Pattern of shiftwork and health status among nurses in a university hospital in northeastern Thailand

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Kampanat Wangsan Naesinee Chaiear Kittisak Sawanyawisuth Piyanee Klainin Kanjana Simajareuk


This study was aimed to explore shiftwork patterns and health status among nurses at a university hospital in northeastern Thailand. A descriptive study was conducted. The study population was 1,221. The data were collected via self-reported questionnaire including personal information and the last month shift schedule. Descriptive statistics were applied using STATA v 10. The response rate was 68.1 % (831/1,221) and completion rate was 59.1% (721/1,221). There were 82.2% (593/721) participants had performed shiftwork. The shiftwork patterns were (a) day shift plus over time, (b) day and evening shift, (c) day and night shift, and (d) rotational shift. All of rotational shift were fast rotation with irregular shift pattern (n=531; 89.5%). Even though there was no pure forward or backward rotations, the researcher divided the participants into three groups (namely, primarily forward, primarily backward, and evenly split between backward and forward). Most shift workers performed primarily backward rotational pattern (n=479; 90.2%). A minority (n=143; 24.1%) did extended shifts:  median extended shift was once a month (IQR 1-3). The majority (n=523; 88%) of participants did quick return shifts (88%) (median=11 times/month, IQR7-13) Nearly one-third (28.0%) of participants had underlying diseases such as allergic rhinitis (7.9%), asthma (1.9%), and/or dyslipidemia (1.8%). Based on a BMI > 25 kg/m2, 17.5 % of the participants were obese. Over one-tenth (12.2%) of the participants had a sleep disorder and 14.9% used sleepiness- or drowsiness-inducing medication. Most of the participants had no depression (86.4%) and were at low risk of obstructive sleep apnea (76.0%). Comparing characteristics of shift and non-shift personnel, median age, proportion of married nurses and caffeine needed were lower for shift workers than the non-shift workers. Working experiences were shorter in shift workers than the non-shift workers and there was a statistically significant difference among job position, task, work unit, and salary. Likewise, shift workers had fewer underlying diseases, using sleepiness or drowsiness drug and depression. In conclusion, there was a high proportion of shift workers represented in the study, and most nurses did rotational shift with primarily backward rotation, quick return and extended shifts which are associated with a higher health risk. The health effect from shiftwork on the current study could not be concluded however, nearly one-third revealed some kinds of underlying diseases. The association of effect from shiftwork will be presented elsewhere.


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[1] World Health Organization International Agency for Research on Cancer. Painting, Firefighting and Shiftwork[Internet]. 2010 [cited 2017 May 5] Available from:

[2] Health and Safety Executive. Managing Shiftwork Health and Safety Guidance. Shefield: Crown; 2006.

[3] CDC - Health Care Workers - NIOSH Workplace Safety and Health Topic [Internet]. [cited 2017 May 23]. Available from:

[4] Knutsson A, Hallquist J, Reuterwall C, Theorell T, Akerstedt T. Shiftwork and myocardial infarction: a case-control study. Occup Environ Med 1999 ;56(1):46–50.

[5] Amani R, Gill T. 1Shiftworking, nutrition and obesity: implications for workforce health- a systematic review. Asia Pac J Clin Nutr 2013;22(4):505–15.

[6] Hansen AB, Stayner L, Hansen J, Andersen ZJ. Night shift work and incidence of diabetes in the Danish Nurse Cohort. Occup Environ Med 2016 ;73(4):262–8.

[7] Knutsson A, Kempe A. Shift work and diabetes--a systematic review. Chronobiol Int 2014;31(10):1146-51.

[8] Costa G. Shift work and occupational medicine: an overview. Occup Med Oxf Engl 2003;53(2):83-8.

[9] Knutsson A. Health disorders of shift workers. Occup Med Oxf Engl 2003;53(2):103-8.

[10] Roger RR, Colligan MJ. plain language about shift work. [Internet]. 1997 [cited 2017 Apr 2]. Available from:

[11] Van Amelsvoort LGPM, Jansen NWH, Swaen GMH, van den Brandt PA, Kant I. Direction of shift rotation among three-shift workers in relation to psychological health and work-family conflict. Scand J Work Environ Health 2004;30(2):149-56.

