Shift Work and Fatigue Awareness

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Welcome to Shift Work and Fatigue Awareness

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Introduction

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This course provides you with information about shift work, fatigue awareness, and related topics.

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After completing this course, you should be able to:
Explain why fatigue awareness is important in relation to shift work;
Name 4 industries where shift work occurs;
Describe 2 best practices related to fatigue awareness and shift work; and
Explain 2 risks of not getting enough sleep for the shift worker.

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Module 1 introduces the topic of shift work and fatigue awareness while Module 2 provides information about industries and a look at industry analysis. In Module 3 you will find answers to frequently asked questions about shift work, fatigue awareness, and related topics. Finally, Module 4 covers best practices and a closer look at particular industries and how to best deal with problems that can arise with shift work.
You will have a short quiz after each module and a final quiz at the end of the course.

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Module 1: Overview

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After completing this module you should be able to:
Describe why it is important to look at shift work and fatigue awareness;
Give 2 examples of the qualities of shift work; and
Name 3 best practices that help overcome problems related to shift work and fatigue.

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Shift work is an important and widely used employment practice in today’s world of work.
Shift work can lead to fatigue that can cause harm. For example, fatigue is cited as a factor in disasters such as when the Space Shuttle Columbia disintegrated as it reentered Earth’s atmosphere, killing its seven crew members. In this course we look at the important topic of how to cope with the fatigue and other problems that can come with shift work and keep shift workers healthy, safe, and accident free. The video shows doctors and nurses pushing a stretcher in a hospital corridor.

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Shift work can make use of all 24 hours of a day and each day of the week. It typically divides the day into shifts. These shifts are periods of time where people work. This can include long term night shifts and rotating shifts. Anything outside of the 9 to 5 business day can be considered shift work.

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Many countries and industries have become dependent on shift workers to meet demands of globalization.
Shift work can make sense from a competitive standpoint.
Millions of people are shift workers that include doctors, nurse, pilots, police officers, drivers, air traffic controllers, call center workers, bridge builders, and road maintenance.

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In this course we look at best practices that can help shift workers and their managers cut down on harm.
Harm can come when shift work contributes to accidents or causes a shift worker to develop health problems.
Health problems can come to shift workers who have sleep rhythm disorders leading to insomnia and sleepiness.

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Other health disorders that can come from shift work include asthma, diabetes, breast and other types of cancer, digestive diseases, hypertension, epilepsy, substance abuse, headaches, heart disease, depression, and obesity.

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Cognitive problems can also come with shift work that involves nights. Attention impairment is one problem. It arises because work at night disrupts a person’s normal and natural circadian sleep pattern that involves sleeping at night and being awake during the day. Sleep during the day for someone who works at night can be shorter than night time sleep.

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Safety and productivity can suffer for those who work at night. There are greater chances of injuries and accidents.

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Let’s look briefly now at some best practices that include avoiding permanent night shifts and providing for several days of work offset by several days off.
Avoiding consecutive night shifts, long work shifts, and overtime work can also help. A predictable schedule is another best practice as is avoiding back to back shifts.

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Adequate lighting, clean air, heat, air conditioning, and reduced noise can also help.

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At home workers should maintain a regular sleep routine, avoid alcohol before sleep, and not exercise before work. Medications such as melatonin can increase sleep for some who work at night and sleep during the day.

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You work a shift that starts at midnight. Before getting to work you exercise and to help you get to sleep after work you unwind with a glass of wine. As a night shift worker, is it a good idea for you to exercise before work and drink wine to help you get to sleep?
(wait 3-5 seconds)
If you said no, it is not a good idea, you are correct. If you work a midnight shift you should avoid exercising before work. You should also avoid alcohol before you go to sleep.

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In this module we looked at why it is important to look at shift work and fatigue, what is shift work, possible problems associated with shift work, and best practices at work and home to overcomes possible problems.
Now we’ll have a brief quiz to review what you have learned.

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Module 2:  Industries and Analysis

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After completing this module, you should be able to name 4 industries or professions where there is shift work and explain the advantages of shift work in industrial settings such as a factory. You should able be able to describe 2 challenges faced by the shift work done by the Royal Canadian Mounted Police.

