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Risks & Risk Reduction For Shift Work: The Seventh In A Series Of Useful Information ‘That You Can Use’ From The Center For Occupational & Environmental Medicine At Buffalo’s Erie County Medical Center

Published Sunday, February 11, 2018
by Nellie J. Brown, MS, CIH/Via The COEM @ ECMC
Risks & Risk Reduction For Shift Work: The Seventh In A Series Of Useful Information ‘That You Can Use’ From The Center For Occupational & Environmental Medicine At Buffalo’s Erie County Medical Center

WNYLaborToday.com Editor’s Note: The Center for Occupational & Environmental Medicine (COEM), located at Buffalo’s Erie County Medical Center (ECMC), is available to Workers both Union and non, providing care to those who are injured, impaired or who develop an illness as a result of workplace factors - which may include exposure issues, physical injuries, or any other job hazard.  The COEM is also a New York State Department of Health-funded Clinic for the diagnosis and treatment of occupational injuries and illnesses for Workers living in the five counties of Western New York.  The COEM also offers services for any Worker with other job-related medical needs, such as physicals required for employment or licensure - and they assist with completion of paper work for Worker Compensation Claims. With state-of-the-art diagnostic equipment and a highly-skilled and caring Staff, the COEM’s Health Care Services meet U.S. Occupational Safety & Health Administration (OSHA), U.S. Environmental Protection Agency (EPA) and Department of Health Safety Standards.  The COEM takes a different approach to the treatment of injured Workers through prevention, early diagnosis and treatment.  Opened in 2015, the COEM was developed with great support from Western New York Labor Unions and their Leadership.  The COEM, which is open Monday through Friday - 9 a.m. through 5 p.m., can be reached at 716-898-5858.

The author of this article is Nellie Brown (pictured below), who serves as the Director of the Workplace Health and Safety Program, a Statewide Program of the Worker Institute at Cornell University’s School of Industrial and Labor Relations.  Nellie provides Industrial Hygiene Services for the COEM.

 

Glenn is a Hospital Nurse who works 11 p.m. to 7 a.m.  His wife, Glenda, works from 8 a.m. to 4 p.m. at the sheriff’s department.  At first, Glenn enjoyed sleeping all day, then making dinner for the kids after school.  He liked grocery shopping or running errands during the day. “I found I can’t really sleep well during the day and that I was feeling drained and, believe it or not, also constipated,” he says.

Glenn’s work schedule is not unusual.  Today, only about 30% of employed Americans work during the daytime, 35 to 40 hours a week, five days a week, Mondays through Fridays.  With the tightly-packed schedule of shifts, Shift Workers work 400 more hours per year than those who work only 40 daytime hours.  Yet, some people like or prefer shiftwork.  Some like compressed work weeks of 10- or 12-hr days so as to have several days off in a row.  For some people, shiftwork makes child care or elder care easier.  Glenn’s Co-Worker, Ramona, wanted to work the night shift.  “That way I don’t have so many supervisors around!,” she says.

Glenn has trouble sleeping during the day, despite earplugs, an eye mask and the occasional Over-the-County (OTC) Medication.  “It’s gotten to the point where I can only sleep four hours at a time,” he says. 

Our body’s daily (circadian) rhythm is the result of our brain and body blending their activities over a 24-hour period.  We are aware of the time of day, light/dark (day/night), meal-times, traffic noise and what everybody else is doing.  The body makes its internal cycles - hormones, heart rate, body temperature, blood pressure, etc. - work in sync with the outside world by going through their own high and low activity periods throughout the 24-hour day.  For example, when body temperature drops to its lowest point around 3 a.m. to 4 a.m., this affects our alertness and is the most difficult time to stay awake.  About 10% to 20% of the population seem to be “Morning Types” (“larks”) and “Evening Types” (“owls”).  And Morning Types seem to have more trouble adjusting to shift work than evening types.

We can adjust to small, gradual changes - such as seasonal changes in day length - but the abruptness of changing shifts causes our bodies to become temporarily and severely disorganized.  The body tries to adapt to the person’s new schedule by re-synchronizing all the affected body functions, but different functions can take different amounts of time to reach the new rhythm.  If the cycle is disrupted again - such as with another shift change - before a new rhythm is in place, then the body needs to adjust again.  Rotating shifts can keep a person’s body in a constant state of disruption.

It can be difficult to sleep during the day with daylight and daytime noises - so people sleep fewer hours and feel less refreshed.  This is Glenn’s problem - he is sleep-deprived.  Sleep deprivation is serious.  We need sleep for the body to repair and for the brain to store new memories, reinforce or prune old memories, and clean out the brain cells’ waste products.

Brain maintenance takes a lot of energy and must be done while we’re asleep.  Most adults need about eight hours of sleep - the typical range is 6 to 10 hours. You can’t make up a sleep debt, even if you sleep late on your days off.  Disruption of the body’s internal rhythms has been associated with a wide range of health disorders, including: cardiovascular problems; coronary heart disease; infections; digestive problems; weight gain; fertility problems; depression; diabetes; disturbed glucose regulation (further affected by meals at non-standard times); and cancers - including breast cancer.

Shifts and longer work hours have implications for many workplace hazards.  When preparing medications for patients, Glenn will actually nod off while standing at his medications cart - his head falls forward and then jerks upright again.  Sometimes the computer screen and written labels become blurry.  He reads information, then promptly forgets and has to start over.  He is concerned that errors could be dangerous for patients.  When we are sleep-deprived, we can fall asleep for seconds or minutes (“micro-sleeps”), even while standing, operating machinery or driving a vehicle.  The sleepier we are, the more rapidly and frequently this occurs.  In fact, a person who has been up 24 hours without sleep has been shown to be just as impaired as a drunk with a blood alcohol level of 0.10%.  So, sleep-deprived Workers are more likely to commit errors or have accidents.

