Mikiko Kawasaki, Master, Ube Frontier University/International University of Health and Welfare; Sachiko Hiramatu, Master, Himeji University; Natuko Sugano, Master, Himeji University; Youko Nakashima, Master, Kindai University Hospital;Â Nobuko Nishimura, Doctor, Himeji University
Purpose/Objectives
The aim of this study was to biochemically assess the stress of nursing professionals working two-shift work schedules (day shift and 16-hour night shift) and to clarify which factors cause the stress. Objective: To clarify the stressors, investigate measures for reducing occupational stress, and create a work environment where it is easy to work.
If the stress caused by two-shift work schedules in the nursing profession can be assessed and the stressors analyzed, it will be possible to detect occupational stress at an early stage, and we can obtain suggestions for mental health prevention measures. If the stress assessment of day and night shifts is carried out biochemically, and we can simultaneously clarify the relations with individual factors of occupational stress, this will allow us to obtain suggestions for workstyles that take working environment improvements and generation-dependent work-life balance into consideration.
Background
The turnover rate of regular employees in the nursing profession is about 11%, and the fact that this has remained unchanged in the past few years is a “question” that can be explored to attempt to improve this turnover rate over the course of many years. The factors of turnover include overwork and shift work, which make it difficult to maintain a family and social life. Shift work, day and night, has become a working condition in the healthcare setting, causing disruptions in the life rhythm of nursing professionals. Over the past few years, as part of workstyle reforms, an increasing number of hospitals has been changing from typical night shifts to 16-hour double shifts running from 16:00 to 9:00. The prolonged night shifts keep the employees at work longer but also lengthen the intervals between night shifts, so they have been introduced with the aim of alleviating stress caused by such shifts. However, some reports indicate deviations from the International Labour Organization (ILO) recommendations. There is a need for environments where nursing professionals can continue to work with job satisfaction and pride, and there is a need for improvements that are tailored to international standards such as the ILO Nursing Personnel Convention.
Through raising awareness of nurses’ stressful situations, reduce the stress of individual workers, and facilitate work environment improvements, motivation can be maintained, turnover can be reduced, and the quality of health care can be assured.
Methods
A questionnaire will investigate the actual stress situations and measure baseline autonomic balance after the end of night and day shifts. The subjects were 168 nurses working in a two-shift system at a domestic university hospital (mean age 30.8 ± 8.35 years). Physical fatigue index (PSI), low and high frequency component of heart rate variability (LF and HF), and sympathetic and parasympathetic balance index (LF/HF) were measured after work using the autonomic nerve activity meter. Further, the WLB index survey was implemented. Associations of autonomic indices between the tasks were tested by t-test, while associations between autonomic activity indices, attributes, and WLB items were tested by calculating correlation coefficients.
Findings
Items for which the non-standard group had higher percentages or proportions relative to the standard group were as follows: PSI: 108 individuals (64.3%) in the overworked after day shift group, 91 individuals (54.2%) in the overworked after night shift group, LF: 130 patients (77.4%) in the overworked after day shift group, and 130 patients (77.4%) in the overworked after night shift group.
Correlation coefficients between length of service and autonomic indices were as follows: in post-day PSI: r = .265 (p = .001), HF: r=-. 211 (p=.006), in the post-night shift, PSI: r=. 238 (p=.002), LF: r=-. 272 (p=.006), HF: r=-. 227(p=.003).
Between WLB and autonomic indices, the following correlations were observed: in “discretion of work” and post-night shift PSI: r =-.219 (p=.005) / LF: r =.250 (p=.001) / HF: r =.209(.007), ‘Personnel management’ and post-night shift LF: r=.262 (p=.001) / post-day shift HF: r =.208 (p=.007), “child care and nursing care at home” and LF after night shift: r =.226 (p=.003), “self-awareness” and post-night shift LF: r =.213 (p=.006).
Discussion
Autonomic nervous system indices among non-standard group nurses indicated that irrespective of working time, many among them experienced high fatigue and stress. Night shift nurses were particularly restricted due to their 16-hour shifts, which had considerable impacts on parenting, nursing role, and self-awareness. In addition to nursing care, mid-level nurses engaged in roles to support junior nurses and hospital committee activities, and reported high job burden and stress. However, we believe that mid-level nurses were able to fulfill responsibilities for a wide range of roles and tasks, which helped them crystallize their professional identity.
Conclusions
Consider effective approaches as well as intervene at both individual and organizational levels to improve nurses’ stress.