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Let’s look more closely at some of the places that have shift work with 24/7 operation and how the practices that managers use at these places can influence the safety of workers and their performance.
Some of the industries that have 24/7 operations and shift work include airlines and air traffic controllers, customer service and call centers, factories health care and hospitals, hotels and food service, military, mining, highway work, and road maintenance.

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Others include trucking, utilities, protective services, retail, security, telecommunications, customs and immigration. police, fire, and EMS work.

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Shifts can start in the morning, evening, and night, with three shifts being a typical operation with 8-hour shift. Some operations use 12 hour shifts as with steelworkers. Other industries such as offshore petroleum can have two week tours or swing shifts. The first two weeks involves day work. The second two weeks involves night work.

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industrial settings shift work increases the use of equipment and provide more finished goods compared to day shift alone. With shifts there also is no overtime which causes higher wage costs.
In some cases some who works a night shift makes more per hour than the person who does the same work during a day shift. This can be cost effective for a company as restart of equipment can be expensive.

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Transportation and public service plus health care are also fields where there is shift work with a variety of shift practices, some involving 8 hour shifts and some involving longer daily shifts, even 24 hour shifts for those who are firefighters.

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Studies indicate that close to 30% of workers in Canada and the US do not work a regular day shift.  Among the highest number of workers not in a day shift are those who work in accommodation and foodservice,  health care and social assistance, and manufacturing.

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As we progress though this class we will look at case studies. We can learn much about best practices as we look at the details of various professions. Looking at individual cases is a best practice when it comes to developing the best approach to handle shift work. Let’s get started with a look at the Royal Canadian Mounted Police.

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Small changes can improve health and safety. So says a report on research concerning the Royal Canadian Mounted Police, fatigue, and shift work. According to the report fatigue is a major problem for shift workers due to sleep disruptions. Night workers find disrupted daytime sleep and shortened deep sleep. This means fatigue, anxiety, and depression results.

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Gastrointestinal concerns include ulcers, colitis, abdominal pain, and appetite disturbance.  Diabetes and cardiovascular disease is also more prevalent with the shift worker. Fatigue leads to higher rates of accidents, negative attitude, and impaired ability to reason.

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According to the study, what helps with shift work fatigue is low doses of caffeine. Higher doses of more than 3 medium coffees cause a decline in performance. Side effects include insomnia, increased heart rate, and anxiety.
Napping can also help with shift work fatigue. Mental performance improves with a nap. Memory and use of driving simulator also improve with napping.

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Regular physical activity also helps with performance for the shift worker. Ten minutes of moderate exercise during a shift can help.
Meals and snacks should include varied and high quality food. High sugar and high carbohydrate foods hurt performance of the shift worker. Large meals can mean a shift worker is less alert and more sleepy.

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Here are some tips that come from the study.
To stay awake the study recommended:
1.	Take naps of 20-30 minutes when possible
2.	Avoid intense exercise
3.	Do 10 minute exercise sessions such as walking
4. Limit high fat food
5. Limit high carb food
6. Take a 1 to 5 hour nap before a shift
7. Eat protein at each meal
8. Know that low fat cheese and almonds are good choices

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You work as a police officer who is scheduled to work a night shift. You feel that taking a nap before your shift is a good idea to help fight being drowsy on the job. Is taking a nap before a night shift a best practice?
[Wait 3-5 seconds.]
 If you said yes, you are right. Taking nap before a night shift can reduce drowsiness on the job.

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In this module we looked at places where shift work takes place, why some industries benefit from shift work, and some overview statistics. We also looked at why it is important to look at individual cases, moving on to the details of a study involving shift work and the Royal Canadian Mounted Police.
You should now be able to name 4 industries or professions where there is shift work and explain the advantages of shift work in industrial settings such as a factory. You should able be able to describe 2 challenges faced by the shift work done by the Royal Canadian Mounted Police.
Now we’ll have a brief quiz to review what you have learned.

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Module 3:  Basic information and FAQ’s

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After completing this module, you should be able to answer these questions. Does shift work cause cancer? Should pregnant shift workers be concerned? What are 2 things a person can do to cope with shift work?

