Original Article

Shift work disorder and related health

problems among nurses working in a tertiary
care hospital, Bangalore, South India
Surekha Anbazhagan,
Abstract Key words: Health problems
Naveen Ramesh,
among nurses, India, nurses, Catherine Nisha,
Introduction: Shift Work Disorder (SWD) is a sleep
shift work disorder Bobby Joseph
disorder characterized by sleepiness and insomnia,
which can be attributed to the person’s work schedule. Department of
Community Health,
Awareness of the mechanisms behind shift work related
St. John’s Medical
health problems could be essential to schedule the INTRODUCTION College, Bangalore,
shift work, employment routines, clinical treatment, Karnataka, India
and selection of employees. Objective: To assess Nursing is a lifesaving profession
the prevalence of SWD and to identify related health and nurses play a pivotal role in the For correspondence:
problems among nurses in a tertiary care hospital in health‑care  industry. If nurses who are Dr. Surekha A,
Bangalore. Materials and Methods: We conducted a the “symbol of service and humanity” St. John’s
descriptive cross‑sectional study in a tertiary care hospital Medical College,
are troubled by their own ill health or
in Bangalore between May and September 2014. Based Bangalore ‑ 560 034,
other stressful circumstances, then
on simple random sampling, 130 nurses were selected Karnataka, India.
they will not be able to give their full E‑mail:
for the study. After obtaining written informed consent
attention to this demanding task. No surecommed87@
from the participants, structured interview schedule using
hospital can function effectively if gmail.com
Standard Shift Work Index and Bergen Shift Work Sleep
there is high incidence of ill health
Questionnaire (BSWSQ) was administered. Results: The
among nurses.[1] Quality of care for
mean age of the 130 nurses was 27.4 ± 2.64 years.
hospital patients is strongly linked to
The prevalence of SWD was found to be 43.07%.
Headache, back pain, gastritis, and menstrual disorders
the performance of the nursing staff.
were the most common complaints, which are found in In line with this, creating a healthy
78 (60.0%), 75 (57.6%), 42 (32.3%), and 39 (30.0%) work environment for nurses is crucial
cases, respectively. Anxiety and depression was found to maintaining an adequate nursing
in 23 (17.6%) and 31 (23.8%) individuals, respectively. workforce.[2]
We also found a significant association of SWD with
increasing age, more number of nights worked in a Nurses are a significant group of
year, and longer duration of working hours. According health‑care personnel in any tertiary
to the BSWSQ, 70 (53.8%) nurses were found to have care hospital. In modern‑day,
Access this article online
sleep problems. Conclusion: A high prevalence of SWD round‑the‑clock performance
Website: www.ijoem.com
symptoms calls for a focus on the antecedents of work is expected in many occupations. DOI:
related sleep problems and appropriate intervention, Census data show that a large 10.4103/0019-5278.183842
such as behavioral changes, clockwise rotating shifts, segment of the workforce is employed Quick Response Code:
and treatment. on nonstandard work schedules
that may include shift work.[3] Such
This is an open access article distributed under the terms of the work schedules have been related
Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 to numerous health problems, which
License, which allows others to remix, tweak, and build upon the include cardiovascular disease,
work non‑commercially, as long as the author is credited and the new
creations are licensed under the identical terms. digestive troubles, fatigue, cancer,
depression, anxiety, and sleep
For reprints contact: reprints@medknow.com problems. Individuals differ in terms
of how they tolerate shift work, with
Cite this article as: Anbazhagan S, Ramesh N, Nisha C, Joseph B. effects on sleep and other health
Shift work disorder and related health problems among nurses parameters varying correspondingly.[4]
working in a tertiary care hospital, Bangalore, South India. Indian J The diagnostic criteria for SWD, as
Occup Environ Med 2016;20:35-8.
defined by the American Academy

