Scheduling of night shifts for care and help-nurse personnel

Association between non-standard work hours and employee health is well documented. Individual characteristics of shift work such as shift length, total number of weekly hours, night work, rest opportunities may impact on employees’ job performance and wellbeing.


To identify research on the characteristics of night shift work that influence employee’s wellbeing. To prevent negative health effect and stress on care and help nurse personnel.

Table with identified studies

Table 1. Systematic reviews
Included studiesPopulationOutcome
Dall'Ora et al 2016 [1]
35 studies were included in the review. Personnel working night shifts.
25 studies of 35 were performed in the health sector.
Narrative analysis of Employee's performance and wellbeing.
Authors' conclusion:
“While recent focus has been on the length of the individual nursing shift, shift workers and their managers must also be mindful of other aspects of shift work including the total hours worked per week, overtime, shift rotation, night shifts and rest opportunities and the potential interaction between these factors.”

“Introducing fixed shift patterns may represent an option to decrease employee circadian misalignment and improve safety.”

“Managers should be cautious requesting nurses to work more than 40 h per week, as this has shown to be associated with medication errors and patient falls with injuries and, therefore, could lead to patient safety issues.”

“Some consistent associations have emerged in the research, such as the absence of any clear evidence for benefits of introducing 12 h shift schedules. Not only this shift pattern has not been associated with improvements in job performance in any study, but there is also evidence that it is associated with decreased job performance and poor safety outcomes. However, it is still possible that these results are confounded by unmeasured factors including other aspects of shift work and working patterns.”
Fischer et al 2017 [2]
29 studies were included in the meta-analysis. We did not limit the eligibility of original studies to a specific type of industry or occupation, minimum sample size, or workers’ age and gender. Quantitative analysis of risk ratio (RR) of work-related unintentional injury (of any severity) or ‘accident’ to the worker. ‘Accidents’ included non-injurious incidents, such as falls and exposure to blood-borne pathogens or body fluids.
Authors' conclusion:
The following trends were observed:
Shift type. Compared to morning shifts, injury risk significantly increased on night shifts (RR = 1.36 [95%CI = 1.15–1.60], n = 14 studies), while risk was slightly elevated on afternoon/evening shifts, although non-significantly (RR = 1.12 [0.76–1.64], n = 9 studies).

Meta-regressions revealed worker’s age as a significant effect modifier: adolescent workers (≤ 20 y) showed a decreased risk on the afternoon/evening shift compared to both morning shifts and adult workers (p < 0.05).

Number of consecutive shifts. Compared to the first shift in a block of consecutive shifts, risk increased exponentially for morning shifts (e.g., 4th: RR = 1.09 [0.90–1.32]; n = 6 studies) and night shifts (e.g., 4th: RR = 1.36 [1.14–1.62]; n = 8 studies), while risk on afternoon/evening shifts appeared unsystematic.

Shift length. Injury risk rose substantially beyond the 9th hour on duty, a trend that was mirrored when looking at shift lengths (e.g., >12 h: RR = 1.34 [1.04–1.51], n = 3 studies).

Rest breaks. Risk decreased for any rest break duration (e.g., 31–60 min: RR = 0.35 [0.29–0.43], n = 2 studies). With regards to time between breaks, risk increased with every additional half hour spent on the work task compared to the first 30 min (e.g., 90–119 min: RR = 1.62 [1.00–2.62], n = 3 studies). Rest break duration and interval seem to interact such that with increasing duration, the time between breaks becomes irrelevant.


  1. Dall’Ora C, Ball J, Recio-Saucedo A, Griffiths P. Characteristics of shift work and their impact on employee performance and wellbeing: A literature review. International Journal of Nursing Studies 2016;57:12-27.
  2. Fischer D, Lombardi DA, Folkard S, Willetts J, Christiani DC. Updating the 'Risk Index': A systematic review and meta-analysis of occupational injuries and work schedule characteristics. Chronobiology International 2017;34:1423-1438.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 11/19/2018
Contact SBU:
Report no: ut201834
Registration no: SBU 2018/79