Short sleep duration is dose-dependently related to job strain and burnout in nurses: A cross sectional survey☆
Introduction
Nurses belong to a profession that has high exposure to job strain and burnout (Felton, 1998, Landsbergis, 1988, Su et al., 2009). Stressful work environment has been reported to damage nurses’ mental health (Yang et al., 2004), and intention to stay working (Aiken et al., 2002, Jourdain and Chênevert, 2010, Lynn and Redman, 2005). In addition, reduced patients’ satisfaction (Leiter et al., 1998, Schmitz et al., 2000) and threatened safety (Cimiotti et al., 2012, Poghosyan et al., 2010) have been associated with nurses’ stress.
In addition to its adverse effects on physical health (Cappuccio et al., 2007, Hamer et al., 2012, Shankar et al., 2008), short sleep duration has effects on several domains of psychological health, including stress and burnout in various occupations. In the United States, the national health interview survey conducted in community population found association between short sleep duration (≤ 6 h/a day) and high self-reported stress (Lauren and Phuong, 2007). In Japan, a survey of 8157 men who underwent health evaluations at health management center in Tokyo found that using those who slept 5–7 h as reference group, sleeping shorter than 5 h was associated with higher risk of mental stress (adjusted OR = 1.66, 95% confidence intervals = 1.42–1.96), whereas sleeping longer or equal than 7 h with lower risk (adjusted OR = 0.75, 95% confidence intervals = 0.66–0.85) (Hsieh et al., 2011). A survey among 143 law enforcement officers of the Iowa Department of Public Safety found that subjects sleeping shorter than 6 h had significantly higher burnout and stress scores than those sleeping 6–8 h (p = 0.001 and 0.003, respectively) (Yoo and Franke, 2013).
Similar findings of short sleep duration-associated stress have been documented in healthcare workers. A survey conducted in 150 family medicine residents in Korea found significantly higher scores of occupational stress in those who slept less than 6 h a day (p = 0.005) (Choi et al., 2013). A study in American medical residents showed an inverse dose–response relationship between daily sleep hours and stress level (Baldwin and Daugherty, 2004). Previous studies have shown that short sleep duration is common among nurses (Geiger-Brown et al., 2011, Geiger-Brown et al., 2012)and healthcare workers (Luckhaupt et al., 2010).
As for the effects of short sleep duration among nurses, studies showed inconclusive findings. A cross-sectional online survey was conducted in Registered Nurses (RNs) in the United States to measure their mental, physical, and total fatigue dimensions. Among 745 RNs completed the survey, less sleep was associated with higher scores in physical fatigue and total fatigue, but not those in mental fatigue (Barker and Nussbaum, 2011). A recent study in Finland among 95 nurses and nursing assistants found no difference of sleep length between high strain and low strain group (Karhula et al., 2013). These findings were somewhat different from those in other occupations. Furthermore, in those studies on nurses, a clear relationship of sleep duration and stress has never been clearly described.
Short sleep duration was common among nurses (Linda et al., 2007). In spite of existing studies related to this issue, the establishment of a conclusive relationship between sleep hours and job strain and burnout is still lacking. The aim of this investigation was to assess the prevalence of short sleep in nurses in Taiwan, and the association between sleep duration and reported job strain and burnout by a detailed description of dose-dependent relationship.
Section snippets
Subjects
We conducted a cross-sectional study among nurses in secondary referral health centers in Taiwan using a self-administered structured questionnaire to obtain information. Stratified sampling was used to select a representative sample of centers for this survey. Considering that severity and complexity of patients’ conditions were different between rural and urban areas and between larger centers and smaller hospitals, stratification was undertaken by region and size (Burns and Wholey, 1991,
Results
There were 366 secondary referral health centers in Taiwan according to 2005–2008 accredited hospital lists in Taiwan (Ministry of Health and Welfare, 2009). Totally, 39 hospitals were selected by the stratified sampling scheme (13 from north, 10 from central, 14 from south, and 2 from east of Taiwan). A total of 3292 full-time female nurses were employed in the participating hospitals. After excluding nurses on extended leave and vacation, and refusals, only 2268 nurses received the
Discussion
In this group of nurses representative of those worked at secondary hospitals in Taiwan, we found that sleep duration on working days was associated with job strain and burnout, with optimal sleep duration at 7 h or longer. Although interpretation of these results into causal relationship has to be cautious, such findings provide valuable indicators for job stain and burnout status when sleep time is short among nursing staff.
