake features on fatigue among female shift work nurses

Background Sleep disturbance and fatigue are prevalent in nurses. Little is known about the characteristics of shift work nurses’ sleep-wake features and their subsequent impact on work performance. The study aimed to describe the characteristics of the sleep-wake index, reaction time, saliva cortisol level, and fatigue severity among female shift work nurses. Methods This is a cross‐sectional exploratory study. A convenience sample of 152 female nurses (8-hour day-evening-night, n = 70; 12-hour day–night, n = 82) participated in this study from nine intensive care units (ICUs) from two teaching hospitals in Beijing, China. A consecutive 7-day actigraphy data were used to analyse sleep-wake indexes, including total sleep time (TST) and circadian activity rhythms (CAR). Before and after shifts, the following data were collected, psychomotor vigilance task for reaction time, saliva cortisol for the level of alertness, and self-reported fatigue severity with the Lee Fatigue Scale-Short Form. Results All nurses reported clinically significant fatigue severity. Compared with the 8-hour shift nurses, the 12-hour shift nurses had significantly more TST (456 vs. 364 min), higher saliva cortisol levels before the day shift (0.54 vs. 0.31), but longer reaction time before the night shift (286 vs. 277 ms). In both shifts, those with better CAR had significantly longer TST. Conclusion Female nurses experienced fatigue and desynchronized CAR, especially nurses on a 12-hour shift. The CAR-friendly shift work schedule is needed to minimize the health and safety impacts of circadian misalignment for nurses. Key messages This is the first use of consecutive 7-day actigraphy data to explore the link between sleep disturbances as a stressor to CAR, salivary cortisol, and reaction time among clinical nurses. CAR may be a helpful indicator for overworked nurses, and it can serve as a modifiable target for interventions to enhance nurses’ well-being.

Construction of a competency index system for shift nurses in China: A Delphi study.

This study developed a set of competency evaluation indicators for shift work nurses in China. Nurses on night shifts must deal with the treatment, nursing, and management work, which requires excellent competency of night shift nurses in their knowledge, skills, and ability. However, the competency evaluation index system for shift work nurses has not been established yet in China. This study performed a literature review and semi-structured interviews to draft the preliminary competency evaluation indicators for nursing shift work. The Delphi technique was adopted to administer two rounds of questionnaires on 21 nursing experts. The positive coefficients of experts in the two rounds were 100% and 90.48%, respectively, whereas the authority coefficients were 0.974 and 0.971, respectively. The coefficients of variation were 0.00-0.26 and 0.00-0.16, respectively. The competency evaluation index system for shift work nurses consisted of 2 first-level indicators, 16 second-level indicators, and 67 third-level indicators. The competency index system of shift work nurses is scientific and applicable. The competency evaluation index system of shift work nurses would provide an effective practical framework for shift nursing administration to evaluate, train, and assess the competency of shift work nurses.

Factors affecting shift work sleep disorder in female shift work nurses: Integrating shift workers' coping with stress and transactional stress coping theory.

Nurses have to work different and often irregular shifts to provide care. This puts nurses at health risks, such as sleep impairment. The aim of this study was to test the comprehensive conceptual framework for predicting shift work sleep disorder of female nurses, we used a structural equation model analysis based on shift worker's coping and transactional stress coping theory. This study used a cross-sectional design. We collected the data from three public hospitals and three private hospitals in South Kalimantan, Indonesia, with a total sample of 201 female shift work nurses. Data were collected from February to April 2020. We were also granted permission by the director and the head nurse of these hospitals. After obtaining the informed consent forms, we distributed the online self-report questionnaire using Google Forms. Demographic data were evaluated using descriptive statistical analysis. We used a structural equation model analysis to test the comprehensive conceptual framework for predicting shift work sleep disorder of female shift work nurses. The model's effectiveness in predicting factors contributing to shift work sleep disorder was confirmed by the good statistical fit indicated by the comparative fit index, root-mean-square error of approximation, incremental fit index, and Tucker Lewis Index. This study provides evidences that workload and interpersonal conflict contribute to occupational stress. Workload, interpersonal conflict, and the biological sleep clock influences shift work sleep disorder through mediators of coping strategies and stress.