Longer work hours can mean longer exposures to workplace hazards such as: chemicals; noise; heat stress; cold stress; electromagnetic fields; and ergonomics. Night-time construction work on buildings or roads may have the added risk of Worker visibility.  Also, when we are coming and going at night, security becomes an important consideration - fewer witnesses at night makes us seem easier victims.  High-risks for violence include poorly-lit building entrances and parking areas, as well as work in the field or making deliveries.  Uncovering these risk factors and hazards enables a workplace to implement appropriate control measures, including violence prevention.

Glenn’s fragmented sleep forced his wife to do more household chores and drive the kids to sports practices after school.  “I felt like he was ‘never’ around,” she said.  Glenn didn’t complain, but Glenda told him that she was unhappy and wanted to separate after nearly 20 years of marriage.  Glenn and Glenda discovered deep sadness beneath their anger because they missed each other so much.  “I ‘didn’t feel like we were a couple,’” she said. 

Sleep deprivation, with its mood swings and fatigue, can affect relationships with family and friends - they may not understand the symptoms, tiredness, moodiness or depression.  Shift work can lead to more separations or divorces.  Children may feel they have an occasional second parent who doesn’t care about them enough to be around more often.  Shift Workers tend to form close bonds and friendships among each other as a way to lessen the pain of isolation.

Training on how shiftwork or long hours of work, as well as sleep deprivation, can affect us helps us know what to expect.  We can share this information with family (Trainees in my workshops often remark: “I wish my wife was here to hear your training.”).

Certainly, we need to take care of ourselves.  When have you last had a physical to see if any of the adverse health impacts discussed above are beginning to appear?  It is especially important to check for elevated blood lipids, glucose intolerance, hypertension, and (for women) mammography and breast exams.  (Also for the effects of smoking, where appropriate.  There are medical assessments available which can evaluate sleepiness and fatigue (physical or mental), as well as treatments such as light therapy (sometimes used with morning melatonin therapy).

During evening and night work shifts, full daylight-spectrum bright lighting promotes the resetting of the body’s sleep and wake cycles.  However, for fluorescent or halogen lighting, which tend to have excessive amounts of blue light, it is important to filter out wavelengths shorter than 480nm, as these have the most serious adverse effects, including breast cancer risk.

We really need to maintain the same regular sleep time for the duration of the week, including days off, so that the various body systems have more time to resynchronize.  Tell your family why these are necessary and ask them to respect the necessity.

We humans are creatures of habit and we can make our habits work for us.  For example, on your morning drive home after working at night, wear dark glasses so daylight will not reset your biological clock and delay your sleep cycle.  Attempt sleep immediately after the night shift.  Try to relax, unwind and go through a regular bedtime routine before sleeping.  A warm bath or shower before bed increases body temperature a couple of degrees, shortening the time to fall asleep and promoting deep recuperative sleep.  Keep your bedroom quiet and insist family and friends respect your sleep hours.  Before bedtime, turn off the TV, computer, notepad or Kindle - blue light from the screen decreases the brain’s melatonin and delays sleep.  Keep your bedroom cool and pitch-dark.  Use eye shades if necessary.  Tune a radio between two stations to use background “white” noise.  Use earplugs, unless you need to be on-call or wake up for duty and try to prepare for your sleep schedule on your days off before the shift changes.

Glenn says: “No one else is available at night, so the Night Nurses have to perform clerical jobs, housekeeping and patient transport.  We collate charts and medication records because (as hospital administration says) ‘they have time on nights.’  But, if we leave something not done, the day nurses are quick to report it, even if they know that our night was a hectic one.”

Regular, predictable work schedules and adequate Staffing Levels should be established in advance - even on a yearly basis, if possible. Knowing your work schedule in advance can help with work/family balance, such as child care (and, from the employer’s point of view, may help with employee retention, also).  And enforce maximum/allowable work hours.  Forward shift rotations only - not backwards against the clock.  Overall, the slower the rotation the better to allow body systems to resynchronize before the next shift change.  Avoid tasks requiring error-free activity toward the end of a 12-hour shift or in the 3 a.m. to 6 a.m. period - whatever the length of the shift.

Glenn tries to sneak a snack at night to keep up his energy levels.  The hospital has a rule about “no food at the Nurses’ station,” but there is a skeleton crew at night and no coverage to enable Nurses to leave the unit.  Also, the cafeteria is closed at night.  He and the other night nurses have complained that the vending machine food is stale and high in starch, fat and calories with little protein or vitamins.

We need to have healthy food choices available.  Avoid caffeine during the last half hour of your shift or near sleep time if you want to sleep soon after arriving home.  The same goes for nicotine, either tobacco smoking or patch.  Avoid alcohol if you must sleep during the day as it can produce easily-disrupted, lighter sleep with intense dreaming, sweating and headaches.

And remember to exercise - improving your physical condition – which can help.  We tolerate shift work better or adjust faster to shift changes.

This morning, Glenda was again offered a promotion to sergeant with a raise of $12,000 more a year, but it required her to work nights. She had turned down this promotion three times before. “I didn’t want to leave the kids at home alone in the middle of the night,” she says. “The raise could pay for a babysitter, but probably not much else.  Glenn says, ‘Go for it! You’ve earned it! Then, we’ll both be working the same schedule – that’s bound to help. Let’s stop living separate lives.’”

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