Short sleep duration is dose-dependently related to job strain and burnout in nurses: A cross sectional survey

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Abstract

Objectives

Lack of sleep is a common problem amongst nurses. Short sleep duration has been related to stress and burnout. However, in nurses, the effects of short sleep duration on job strain and burnout are controversial and a clear relationship has been lacking. This study aims to assess whether short sleep duration is related to job strain and burnout statue, and whether such relationship is in a dose-dependent manner.

Methods

A cross-sectional survey among female nurses in secondary referral health centers in Taiwan, using a self-administered structured questionnaire. Stratified sampling by region and patient bed number category was done to select representative centers for this survey. Approximately 10% of all secondary referral centers were randomly selected from each stratum. Non-linear dose–response relationship between sleep duration and job strain and burnout scores was assessed by general additive models (GAM), adjusting for personal characteristics, work condition, and family situation.

Results

Among the 2268 full-time nurses in 39 hospitals invited to participate in this study, 1384 (61%) satisfactorily completed the questionnaire. There were 169 nurses (12.2%) who slept less than 6 h per working day. Among the participants, 37% (n = 512) were classified into high strain group. The mean scores of personal, work-related, and client-related burnout were 59.4 (SD = 22.0), 54.6 (SD = 21.7), and 42.3 (SD = 18.6). Compared to those slept longer than 7 h, nurse who slept less than 6 h per working day had higher risk for job strain (adjusted odds ratio, AOR = 1.8, 95% confidence interval, CI = 1.2–2.7), personal burnout (AOR = 3.0, CI = 1.7–5.2), work-related burnout (AOR = 3.4, CI = 2.0–6.0), and client-related burnout (AOR = 2.0, CI = 1.2–3.6). GAM analysis found a linear relationship between sleep duration and job strain, and client-related burnout. For personal and work-related burnout, a linear increase in burnout score between 7 h and 5 h of sleep was observed, followed by a leveling off for durations of less than 5 h.

Conclusion

Our study found sleep duration at working days was inversely associated with female nurses’ job strain and burnout in a dose-dependent manner. Further studies on work factors which affecting sleep duration are warranted.

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

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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.

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