![]() ![]() Over the long term, these improvements are paralleled by some sleep difficulties during the morning and afternoon shifts. Prospective studies 4, 5 suggest that the change from a slowly rotating backward system to a slowly rotating forward system has the greatest effect on night shift workers, in terms of improved sleep quality, decreased fatigue, and fewer attention lapses. It is commonly assumed that forward rotation is easier to adapt to physiologically because the human circadian rhythm tends to move forward, and it is more difficult to fall asleep earlier than the normal bedtime. In contrast, backward-rotating shifts (BRSs) consist of night shifts followed by afternoon and then morning shifts. In forward-rotating shift (FRS) work, morning shifts are followed by afternoon and then night shifts. 2 The direction of shift rotation (ie, clockwise or counterclockwise ) also affects workers’ adaptability. In the US, slow rotations are becoming more common, allowing workers to adjust their circadian rhythm gradually over a period of 2 to 4 weeks, 1 whereas in Europe and Japan fast rotations (ie, changing every 3-5 days) are more common, which permits workers to maintain constant circadian rhythms. A nurse’s adaptability to night shifts is often affected by the speed and direction of the shift rotation. Shifts vary owing to numerous factors, including the timing and length of work hours (ie, 8- or 12-hour shifts), fixed or rotating schedules, duration of rotations, and number of consecutive days of night work. Within the health care industry, 24-hour rotating shifts for hospital nursing staff are necessary to ensure continuity and high-quality care. Optimization of shift rotations should be implemented to decrease the combination of the negative outcomes associated with shift work and reduce the potential risk of medical errors in health care systems. These findings suggest that forward shift rotation may be more beneficial than backward rotation for several measured performance attentional outcomes and sleepiness. The median reaction time ( F 1,139 = 42.12 P < .001), 10% fastest reaction time ( F 1,139 = 97.07 P < .001), minor lapses ( F 1,139 = 46.29 P < .001), and reaction time distribution ( F 1,139 = 60.13 P < .001) of nurses on backward-rotating schedules indicated a lower level of vigilance, which is negatively associated with neurobehavioral performance.Ĭonclusions and Relevance In this study, both shift rotation models were negatively associated with health and cognitive performance. Of nurses working on a backward-rotating schedule, 60 (93.8%) reported elevated sleepiness (Karolinska Sleepiness Scale score ≥7) after the night shift. Importantly, these differences were not affected by age, years of employment, and quality of sleep. Nurses working backward-rotating shifts exhibited significantly greater sleepiness ( F 1,139 = 41.23 P < .001) and cognitive slowing (ie, longer median reaction times F 1,139 = 42.12 P < .001) than those working forward rotations. Nurses with irregular sleep-wake patterns due to night shift work had poor sleep quality (46 in forward-rotating schedule group 37 in backward-rotating schedule group). Results A total of 144 nurses (mean age, 41.3 years 92 women ) participated in the study 80 nurses had forward-rotating schedules, and 64 had backward-rotating schedules. Tiredness was evaluated using the Tiredness Symptom Scale. Sustained attention was measured using the Psychomotor Vigilance Task. Main Outcomes and Measures Sleep data were collected using the Karolinska Sleepiness Scale and Pittsburgh Sleep Quality Index. Data analysis was performed from May to October 2020.Įxposures Participants were working either forward- or backward-rotating schedules, in which the sequence of 3 shifts (morning, afternoon, and night) changed in a clockwise or anticlockwise direction. The data were collected from July 2017 to February 2020. The nurses had either a forward-rotating schedule (ie, morning to afternoon to night) and or a backward-rotating schedule (ie, afternoon to morning to night). Objective To investigate the association of shift rotation direction with tiredness, sleepiness, and sustained attention among nurses working forward- and backward-rotating shifts.ĭesign, Setting, and Participants Data of this cohort study were collected from nurses working at 5 midsized Italian hospitals. ![]() Importance The association of fast backward-rotating shift work (ie, anticlockwise sequence of afternoon, morning, and night shifts) with subjective and objective measures of sleep-wake quality, daytime attention, and tiredness of health care workers has not yet been established. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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