8. Shift impacts
UK Safety Representatives' Committee
(R) This meeting of RCN Congress calls on employers to do more to reduce the recognised harmful effects of shift working on staff and patients
Result
The resolution was passed.
For: 413 (96.05%)
Against: 17 (3.95%)
Abstain: 15
Debate report
This resolution was passed after a heated debate at Congress on Tuesday afternoon. The discussion opened with the proposer, Cat Forsyth, Vice Chair of UK Safety Representatives, recognising the necessity of shift working to provide 24-hour health care. However, Cat questioned whether employers have forgotten their duty of care to employees. Employers were called upon to remember the importance of maintaining a healthy workforce and the potential negative impact shift working could have on quality of care for the patient.
The proposer and Cathy Lorrie, UK Stewards Committee, cited the harmful effects induced by unreliable shift patterns and long shifts to include sleeping difficulties, disturbed appetite, and the increased likelihood of accidents. The ability to adjust to changing shift patterns declining with age was raised following the government’s proposed increase in retirement age.
The resolution calls for adequate rest periods and risks assessments on the impact of shifts on staff health. Bruce Hopkins, East Dorset Branch, urged the RCN to provide more robust advice on appropriate breaks for shifts longer than eight hours. Multiple delegates criticised e-rostas, with Gareth Phillips, Gwynedd Branch, noting how individuals have different working constraints and respond differently to shift work. Douglas Lockhart, retired member from Northern Ireland, called on the RCN to ”make a definitive statement on the 12 hour shift”.
Background
The reality of 24-hour health care delivery means many health care workers are required to work shifts. This shift work can take many forms including night shifts or rotating shifts, and shifts can vary in duration with 12-hour shifts becoming increasingly commonplace.
The health and safety effects of shift work are widely recognised. Long hours, fatigue and lack of rest breaks or time to recuperate between shifts are associated with an increased risk of errors. For example, fatigue and shift working arrangements were cited as major contributory factors in incidents such as Bhopal, Clapham Junction and Chernobyl, and fatigue is a recognised factor contributing to patient safety incidents such as drug errors.
While some individuals tolerate shift work better than others, night shifts can disrupt the body’s natural circadian rhythm. Long term exposure to shift work has been associated with chronic sleep deficit, gastrointestinal problems, cardiovascular problems and increased susceptibility to minor illnesses such as colds and gastroenteritis. There is also evidence to demonstrate the decreased tolerance to shift working in older workers.
Shift work can exacerbate long term conditions such as diabetes or epilepsy, and workers with such conditions may be classed as disabled. Guidance issued to RCN representatives Spinning plates: establishing a work-life balance (Royal College of Nursing, 2008) highlights that between 20% and 25% of people reject and leave shift work at an early stage because of chronic ill health.
Emerging evidence from the International Agency for Research has also linked night shift work and the disruption of circadian rhythms with an increased risk of breast cancer (as highlighted at Congress 2011 by the Danish Nurses Association).
Health and safety laws place legal duties on employers to manage and reduce the health and safety risks of shift work. There are also duties on employers to comply with the requirements of working time regulations, which includes implementing health assessments for those who regularly work night shifts.
Professionally, nurses have a responsibility to recognise when they are fatigued and take steps to reduce the impact of fatigue on the safety of patients under their care. Demographically, internationally recruited nurses are more likely to work permanent night shifts compared to UK-qualified BME or white nurses.
The European Working Time Directive (EWTD) places restrictions on daily and weekly working hours, and contains minimum provisions for rest breaks and annual leave. European negotiations are currently underway between social partners on aspects of the EWTD, which is implemented in Britain as the Working Time Regulations (1998) and in Northern Ireland as the Working Time Regulations (Northern Ireland) (1998).
The RCN has an established position on the EWTD, including the importance of compensatory rest in limiting fatigue and controls on the average working week. The RCN has also issued guidance on flexible working which includes reference to the different types of shift patterns and the potential health impacts of shift work (Royal College of Nursing, 2008).
References and further reading
Health and Safety Executive (2006) Managing shift work: health and safety guidance. London: HSE Available at: http://www.hse.gov.uk/pubns/books/hsg256.htm (Accessed 27/02/12) (Web)
Norman, W. (2011) Rough nights: the growing danger of working at night. London: The Young Foundation Available at: http://www.youngfoundation.org/publications/reports/rough-nights-the-growing-dangers-working-night-april-2011 (Accessed 27/02/12) (Web)
Royal College of Nursing ( 2008 ) Spinning plates: establishing a work-life balance: a guide for RCN Representatives London: RCN Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0007/156166/003214.pdf (Accessed 27/02/12) (Web)
