On- and off-the-job accidents. Carolyn points out the impact of fatigue and sleep deprivation on efficiency, accidents, and injuries

is not just on the job. “One of the greatest risks to shiftworkers is driving home after work. Employers have been held liable when an employee was killed in a drive-home accident. Also the employer may incur liability when an employee is called back to work knowing he/she hasn’t had a sufficient amount of sleep.”

Carolyn emphasizes shiftwork isn’t necessarily a bad thing. “There’s this perception no one wants to work shifts, and that’s really not true. Shiftwork provides many opportunities not available to day workers. Shiftworkers can conduct personal business, go to school, or play golf during the week. I knew a couple who were both nurses. They would get scheduled on opposite shifts so their children always had a parent at home. So it really can be made to work.” She notes employee retention can be a workplace factor.

“Employers hire with little consideration as to how adaptable an employee might be to the demands of shiftwork. The employee is excited to get a well- paying job regardless of the shift demands. Eventually some come to realize the lifestyle is not for them, but they have no way of knowing that in advance. Employers need to consider applicants’ ability to cope with the challenges of shiftwork as an essential skill for the job.” Employers often ask Carolyn to conduct shiftwork orientation for incoming employees. “I recommend giving such programs after they’ve experienced rotations for about 8 weeks. This allows employees to feel firsthand the disruption in sleep and problems it causes. The programs will then be more meaningful and valued.”

HEALTHY SHIFTWORKER CHARACTERISTICS

Carolyn explains genetically predetermined circadian rhythms that you can no more control than the color of your hair or the shape of your face. “In some people, these rhythms manifest in a later sleep/wake schedule — night owl types. In other people, these rhythms manifest in earlier sleep/wake cycles — early bird types. Early birds have the most rigid circadian rhythms. They find it more difficult to stay awake at night and sleep during the day. Night owls, because of their delayed sleep cycle, can be more alert on the night shift, but it’s harder for them to advance to an earlier shift. Intermediates, the third type, possess the greatest flexibility in their circadian rhythms. Physiologically, it’s easier for them to deal with changing work schedules. All types can do shiftwork, but it requires good schedules and shiftwork management practices to ensure everyone stays healthy.” She can look at an organization’s shiftwork schedule and predict what days they experience the greatest absenteeism. “As an example, when

early bird types work 4 night shifts in a row, they can usually make it through the first 2 nights, then struggle through the third, but the fourth becomes very difficult, so they take a sick day to catch up on their sleep. The employer pays for that loss in productivity and absenteeism.” Carolyn describes other characteristics that influence adaptability. “While age can play a role, it’s not necessarily the primary factor. A lot depends on how much sleep you require. Some people can function quite well with 6-7 hours while others need 9. If someone needs 8 or more hours of sleep regularly to feel healthy, they will easily become sleep deprived when a shift rotation requires working 4 or more of the same shift in a row.”

SHIFTWORK MANAGEMENT MODELS

Carolyn feels Europe and Canada do better in shiftwork management than the US, partly because these countries have different

disability and accommodation laws. “Employers in Europe and Canada will allow work schedule accommodation for an employee who struggles with shiftwork just like you might expect an accommodation for someone with a physical disability. While US employers are not subject to the same laws, they pay for the consequences of unhealthy shiftwork practices in their healthcare costs.” She acknowledges you can’t generalize about shiftwork management practices across all 50 states. “But for many years the trend has been toward longer schedules/rotations. This grew out of research that found people do better when they stay on a shift for longer periods because the body adapts to it. If you work 6 or 7 shifts in a row, however, your body gets used to that schedule and then you go off that shift and force it to start the change all over again. This constant changing causes the most stress and fatigue to the body. European research demonstrates that, except for employees working 14 or more consecutive shifts, short rotations are preferable. This model works better because the goal is to not adapt to alternate shifts, especially night work, at all. You want to get through it and over it so you can stay on your daytime circadian rhythm.” Like any rule, Carolyn admits there can be exceptions. “I’m always asked ‘What is the best schedule?’ The answer depends on what industry you are in, what the work flow is, customer needs, type of work, etc. We tend to think of shiftwork generically, but every workplace is different. For example, nurses may work in the same hospital, but the kind of work they do depends on the unit they are on. Firefighters

• Minimize overtime; but be prepared for resistance from employees who want the overtime pay, despite the inherent lifestyle and health risks.
• Flexible scheduling is highly valued by employees… especially millennials and parents… and doesn’t cost the employer anything.
• If possible, project the schedule at least 3 months in advance and allow for shift trading. This gives employees a valuable sense of control over their lives.