© 2016 Indian Journal of Occupational and Environmental Medicine | Published by Wolters Kluwer - Medknow 35
 Anbazhagan, et al.: Shift work disorder among nurses in India

of Sleep Medicine (AASM)’s International Classification of validated questionnaire. A structured interview schedule was
Sleep Disorders‑2 (ICSD‑2), are as follows: (i) Complaints used to collect relevant data from the respondents.
of insomnia or excessive sleepiness temporally associated
with a recurring work schedule in which work hours overlap The interview schedule had the following parts:
with the usual time for sleep, (ii) symptoms associated with • Demographic details and the study variables: Age, gender,
the shift work schedule over the course of at least 1 month, marital status, religion, place of stay, duration of work, etc
(iii) sleep disturbance not better explained by another sleep • Details about work schedule: Current shift, shift timings,
disorder, mental disorder, a medical or neurological disorder, average number of hours worked per day, difficulties in
medication use, or substance use disorder.[5] falling asleep, or feel excessive sleepiness
• Standard Shift Work Index Questionnaire: It is a
Need for the study questionnaire to assess the details about shift work,
Not many studies have been published on the prevalence of problems due to shift work, etc
SWD and its related health problems among nurses especially • Bergen Shift Work Sleep Questionnaire (BSWSQ): It is a
in India. This study will help to identify the prevalence of SWD questionnaire to assess the sleep problems.
and its associated factors in a typical tertiary care setting.
Thereafter, interventions can be planned to improve the quality Procedure
of work life of nurses that in turn improves the quality of This study was approved by the Institutional Ethical
patient care, thereby beneficial for the management. Nurses’ Committee. After establishing rapport with the nurses, the
turnover could be minimized which is a major problem in the purpose and procedure of the study were explained. Informed
discontinuity of the patient care. This study would give an written consent was obtained from the participants and the
opportunity for the nursing staff to express their difficulty in interview schedule was administered to the participants.
professional life especially during the shift work.
Statistics and analysis of the data
Objectives The data were entered and coded in Microsoft Excel and
• To assess the prevalence of shift work disorder (SWD) were analyzed using Statistical Package for the Social
among nurses working in a tertiary care hospital in Sciences (SPSS) version 16 (SPSS‑Inc., Chicago, IL) for
Bangalore proportions, frequencies, and associations. Measures of
• To identify the health problems associated with SWD central tendency, dispersion, and Chi‑square tests were used
among nurses. to analyze data. We considered P value of less than 0.05 as
significant. When more than 20% of the cells in tables had
MATERIALS AND METHODS value less than 5, then we considered Fisher’s exact test for
significance.
A cross‑sectional study was carried out among the staff nurses
in a tertiary care hospital. The study was conducted during RESULTS
the period of May–September 2013. The study population
comprised staff nurses who have completed at least 12 months The study population comprised of 130 female nurses. Of
of service in the study hospital. Staff nurses who are not doing the 130 nurses, nearly 68% were less than 30 years of age
shift duties were excluded from the study. The sample size and the mean age was 27.4 ± 2.64 years. Nearly 50% had the
was calculated to be 130 based on the prevalence of previous work experience of 1–2 years. The demographic details are
studies.[6] represented in Table 1. Majority [110 (84.6%)] of the nurses
had been working for around 50–100 night shifts in the last
The list of nurses was obtained from the Nursing 12 months. Around 71 (54.6%) of the nurses had 1–2 years of
Superintendent’s office. Nurses were selected by simple experience in shift duties. The work schedule of the nurses
random sampling and the work place and contact details is explained in Table 2.
of the selected nurses were collected from the Personnel
Department of the hospital. Permission was obtained from the The prevalence of SWD was found to be 43.07%. Of this,
concerned authorities and we made sure that data collection 41 (31.5%) were in the age group less than 30 years, and
did not interfere with the daily routine of the staff. After 35 (26.9%) with work experience of 1–2 years had SWD.
obtaining the informed consent, the study participants were Table 3 explains the prevalence of SWD by age and years of
interviewed to collect information regarding age, education, experience. Headache, back pain, gastritis, and menstrual
date of employment, type of occupation, working conditions, disorders were the most common complaints related to
duration of work, shifts, and present health status. Chronic shift work [Table 4]. Anxiety and depression were found in
illness was  elicited through past history. All nurses were 23 (17.6%) and 31 (23.8%) of the individuals, respectively.
assessed on problems of shift work using a pretested and According to the BSWSQ, 70 (53.8%) were found to have sleep

