Shiftwork: what health care managers need to know.

Shiftwork is one of health care worker's oldest problems and is known to have important implications on health. Health risks are compounded with age and the amount of cumulated shiftwork. No shift system is clearly advantaged, yet the worker's ability to choose the shift system seems to maximize adaptation to shiftwork. When designing a work schedule, it is important to take into consideration the shift pattern, length of the shift, and the number of consecutive days worked. A poorly designed work schedule can impact the quality of care, the personal and professional outcomes for health care workers, patient satisfaction, length of stay, unplanned absenteeism, cost effectiveness, and productivity. Long-term studies of shiftworkers may disproportionately represent workers who have adapted to shiftwork. Self-scheduling is an interesting alternative in the quest for a more responsive work environment and is a strategy for retention among new, mid-career, and senior nurses. Planned on-site napping may be a useful tool to combat the pernicious effects of sleep debt on performance. Guidelines must be developed and initiatives implemented and evaluated to protect health care workers, especially older female shiftworkers, from the negative impact of shiftwork as they represent a precious resource in a shrinking supply.