Study: Naps May Reduce Injuries, Errors Among Shift Workers

Sarasota, FL (WorkersCompensation.com) – Doctors prescribing the wrong medications; construction workers tripping over obvious obstructions; and police officers engaging in risky behaviors. Those are among the hazards common to shift workers, due to decreased cognitive performance. 

While numerous studies have found correlations between shift work and various physical conditions, researchers in Austria have identified the impact of non-traditional working schedules on neurobehavioral performance. Their findings suggest employers implement strategies that can ramp up cognitive abilities and reduce work-related injuries and errors. 

“Cognition plays a key role in numerous work-related tasks. Therefore, reduced neurobehavioural performance due to shift work may ultimately lead to work-related injuries,” the researchers wrote in the BMJ journal Occupational and Environmental Health. “The results of our meta-analysis show significantly worse performance in adults exposed to shift working in comparison to non-exposed controls regarding working memory, processing speed, psychomotor vigilance, cognitive control as well as visual attention.” 

The Study

Shift work, described as “unusual working hours outside the conventional time frame of 7:00 AM to 6:00 PM” has become invaluable for a well-functioning society. In addition to ensuring adherence to the 24-hour working schedules required of many industries throughout the world, the 24/7 schedule of healthcare workers and first responders is critical for the safety and health of residents. 

But working these off hours disrupts the human circadian system, leading to sleep- and hormonal-related problems. Among the physical effects that have been shown to be related to shift work are sleep disorders, cardiovascular problems, obesity and diabetes mellitus. Other potential results are cancer, mood disorders, social isolation, substance abuse and cognitive impairment. 

While many studies have identified the physical conditions caused by working irregular hours, few have focused specifically on the neurobehavioral performance of these workers. They authors conducted an extensive meta-analysis to draw some conclusions. 

They analyzed 18 studies, published between 2005 and 2020. The total sample of participants was 18,802 and had a mean age of 35.75. Many of those included were nurses or physicians, as well as first responders, IT staff and others prone to shift work.

The authors summarized the effects of several neurobehavioral tests, including:

• Processing speed
• Working memory
• Psychomotor vigilance
• Cognitive control
• Visual attention
• Task switching

Findings

“This meta-analysis provides the first summarising results regarding significant association between shift work and decreased performances in processing speed, working memory, psychomotor vigilance, cognitive control and visual attention,” the authors wrote. “We highlight the potential impact of impairment in these neurobehavioural domains on occupational health and safety.”

The results indicate that reduced performance in the neurobehavioral domains could help explain work-related injuries or errors. Shift workers in high-risk and safety sensitive positions, in particular, could be impacted by the decreased cognitive functions.

One of the studies included in the research looked at the association between working memory and task error among emergency department physicians in a clinical environment. “The results showed that physicians with lower scores in working memory significantly increased the risk of clinical and procedural prescribing errors (eg, wrong drug, incomplete order),” the researchers found. “Additionally, decreased psychomotor vigilance, which can be used as an assessment for fatigue due to sleep loss, has been connected to impaired attention in nurses, which is commonly reported as a contributing factor to self-injuries or errors in patient treatment.” 

A separate study centered on construction workers and looked at the relationship between visual attention and occupational injuries. Employees with decreased visual attention were less likely to notice tripping hazards. 

Other studies looked at first responders. “Decision-making during stressful training in police officers is associated with processing speed and cognitive control,” the researchers wrote. “Studies with reality-based training scenarios showed that lower scores in inhibitory control were associated with negative health and safety outcomes. Therefore, police officers with higher inhibitory control are less likely to engage in risky behaviors.”

The authors specifically addressed ‘cognitive control,’ which they described as “an executive function including cognitive processing and flexibility as well as the ability to focus on one stimulus when a second stimulus is simultaneously given.” It is especially important for workplace performance “since it ensures adequate and accurate decision making.”

Workers with high performances in cognitive control were more successful adapting to changing environments and high monitoring of important stimuli, leading to higher quality of work and productivity and fewer errors. Shift workers in high-risk and safety sensitive positions with high levels of cognitive control fare better in terms of preventing workplace injuries and errors.

“As a conclusion, protective countermeasures (eg, naps, recovery plans, regular monitoring) for reduction in neurobehavioural performance of shift workers should be promoted to minimize the risk of adverse health and work-related outcomes,” the authors advised.

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