36 Indian Journal of Occupational and Environmental Medicine - April 2016 - Volume 20 - Issue 1
 Anbazhagan, et al.: Shift work disorder among nurses in India

problems. Out of 130 participants, 59 (45.3%) were also found Table 1: Demographic details (N=130)
to have more than normal intake of beverages when they were Variable Category No. Percentage
asked—“Do you drink Coffee/tea/cola (with caffeine/energy Age (in years) ≤30 89 68.4
drinks) more than usual during your shift work?” 31-40 35 26.9
>40 6 4.7
Marital status Married 49 37.6
We found that there was a statistically significant association Unmarried 78 60.0
between the presence of SWD and age, number of nights Separated/divorced 3 2.3
worked in a year on univariate analysis [Table 5]. There Place of stay Hostel 74 56.9
House 47 36.1
was no statistically significant association between the
Quarters 9 6.9
presence of SWD and marital status, place of stay, duration Work experience 1-2 years 65 50.0
of work, number of years of shift duties and sleep problems. 2-5 years 42 32.3
Multivariate analysis showed significant association of SWD >5 years 23 17.6

with decreasing age.

Table 2: Work schedule
DISCUSSION Variable Category No. Percentage
Number of days of night <50 6 4.6
The prevalence of SWD among nurses in the present study was shifts in the last 12 months 50-100 110 84.6
found to be 43%. We found that young nurses who were aged >100 14 10.7
No. of years of shift duties 1-2 years 71 54.6
less than 30 years and who had 1–2 years of experience were 2-5 years 41 31.5
more likely to have SWD. This is consistent with the previous >5 years 18 13.8
study done among nurses in Norway, where about one‑third of Shift work disorder Present 56 43.07
Absent 74 56.92
the nurses showed symptoms indicative of SWD, with highest
prevalence (45%) in schedules involving night shifts. They
also found a positive relationship between the numbers of Table 3: Prevalence of SWD by age and years of experience
nights worked and SWD.[6] This is probably because the young Variable Category SWD (%) No SWD (%)
nurses with less years of experience are not adapted for the Age group ≤30 41 (31.5) 48 (37.1)
shift work and the mechanisms behind coping with the shift 31-40 14 (10.8) 21 (16.1)
>40 1 (0.7) 5 (3.8)
duties. We need further studies to identify the precise reason Years of experience 1-2 35 (26.9) 30 (23.0)
for this phenomenon. This fact also underlines the importance 3-5 14 (16) 28 (21.5)
of educating the nurses and counseling them before giving >5 7 (5.4) 16 (12.3)
the shift duties. Rathore et al. in a study done in Rajasthan SWD: Shift work disorder

found out that gastrointestinal and digestive problems, such

as indigestion, heartburn, stomach ache and loss of appetite, Table 4: Health problems due to SWD
were more common and sleep problems were found in around Health problems No. Percentage
64% among rotating shift working nurses that was comparable Headache 78 60.0
to our study. The health problems might be related to the Back pain 75 57.6
Gastritis 42 32.3
disturbance of biological clock under stressful conditions. In Menstrual disorders 39 30.0
the present study, we had certain limitations such as influence ARI 38 29.2
from possible confounding variables (i.e., different work load, Depression 31 23.8
Anxiety 23 17.6
environment, work schedule, etc.) was not addressed and
SWD: Shift work disorder, ARI: Acute respiratory infection
recall problems for certain questions, such as number of
night duties in the last 1 year, when they did extra night shifts
during staff shortage. Table 5: SWD and associated factors
Variable SWD present (%) SWD absent (%) P value
Shift work and related health problems are important topics Age
≤30 41 (31.5) 48 (37) 0.035
in the health‑care sector due to their possible negative 31-40 14 (10.8) 21 (16.1)
impact on the workers’ health and safety. Awareness of >40 1 (0.7) 5 (3.8)
the mechanisms behind shift work related sleep problems Number of nights
<50 2 (1.5) 4 (3.07) 0.010
could also be essential regarding shift work scheduling, 50-100 48 (36.9) 62 (47.7)
employment routines, clinical treatment, and for employee >100 6 (4.6) 8 (6.1)
selection. [7] However, it can be difficult to distinguish SWD: Shift work disorder
between the sleep issues related to shift work and those
which are most likely unrelated. Consequently, there is a associated with and those bearing no relation to the work
need to conceptually differentiate between sleep problems schedule.[8]

Indian Journal of Occupational and Environmental Medicine - April 2016 - Volume 20 - Issue 1 37
 Anbazhagan, et al.: Shift work disorder among nurses in India

In medical domain, physicians, nurses, and other ancillary Conflicts of interest

staff are expected to perform their jobs or to be on call There are no conflicts of interest.
round‑the‑clock. Studies have shown that a greater percentage
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