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Why should we look at the effects of shift work?
Let’s remind ourselves that a major reason to look at the effects is that shift work can be a factor in accidents in many industries. This can include air crashes and nuclear power plant incidents.
The video shows a nurse comforting a patient in a hospital setting.

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Does shift work cause cancer?
The International Agency for Research on Cancer (IARC) concluded that shift work is “probably carcinogenic to humans” as it involves circadian disruption. A circadian rhythm is a 24-hour body cycle. Those who work nights follow a schedule that is not “natural” as sleeping at night is considered natural.

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What does “rotational shift work” mean?
The term can refer to any kind of shift work that is outside of a 9 to 5 work schedule. This can include shifts that rotate and change according to a schedule. The term can apply to shifts that run 24 hours a day every day or semi continuous shifts that run without weekends. Typically, workers take turn working various shifts. Shifts can vary between 8 and 12 hours.

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What concerns exist for pregnant shift workers?
Studies are now in progress concerning answers to this question. Some studies have looked at irregular shifts for pregnant individuals and resulting low birth weight. We do not now have firm answers on the connection.

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What strategies can help shift workers?
Strategies can involve organizations and individuals. Organizations can work to design effective shift schedules, provide education, and develop better facilities. Individuals can work on better sleep, reduction of stress, and a healthy diet.

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What can a person do to cope with shift work?
If you work shifts you should recognize you face problems other do not have. These concern patterns of sleeping, eating, and working. Make sure you develop effective habits at work including how you handle meals and exercise.

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An optimal design for shift schedules can help reduce safety and health problems.  Compromise can include a combination of medical, personal, social, and psychological concerns.

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How long should you be on one shift before switching to the next shift?
Approaches vary. In some organizations, you stay on a rotation for one week. This can include 5 to 7 consecutive night shifts. In other organizations, you spend two to four weeks on the same shift. This is because it can take 7 days for adjustments in circadian rhythms. You should not go back to a “normal” day/night schedule on days off. This can hurt the ability to adapt. Workers and managers should work together to look at individual differences and preferences.

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You work for a hospital as a nurse who worked a night shift from Monday to Friday. Your supervisor asks you to work the weekend from 9AM to 5PM before returning to your night shift on Monday. Is this return to a day shift on a weekend a good practice?
(wait 3-5 seconds)
If you answered no, you are correct. You should not go back to a “normal” 9 to 5 schedule on a day off after you work 5 consecutive night shifts. This can hurt the your ability to adapt.

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In this module we looked at the answers to questions about shift work, cancer, and pregnancy. We also looked at what an individual and organization can do to minimize problems associated with shift work.
We will now have a short quiz about the information in this module.

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 Module 4:  Best Practices

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After completing this module, you should be able to describe 3 ways to fight the fatigue that can come with shift work. You should also be able to give 2 tips for effective sleeping during the day and explain 2 ways of know you have had enough sleep.

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 As fatigue can contribute to accidents on the job and harm to the health of a shift worker, let’s looking at some best practices in recognizing and managing fatigue. Let’s start by looking at shift work disorder and the symptoms that include:
Insomnia;
Irritability;
Depression;
Disrupted sleep schedules;
Reduced performance; and
Difficulties with relationships.

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Treatment of fatigue is limited. Drugs and therapy can help. In some cases nothing helps as the body never fully adapts.

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Coping
Avoid long commutes
Avoid extended hours past 8 hours a day
Take short naps
Work with others

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Some more tips for coping with fatigue include that you should:
Be active during breaks;
Take a walk;
Drink caffeinated beverages; and
Know the most sleepy time is 4 -5 am.

