Young Nurses' Injury Risk Increased by Overtime, Night Shifts

Janis C. Kelly

August 10, 2015

Newly licensed registered nurses (RNs) were likely to work schedules associated with significantly increased risks for occupational injuries, including overtime (61%) or night shifts (44%), according to a major new analysis of occupational injuries published online June 29 in the International Journal of Nursing Studies.

"Overtime and night shift work were significantly associated with increased injury risk in newly licensed nurses independent of other work factors and demographic characteristics,” the analysis authors write. "The findings warrant further study, given the long-term consequences of these injuries, costs associated with treatment, and loss of worker productivity," write Amy Witkoski Stimpfel, PhD, RN, assistant professor at New York University College of Nursing, and colleagues.

The researchers conducted the secondary analysis of 1744 newly licensed registered nurses drawn from data collected as part of RN Work Project, a nationally representative, 10-year (2006 - 2016) longitudinal study of the work life and career trajectory of new nurses, sponsored by the Robert Wood Johnson Foundation. Data were collected by sending a 100-question survey to nurses in 34 states and the District of Columbia. The analytic sample included nurses who worked in a hospital and were within 6 to 18 months of passing the National Council Licensure Exam.

The study goal was to explore associations between new nurses' occupational injuries and their work scheduling and shifts. The participating nurses had a mean age of 31 years, 79% were white non-Hispanic, and 53% were married.

The authors report that most new nurses (79%) worked 12-hour shifts, most (61%) worked overtime (either mandatory or voluntary), and nearly half (44%) regularly worked night shifts.

Two of these factors were independently associated with increased risk for injury. Risk for a needle stick increased by 32% for nurses who worked weekly overtime. Risk for a sprain or strain injury increased by 16% for nurses who worked night shift.

"We found that needle stick injuries were more frequent in nurses working 12-h shifts, total weekly hours over 40, and weekly overtime of 8 h or more,” the authors write. “Sprains/strains were more frequently reported by nurses working in shifts other than 12 h, total weekly hours over 40, and weekly overtime of 8 h or more."

In addition, the researchers found that needle stick injuries were also more common among nurses who were younger than 30 years, had a higher-than-average workload, or had lower-than-average autonomy, defined as the ability to work independent of others.

The risk for strains and sprains was lower for nurses whose first nursing degree was a BSN, who had higher-than-average job commitment, who worked in hospitals with higher-than-average nurse-to-patient ratios, and who lived in places with higher unemployment rates.

The authors note that one limitation was the cross-sectional nature of the study, as well as that the study did not include data on whether the nurses had received safety training, what type of continuing safety education they received, or whether safety equipment (such as patient lift devices) were available and used. They recommend that future studies also consider nurses' fatigue, sleep quantity, and sleep quality as possible contributors to injury risk.

"[O]ur results suggest that certain scheduling and shift characteristics are significantly associated with injury risk in newly licensed nurses. Findings from this study are salient for hospital administrators, nurse managers, and occupational health staff who are charged with using the timeliest evidence to develop effective strategies to improve nurses' safety at work," the authors advise.

The authors have disclosed no relevant financial relationships.

Int J Nurs Stud. Published online June 29, 2015. Abstract

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