[12] Lavie P, Tzischinsky O, Epstein R, Zomer J. Sleep-wake cycle in shift workers on a “clockwise” and “counter-clockwise” rotation system. Isr J Med Sci 1992;28(8–9):636-44.

[13] Shon Y, Ryu S, Suh B-S, Kim S-G, Kim W-S, Son H-S, et al. Comparison of sleep quality based on direction of shift rotation in electronics workers. Ann Occup Environ Med 2016;28(1):37. DOI 10.1186/s40557-016-0122-3

[14] Thailand nursing and midwifery council. Working hour policy of nurses in Thailand for patient safety.[Internet]. 2017. [cited 2017 Jun 28] Available from:

[15] Wisetborisut A, Angkurawaranon C, Jiraporncharoen W, Uaphanthasath R, Wiwatanadate P. Shift work and burnout among health care workers. Occup Med Oxf Engl 2014 ;64(4):279-86.

[16] Ngamjarus C, Chongsuvivatwong V, McNeil E. n4Studies: sample Size calculation for an epidemiological study on a smart device. Siriraj Med J 2016;68:160–70.

[17] Science and Technology Infrastructure Databank [Internet].2017. [cited 2017 Jun 28]. Available from:

[18] Kongsuk T. Hamilton Rating Scale for Depression (HRSD-17) The Reliability and validity of the 9 Questions for Assessment of Depressive Symptom comparison with the Hamilton Rating Scale for Depression [Internet]. [cited 2017 May 22] Available from:

[19] Scott LD, Hwang W-T, Rogers AE, Nysse T, Dean GE, Dinges DF. The Relationship between Nurse Work Schedules, Sleep Duration, and Drowsy Driving. Sleep 2007;30(12):1801-7.

[20] Eldevik MF, Flo E, Moen BE, Pallesen S, Bjorvatn B. Insomnia, excessive sleepiness, excessive fatigue, anxiety, depression and shift work disorder in nurses having less than 11 hours in-between shifts. PloS One 2013;8(8):e70882.

[21] Scott LD, Rogers AE, Hwang W-T, Zhang Y. Effects of critical care nurses’ work hours on vigilance and patients’ safety. Am J Crit Care Off Publ Am Assoc Crit-Care Nurses 2006;15(1):30-7.

[22] Jirapramukpitak T, Tanchaiswad W. Title: Sleep disturbances among nurses of Songklanagarind Hospital. J Psychiatr Assoc Thail 1997;42(3):123–32.

[23] Kunaviktikul W, Wichaikhum O, Nantsupawat A, Nantsupawat R, Chontawan R, Klunklin A, et al. Nurses’ extended work hours: Patient, nurse and organizational outcomes. Int Nurs Rev 2015;62(3):386-93.

[24] Zhang L, Sun D-M, Li C-B, Tao M-F. Influencing Factors for Sleep Quality Among Shift-working Nurses: A Cross-Sectional Study in China Using 3-factor Pittsburgh Sleep Quality Index. Asian Nurs Res 2016;10(4):277-82.

[25] Lajoie P, Aronson KJ, Day A, Tranmer J. A cross-sectional study of shift work, sleep quality and cardiometabolic risk in female hospital employees. BMJ Open 2015;5(3):e007327.

[26] Tucker P, Smith L, Macdonald I, Folkard S. Effects of direction of rotation in continuous and discontinuous 8 hour shift systems. Occup Environ Med 2000;57(10):678-84.

[27] Vedaa Ø, Harris A, Bjorvatn B, Waage S, Sivertsen B, Tucker P, et al. Systematic review of the relationship between quick returns in rotating shift work and health-related outcomes. Ergonomics 2016;59(1):1-14.

[28] Angerer P, Schmook R, Elfantel I, Li J. Night Work and the Risk of Depression. Dtsch Ärztebl Int 2017;114(24):404-11.

[29] Schlafer O, Wenzel V, Högl B. [Sleep disorders among physicians on shift work]. Anaesthesist. 2014;63(11):844-51.

[30] Wright KP, Bogan RK, Wyatt JK. Shift work and the assessment and management of shift work disorder (SWD). Sleep Med Rev 2013;17(1):41-54.