Abstract

Background: Evidence suggests that working long hours or unconventional shifts (night, evening and rotating shifts) can induce fatigue and stress in healthcare employees that might jeopardise quality of care and patient safety.

Methods: This study is based on a retrospective analysis of 13 years of occupational data from the National Longitudinal Survey of Youth, covering nearly 11 000 American workers. During the study period, 545 injuries were reported by employees in healthcare professions. Cox proportional hazard analyses were used to calculate adjusted hazard ratios comparing the risk of a job-related injury among healthcare workers in various types of demanding schedules to employees working conventional schedules. The analyses were stratified to estimate risks within different occupational classifications and care settings.

Results: The greatest injury risks to healthcare workers were in schedules involving overtime or at least 60 h per week. Interestingly, an elevated risk of injury was not observed for healthcare employees working 12 or more hours per day or for those in night, evening or rotating shifts. Among employees working overtime and long-hour (>60 h per week) schedules, those at medical provider offices had a significantly higher risk of injury (HR 2.86) than at hospitals, rehabilitation clinics or long-term care facilities. Support personnel, including aids, attendants, technicians, therapists and dieticians, faced a higher risk of injury than did physicians and nurses.

Conclusion: Healthcare managers responsible for quality improvement and patient safety programmes should be aware of the possibility for worker fatigue and injury in particular scheduling arrangements.