A Hard Day’s Night: Training Provides Nurses with Strategies for Shift Work and Long Work Hours

Posted on by Claire Caruso, PhD, RN, FAAN

“The problem for me became very severe and my head nurse actually called me into her office to discuss it… it had gotten to the point where I was so chronically sleep-deprived that I was falling asleep while I was trying to report off to the on-coming shift. So, I’m sitting there talking about very complicated medical issues, and in the middle of a sentence, I would nod-off. And as you can imagine, the person I’m speaking to would be very upset that I’m so distracted and unfocused…”

– Quote from a night shift nurse

People get sick and injured at all hours of the day. These injuries and illnesses are not restricted to a typical 9-5 work shift. In the U.S., healthcare services are available 24 hours a day 7 days a week.  To meet this demand, nurses work in shifts–often 8-12 hours at a time–which may require them to work at night during traditional sleeping hours. Research has shown that shift work and long work hours are associated with: declines in functioning of the brain (thinking, remembering, etc.); reduced job performance, accidents, and errors; negative impact on health behaviors (obesity, smoking, etc.); increased short-term and long-term health risks; and negative impacts to patients, families, employers, and the community.

The symptoms of sleep deprivation are similar to alcohol intoxication. Research show that performance after being awake for 17 hours is similar to having a blood alcohol concentration (BAC) of 0.05% and being awake for 24 hours is similar to having a BAC of 0.10%. Note that the United States defines legal intoxication for purposes of driving as a BAC of 0.08% or greater. However, driving impairments are seen at a BAC of 0.05%, and some countries use a cutoff of 0.05% or lower for driving purposes.

The National Institute for Occupational Safety and Health (NIOSH) released a free online course to train nurses and their managers on the risks of shift work and long work hours, and strategies to reduce these risks.   The training course was developed in collaboration with healthcare stakeholders, including nursing organizations and academic groups and will provide continuing education certificates for registered nurses who complete the course. A certificate of completion is available for persons who are not registered nurses.

The NIOSH Training for Nurses on Shift Work and Long Work Hours is designed to increase knowledge and promote better personal behaviors and workplace systems to reduce the risks linked to working shift work, long work hours, and exposure to related issues from insufficient sleep. Content is derived from scientific literature on shift work, long work hours, sleep, and circadian rhythms.

The training will inform nurses and their managers about the following:

  • How shift work and long hours are linked to a wide range of health and safety risks by reducing time for sleep, disturbing circadian rhythms, and disrupting family and non-work responsibilities
  • What vital functions occur during sleep and the relevant physiologic processes that determine the timing of sleep and the development of fatigue
  • Good sleep practices and other coping strategies nurses working shift work and long work hours can adopt in their personal lives to reduce risks
  • Work organization strategies for employers to reduce risks associated with shift work and long work hours

The NIOSH training is a multi-media course that incorporates lesson text, lesson quizzes, and video testimonials from several nurses. The course is divided into two parts to make it easier for nurses to schedule time and receive contact hours for at least part of the training: Part 1) Health and safety risks to shift work and long work hours and why these occur; Part 2) Strategies to reduce risks from shift work and long work hours. Part 1 takes about 1.5 hours to complete and Part 2 takes about 1.7 hours. It can be taken at any time that is convenient and over a series of 15 or 20 minute time periods if desired.

The course is available for desktop and mobile devices on the NIOSH website.   For more information about NIOSH’s research and recommendations on healthcare workers, visit the healthcare topic page.

Training and raising awareness of the issues is a step towards prevention.  Please share with us what you or your workplace have done to combat safety and health issues associated with shiftwork and long hours.

NIOSH also offers an online Workplace Violence Prevention Training for Nurses. In the comment section below please let us know what other online training would be beneficial to the healthcare industry.


Claire Caruso, PhD, RN, FAAN

Dr. Caruso is a research health scientist in the NIOSH Division of Applied Research and Technology.

Posted on by Claire Caruso, PhD, RN, FAAN

6 comments on “A Hard Day’s Night: Training Provides Nurses with Strategies for Shift Work and Long Work Hours”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    A sleep-deprived nurse is a problem for herself and, worse, to a patient. For this, we cannot blame the nurse.
    Suppose, we adopt the 2-2-2 shift pattern; two days first (morning) shift; two days night shift; and two days second (evening) shift. This may solve the problem. At any rate, it will not worsen the problem.

    K.N.Krishna Prasad
    EH&S:Trainer and consultant.

    In the United States each state has a Board of Nursing who is responsible for the regulation of nursing practice. These boards outline the standards for safe nursing care and issue licenses to practice nursing. Most state boards of nursing require registered nurses to obtain continuing education to maintain their license. This link lists the basic continuing education requirements by state (current as of 2013) but see each state for more details on their requirements. http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/NursingEducation/CE-Licensure-Chart.pdf

    I will definitely be reviewing this. This story is very interesting as it relates to a few of the trends that we are seeing in the healthcare arena; there will be some major changes to the industry over the next few years.

    ypu dont make any reference to the best measyrehat needs to be taken in order to minimize the side-effects and health problem for healthcare shift workers… and that is the total number of shifts in the evening and especiall at night…if i am a nurse and I work only 1 night / week (up to 4 night shifts/per month) it is consequent that the helath risks and social life problems will be minimized and the job satisfaction will be much better. and that means hiring more nurses in order to cover the work programme.thank you.

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Page last reviewed: April 26, 2021
Page last updated: April 26, 2021