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chapter 12 | Promoting a Healthy Workplace 187 CikguOnline
withdrawn. A more serious form of TB, mutidrug- ■ Limit caffeine intake, especially toward the end
resistant tuberculosis (MDR-TB) is on the rise. of the shift.
Nurses often come in contact with persons with ■ If you work evenings or nights, do not eat a big
active TB. At times, patients do not know they are meal at the end of the shift. This interferes with
infected until coming to the hospital with another sleep.
complaint. As with SARS, the CDC provides cur- ■ Try to sleep a continuous block of time instead
rent information and guidelines for dealing with of catching a few hours here and there.
TB in the workplace (cdc.gov/nchstp/tb/pubs/ ■ Make the room you are sleeping in as dark and
TB_HIVcoinfection/default). noise-free as possible.
■ Maintain good nutrition and an exercise
Enhancing the Quality of Work Life program.
■ Negotiate your schedule with your manager.
The continued nursing shortage enforces an aware- If you and your colleagues feel strongly about
ness to “treat with kindness”the nurses who remain eliminating rotating shifts, work together to
in the workforce. make changes (Trossman, 1999b).

Mandatory Overtime
Rotating Shifts
When nurses are forced routinely to work beyond
Safety in the workplace involves nurses working
their scheduled hours, they can suffer a range of
rotating shifts. Nurses who work permanently at
emotional and physical effects. As patient acuity
night often readjust their sleep-wake cycle.
and workloads increase, nurses working overtime
However, even permanent night-workers may be
put both patients and nurses at greater risk.
subjected to continuous sleep deprivation. Nurses
Mandatory overtime is seen by nurses as a control
who randomly rotate shifts throw off their circa-
issue. Working overtime should be a choice, not a
dian rhythm. Fatigue, the primary complaint of
requirement. In some facilities, nurses are being
these nurses, is the result of the body never get-
threatened with dismissal or charge of patient aban-
ting the chance to adapt to changing sleep-wake
donment if they refuse to participate in mandatory
cycles. The literature links some of the world’s
overtime (nursingworld.org/tan/98mayjun/ot).
worst disasters, such as the Chernobyl nuclear
The ANA presented the following message to
reactor catastrophe and the Exxon Valdez oil
the 107th Congress in 2001: “ANA opposes the use
spill, to rotating shift work and the changes in
of mandatory overtime as a staffing tool. We urge
circadian rhythm. Other effects of shift work
you to support legislation that would ban the use of
include a higher risk of miscarriage and prema-
mandatory overtime through Medicare and
ture labor, menstrual and digestive problems, and
Medicaid law. Nurses must be given the opportuni-
respiratory irritation. One of the most serious
ty to refuse overtime if we believe that we are too
results of rotating night shifts is the increasing
fatigued to provide quality care” (nursingworld.org
number of nurses affected by coronary heart dis-
/gova/federal/legis/107/ovrtme).Dembe,Erickson,
ease (CHD). Studies indicate that nurses who
Delbros, and Banks (2005) analyzed the occurrence
rotate to nights for 6 years have a 70% greater
of occupational injury and illness between 1987
risk of developing CHD than nurses who never
and 2000. After a review of 10,793 participants
rotated shifts due to the circadian effect of lower-
working at least 12 hours per day, working overtime
ing of blood pressure and heart rate at night
was associated with a 23% increased work hazard
(Trossman, 1999b). Suggestions for nurses who
and a 61% higher injury hazard rate compared with
rotate shifts:
jobs without overtime. More recently, Rogers et al.
■ Try to schedule working the same shifts for an (2004) found that nurses’error rates increase signif-
entire scheduling period instead of rotating icantly during overtime, after 12 hours and over
different shifts in one schedule. more than 60 hours per week. Currently, there are
■ Try to schedule to same days off within the no regulations governing nurses’work hours. About
schedule. half of staff nurses are scheduled routinely to work
■ If you become sleepy during the shift, take a 12-hour shifts, and 85% of staff nurses routinely
walk or climb stairs. work longer than scheduled hours.