Associations between adverse working hours and nurses' sickness absence: a longitudinal analysis of e-roster data from acute hospital wards.

Abstract

To examine the associations between registered nurses' shift work patterns and sickness absence in hospital inpatient wards. Retrospective longitudinal study using 1.4 million e-roster and sickness absence records analysed with logistic mixed-effects models. All adult acute inpatient hospital wards in two large healthcare organisations (Trusts) in England. Registered nurses (N=7515) working across 95 adult acute wards in 2015-2020. Nurses' sickness absence in relation to the shift pattern configurations worked in the previous 7 days. Logistic mixed-effects models were adjusted for total working hours, bank hours, previous sickness and part-time status. Higher odds of sickness absence were significantly associated with each additional rest period of fewer than 11.5 hours (OR 1.23, 95% CI 1.19 to 1.27, p<0.001), change between day and night shifts (OR 1.09, 95% CI 1.04 to 1.13, p<0.001) and spell of 3 or more consecutive shifts (OR 1.24, 95% CI 1.16 to 1.32, p<0.001) in the previous 7 days. By accounting for nonlinearity, analyses revealed that working 70% of shifts as ≥12-hour shifts and 100% of shifts as night shifts were associated with increased odds of sickness (OR 1.68, 95% CI 1.53 to 1.84 and OR 1.07, 95% CI 1.01 to 1.13, respectively) when compared with working none of these shift types. Sensitivity analysis using 28-day exposure windows did not change the direction of effects; however, the magnitude and significance of some associations attenuated. This study highlights the organisational consequences of adverse working hours arrangements for registered nurses working in hospital wards. Short recovery periods, frequent shift rotations, consecutive working spells and high proportions of long and night shifts were associated with higher odds of sickness absence, with associations most apparent over 7-day exposure windows. Overall, these findings can inform shift planning policies that better support staff well-being through proactive management of sickness absence.