Our findings were compatible with a study by Rutledge et al., in which
Acknowledgments
This work was supported by Department of Health, Executive Yuan, R.O.C. (Taiwan) grant DOH099-TD-M-113-098006. We thank governments’ support and also appreciate all participants. We are grateful to Dr. Hintchun Huang help us to use statistic product for GAM analysis.
Conflict of interest: No conflicts of interest.
Funding: This work was supported by Ministry of Health and Welfare, R.O.C. (Taiwan) grants DOH099-TD-M-113-098006.
Ethical approval: The Institutional Review Board (IRB) at the National
References (60)
- et al.
Working hours, sleep duration and the risk of acute coronary heart disease: a case–control study of middle-aged men in Taiwan
Int. J. Cardiol.
(2014) - et al.
Health issues among nurses in Taiwanese hospitals: National survey
Int. J. Nurs. Stud.
(2013) - et al.
Nurse staffing, burnout, and health care-associated infection
Am. J. Infect. Control
(2012) - et al.
Work hours, workload, sleep and fatigue in Australian Rail Industry employees
Appl. Ergon.
(2011) - et al.
Sleep and errors in a group of Australian hospital nurses at work and during the commute
Appl. Ergon.
(2008) - et al.
Generalized linear and generalized additive models in studies of species distributions: setting the scene
Ecol. Model.
(2002) - et al.
Job demands—resources, burnout and intention to leave the nursing profession: a questionnaire survey
Int. J. Nurs. Stud.
(2010) - et al.
A survey of sleep deprivation patterns and their effects on cognitive functions of residents and interns in Korea
Sleep Med.
(2011) - et al.
Smoking behavior and patient education practices of oncology nurses in six countries
Eur. J. Oncol. Nurs.
(2008) - et al.
Relationship between sleep and mood in patients with rapid-cycling bipolar disorder
Psychiatry Res.
(1996)
The correspondence of patient satisfaction and nurse burnout
Soc. Sci. Med.
Disturbed sleep and burnout: implications for long-term health
J. Psychosom. Res.
Stress, burnout and locus of control in German nurses
Int. J. Nurs. Stud.
Insomnia and sleep quality among primary care physicians with low and high burnout levels
J. Psychosom. Res.
HOspital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction
JAMA
Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents
Sleep
Fatigue, performance and the work environment: a survey of registered nurses
J. Adv. Nurs.
American time use survey: sleep time and its relationship to waking activities
Sleep
The effects of patient, hospital, and physician characteristics on length of stay and mortality
Med. Care
Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study
Hypertension
Occupational stress and physical symptoms among family medicine residents
Korean J. Fam. Med.
Overtime work and its effects on sleep, sleepiness, cortisol and blood pressure in an experimental field study
Scand. J. Work. Environ. Health
Dose–response analyses using restricted cubic spline functions in public health research
Stat. Med.
Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4–5 hours per night
Sleep
A pilot study of the safety implications of australian nurses’ sleep and work hours
Chronobiol. Int.: J. Biol. Med. Rhythm Res.
Burnout as a clinical entity—its importance in health care workers
Occup. Med.
Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses
Chronobiol. Int.
The impact of work schedules, home, and work demands on self-reported sleep in registered nurses
J. Occup. Environ. Med.
Sleep loss due to worry and future risk of cardiovascular disease and all-cause mortality: the Scottish Health Survey
Eur. J. Prev. Cardiol.
Generalized additive models
Stat. Sci.
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This abstract of this paper has been presented at the following international conference: Chin WS, Guo YL, Shiao JSC. The Association between Sleeping time, shift work and risk of high job stain and burnout among nurses. Poster Presented at the 22ndInternational Conference on Epidemiology in Occupational Health, September 7–9, 2011 in Oxford, UK. Chin WS, Guo YL, Shiao JSC. The Association between Sleeping time, shift work and risk of high job stain and burnout among nurses. Occup Environ Med 2011;68:A124 doi:10.1136/oemed-2011-100382.411. Abstract. Chin WS, Guo YL, Shiao JSC. The Association between Sleeping time, shift work and risk of high job stain and burnout among nurses. Poster Presented at the 20th International Conference on Health Promoting Hospitals and Health Service, April 11–13, 2012 in Taipei, Taiwan.