No-one tells you about the wind; the effects of shift working

Friday – the most magical day of the week. 5pm – best time of the day. Songs have been written, films made (although if you remember the film Thank God It’s Friday, you are much older than you think you are…), Twitter, Facebook and other SoMe alive with plans for the weekend. However, most of us working within the health service know that despite working time directives/the New Deal (box 1) and other such nonsense, weekend’s off come around only once every Preston Guild [1].

Received wisdom suggests that we have evolved to work from 9-5pm, Monday to Friday. Quite how that worked when we were still trying to forge blades to kill the nearest woolly mammoth has yet to be determined by Tony Robinson and his Time Team, but a recent study from China suggests that we are actually programmed to be scared of night-time (not the dark) [2]. Which probably explains why those hospital superstitions such as covering the 3^rd floor portrait of an old doctor each evening or a patient would die, opening the window to let a deceased patient’s soul out, or not allowing lilies as they are funeral flowers (although that’s rather redundant as flowers are now verboten). Of course, that fear is completely founded when you are walking through miles of underground corridor at 3am and you swear the sound of footsteps following you is real…

Shift work isn’t just about nights. It’s the weekend, its 13 hour stints, or bizarre shifts that start at 1pm and go on ‘til 10pm, or interrupted ‘off-duty’. After a while you feel permanently jet-lagged and look like the star attraction on a Panda dating site. This is unsurprising as shift work does have a physiological effect, even if you do manage to sleep the sleep of the just.

So what effect does this have on you? Well apart from justifying the fact that you are in a pub knocking back a pint and fry-up at 8.30am, physiologically, you may be in for a rough ride. Shift work can affect you both biologically and in terms of lifestyle [3]. This includes:

• Increased risk of Type 2 diabetes
• Sleep disturbances
• Lack of concentration
• Increased risk of accident or injury
• Raised risk of cardio-vascular disease
• Obesity (from the fry-ups!)
• Digestive upsets (no-one every mentions the wind…)
• Depression and mood disorders
• Raised blood pressure
• Cancer [4]

Ameliorating the effects

The Health and Safety Executive (yes, I know!) [5] has suggested some steps one can take to help ameliorate the effects of shift work:

• Concentration while driving may be impaired – if possible…use public transport (you try getting a bus after 6pm if you live in the sticks…)
• Identify a sleep schedule of at least seven hours a day in an environment that promotes sleep (heavy curtains or an eye mask)
• Improve digestion – smaller healthy snacks rather than one big meal (not too difficult, night canteens went out with Oxford Bags)
• Limit your use caffeine, energy drinks, and alcohol (you must be joking…)
• Try to get regular exercise of at least 30 minutes a day (see first bullet point)

If all else fails and you are a male, have a sex-change, or have children and invoke the Chew Ruling [6], which allows any woman with young children claim she does not have to work early, late or at night. In practice, the ruling also applies to fathers.

Good luck with running that one up the flag-pole at the next MDT meeting.

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

References

1. Preston City Council. History of Preston Guild. Available at: http://www.preston.gov.uk/yourservices/events/preston-guild/guild-history/ Accessed July 2015
2. Freeman S. Afraid of the dark? It’s actually a fear of the NIGHT: We have evolved to be more vigilant when our body clock thinks it’s the evening. 1 June 2015, Available at: http://www.dailymail.co.uk/sciencetech/article-3105853/Afraid-dark-s-actually-fear-NIGHT-evolved-vigilant-body-clock-thinks-s-evening.html Accessed July 2015
3. Morgan-Griffin R. The Health Risks of Shift Work. WebMD. 2010. Available at: http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/shift-work Accessed July 2015
4. Van Dyke KCG, Rodenburg W, van Oostrom CTM, van Kerkhof LWM, et al. Chronically Alternating Light Cycles Increase Breast Cancer Risk in Mice. Current Biology. 2015. 25; 14:1932–1937. Available at: http://www.cell.com/current-biology/abstract/S0960-9822%2815%2900677-6 Accessed July 2015
5. Health & Safety Executive. Hints and tips for shift-workers. Available at: http://www.hse.gov.uk/humanfactors/topics/shift-workers.htm Accessed July 2015
6. Thompsons Solicitors. Chew on it. Chew v Chief Constable of Avon and Somerset Constabulary. Employment Appeal Tribunal Decision. 2001. Available at: http://www.thompsons.law.co.uk/ltext/l0950001.htm. Accessed July 2015
7. Royal College of Physicians. Royal College of Physicians Parliamentary Briefing Medical workforce: New Deal and European Working Time Directive. Available at: https://www.rcplondon.ac.uk/sites/default/files/documents/rcp_parliamentary_briefing_ewtd_and_new_deal.pdf Accessed July 2015
8. NHS Employers. Working Time Directive. 2015. Available at: http://www.nhsemployers.org/about-us/nhs-european-office/nhs-workforce-and-the-eu/working-time-directive  Accessed July 2015