Long hours put nurses at higher risk for MSDs

Long shifts linked to back, neck pain

Long working hours among nurses may contribute to higher injury rates, new research shows.

Nurses who work more than 12 hours in a shift have higher rates of neck, shoulder, and back problems, according to the Nurse Worklife and Health Study, sponsored by the National Institute for Occupational Safety and Health (NIOSH).1

"It's very exerting work. As nurses work longer hours and have extended hours, that adds to the injury potential," says principal investigator Alison Trinkoff, RN, ScD, FAAN, professor at the University of Maryland School of Nursing in Baltimore.

Mandatory overtime, being on-call, working while sick or on a day off, and working with less than 10 hours off between shifts also increase the risk of musculoskeletal disorders (MSDs), Trinkoff and her team found.

In this longitudinal survey of more than 2,600 nurses, 14% said they developed neck problems, 17.3% had shoulder problems, and 21.1% had back problems that occurred during the 15-month follow-up period. MSDs were linked to work schedules even after adjusting for age and psychological work demands. The impact of longer hours could be even greater as nurses age, Trinkoff says.

Although some states have prohibited mandatory overtime, being "on-call" can be just as risky and is becoming more commonplace, she says. In the study, 16.7% of the nurses said they were subject to mandatory overtime and 38.9% had on-call hours.

In 2003, an Institute of Medicine (IOM) panel recommended mandatory limits on work hours in health care.2 The panel recommended that nurses should be prohibited from working more than 12 hours a day or 60 hours a week.

Trinkoff and her team found that hospital-based nurses frequently exceeded the IOM recommendations. About a quarter (23%) of hospital nurses reported working 13 or more hours in a shift, 15% of them more than once a week.3

Hospital-based nurses also were more likely to have mandatory on-call duty (43.5%). Meanwhile, one in 10 of the nurses took no breaks of any kind during their work shift.

"The work schedules of nurses described in this survey suggest that there should be industry-wide concerns about fatigue and health risks to nurses as well as the safety of patients in their care," the authors said.


1. Trinkoff AM, Rong L, Geiger-Brown J, et al. Longitudinal relationship of work hours, mandatory overtime, and on-call to musculoskeletal problems in nurses. Am J Ind Med. In press, November 2006.

2. Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academies Press; 2003.

3. Trinkoff A, Geiger-Brown J, Brady B, et al. How long and how much are nurses now working? Am J Nurs 2006; 60-71.