Towards a sustainable work force in the healthcare sector for the 21st century: Health-promoting Work Schedules (HeWoS)

One in four employees in Norway are engaged in shift work. Thus, knowledge about health-promoting work schedules is relevant for a large proportion of the Norwegian workforce. Much of the research conducted on the association between shift work and health has been focusing on night work, however in recent years, research has also shown that short rest periods between two shifts (<11 hours), so-called "quick returns" (QR), can also have negative consequences. A QR most often occurs when an evening shift is followed by an early morning shift. Lack of objective data to measure shift work exposure, lack of randomized controlled trials (RCT) investigating the effect of different working time arrangements and effective interventions to reduce shift work disorder are also lacking in the field. This project consists of 5 work packages (WPs): In WP 1, the aim is to establish a working time register for employees in Norwegian hospitals and to investigate the association between shiftwork and sickness absence. A webpage for the Norwegian Working hour Registry for employees in Hospitals (NWRH) has been published on the Research Centre for Sleep Work and Health's website. Legal basis has been discussed and a data assessment plan and safeguarding of employees' rights have been approved by lawyers and data protection officers at the University of Bergen and Helse Bergen. Data from Helse-Bergen has been included to NWRH. Invitations to other health trusts will continue in 2024. The establishment of a register contributes to high quality and control of data in the field study that is part of HeWoS. In addition, the collaboration on the register will contribute to bring the practice and the research fields closer together. To gather existing knowledge about the relationship between shift work and sickness absence a systematic review and meta-analyses on the associations between shift work and sickness absence will be conducted. The protocol for this work is published and the article is in progress. In WP 2, we have conducted a randomized controlled trial examining the effect of a work schedule without short rest time (<11 h) between two shifts in almost 3700 health workers, working in 66 different units at Helse Bergen. Main outcomes are sick leave and turnover intention. Two articles from this study have been submitted to international journals. See webpage for more information. WP 3 has an experimental approach. To gain knowledge about sleep quality and work performance in relation to QRs, as well as identify individual differences and specific genotypes related to tolerance of QRs, a laboratory study including a total of 60 participants has been conducted. In the lab study participants were randomized to two conditions in a cross-balanced design: 1) short rest (< 11h) between two shifts (an evening shift followed by a day shift), 2) two consecutive day shifts A systematic review and meta study gathering existing knowledge about the relationship between work performance (cognitive functioning) at night versus day-work will also be conducted as part of this WP. The protocol is pre-published in PROSPERO. One article has been submitted and one will be submitted spring 2024. In WP 4, the main object is to evaluate whether a self-help book to cope with shift work can reduce the prevalence of shift work-related sleep disorders, increase knowledge about sleep and circadian rhythms, provide better health and reduce "turnover intention" among health workers who experience these sleep problems. A total of 300 health care workers with shift work disorder will be randomized into two groups: one group (n = 150) receiving the self-help book and one group (n = 150) receiving sleep hygiene advice. Recruitment started in the autumn of 2022 and so far, approximately 100 health workers with shift work disorders have been included. The data collection will continue in 2024. In WP 5, the aim is to ensure that new and important knowledge about shift work will be communicated to practice and relevant stakeholders. Thus, the research group plan for a national conference in 2024. For more information see: https://www.uib.no/fg/sc/158911/mot-en-b%C3%A6rekraftig-arbeidsstyrke-i-helsesektoren-i-det-21-%C3%A5rhundre-helsefremmende

The need for healthcare workers is expected to increase in the future, yet there is a current high absence due to sickness, and high turnover rate. HeWoS will identify effective and health-promoting work schedules to maintain the health and well-being of healthcare workers and to ensure a sustainable work force in the healthcare sector for the future. HeWoS will be the first shift work register with the opportunity to examine the moderating effect of seasonal fluctuations in light exposure on the association between shift work and sickness absence. HeWoS will use an RCT-design to establish the effect of abolishing quick returns (QR) on sickness absence, sleep, health and work-related accidents. HeWoS will conduct shift work simulation study to investigate the effect of QRs on shift functioning, and the potential moderating effect of light and specific genotypes. HeWoS will generate new knowledge by a) examining effects of abolishing QR from the work schedule on sickness absence and turnover intention; b) identifying individual differences and specific genotypes related to QR tolerance; c) investigating effects of light differences on the negative effects of QR. HeWoS aim to distribute knowledge on the effect of a low-threshold intervention (a self-help book) among those who struggle with shift work disorder. The interdisciplinary research team includes expertise in psychologists, a medical doctor, statisticians, a physiologist and nurses with master’s degrees in health promoting work. The research team is complemented by relevant civil society service providers. Partnership with the Haukeland University Hospital involves implementing findings from research. The project includes two PhD candidates and one postdoc fellowships.