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Tips for sleeping during the day include that you should:
Keep the same bedtime;
Wear dark glasses to block out sunlight on your way home;
Avoid caffeine close to bed time; and
Avoid alcohol before bed time.
Safe work practices for managers and workers
Remember that health and safety issues are connected with shift work
For a shift over 8 hour – with extended hours – this can prolong exposure to hazards such as chemical, noise, and heat
For long shifts the exposures could exceed health standards
Work schedules should provide for responders to sleep and recover from work shifts
Schedules should prioiritize what work needs to be done
Two guideslines
Provide at least 10 consecutive hours per day of time to allow for 7-8 hours of sleep
Allow for frequent rest break every 1-2 hours
When work is demanding – this will help with fewer erros and injuries on the job. Allow for longer breaks for meals
Are you getting enough sleep
You should feel refreshed when you wake
Don’t feel drowsy during the day
Don’t need much caffeine during the day
If you do not feel this you might need more sleep

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Safe shift work practices include that managers and workers should remembers that health and safety issues are connected with shift work.
For a shift over 8 hour – with extended hours – this can prolong exposure to hazards such as chemicals, noise, and heat.
For long shifts the exposures could exceed health standards
Employers must limit worker exposure to health hazards according to the Occupational Safety and Health Act.

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Work schedules should provide time for workers to sleep and recover from work shifts.
Schedules should also prioritize work that needs to be done.

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Here are two guidelines to follow.
First, you should provide at least 10 consecutive hours per day of time to allow for 7-8 hours of sleep. Second, you should allow for frequent rest break every 1-2 hours.

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Also allow for longer breaks for meals.
When work is demanding – this will help with fewer errors and injuries on the job.

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Are you getting enough sleep?
This is an important question to answer in fatigue awareness.
If you are getting enough sleep you:
Should feel refreshed when you wake;
Don’t feel drowsy during the day; and
Don’t need much caffeine during the day.
If you do no feel this you might need more sleep.

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Air traffic controllers work 24/7 with individuals typically working 8 hours a day and 5 days a week.  Work performance deteriorates when a controller is in position for more than two hours so a best practice is to keep this in mind. Another best practice is to divide a 24 hour day into three shifts.  These typically include starting in the morning, late afternoon, and night.

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Some best practices based on conclusions from the study include:
Set a predictable schedule;
Manage overtime;
Increase lighting; and
Train on diet and the use of caffeine.

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The video shows a tandem truck moving a sunset.
Here are 10 tips to fight the possible fatigue that can come with the business of truck driving.
Below are ten tips to help alleviate potential fatigue brought on by the day-to-day business of truck driving:
1. Eat a well-balanced diet that includes meat, fish, fruits, grains, vegetables, and dairy products.
2. Keep a comfortable environment and review your sleeping quarters. Check for noise, poor ventilation, and high or low temperatures.
3. Exercise regularly. Do not spend much of the day sitting. Plan an exercise program to build stamina.
4. Reduce excess weight. Excess pounds can contribute to fatigue.
5. Improve sleep. If you have insomnia, try to sleep more or less. Experiment. Try changing your bed time.

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6. Manager your time better. Use time management techniques to get control of your life.
7. Relax more. Spend free time doing something you enjoy. Fishing, camping or golfing can each stress and help you sleep better.
8.	Reduce caffeine. Too much caffeine can over stimulate the body and mind. Caffeine can interfere with sleep and increase anxiety. Keep it to two cups a day to see if that reduces fatigue.
9.	Quit smoking. Smoking is linked to diseases that cause fatigue.
10.	Avoid alcohol. Alcohol can cause fatigue. It also disturbs sleep especially before bedtime. It can also cause emotional turmoil that contributes to fatigue.

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You have a job where you work a night shift so you must sleep during the day.
Does it help to wear dark glasses to block out sunlight on your way home and avoid alcohol before going to sleep?
(Wait 3-5 seconds)
The correct answer is yes. These practices both can help you sleep during the day.

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In this module we looked best practices in recognizing and managing the fatigue that can come with shift work. We also looked at fatigue treatment options and coping, plus tips on how to sleep better during the day. We concluded with listing safe work practices and studies involving air traffic controllers and truck drivers.
Now we’ll have a brief quiz to review what you have learned.

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Course Summary

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In this course you looked at overview information concerning shift work and fatigue awareness and learned more about industries with shift work and related studies. You also looked at answers to frequently asked questions about shift work and finally learned about best practices and more studies.
Let’s go on to the final quiz.

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Congratulations! You have completed the course.
We hope you will use what you have learned to protect yourself and others on the job and continue to work safely throughout your life.