Few industries in the United States have undergone more sweeping changes over the past decade than the health care industry. These changes have primarily come from a desire to reduce or control costs. One of the major cost-cutting strategies has been to reduce the size of the nursing workforce. To compensate, nurses are often required to work extended schedules, including > 8 hour days, >40 hour workweeks, mandatory overtime, double shifts, and other inflexible scheduling demands. Little is known about the health impact of these extended work schedules on nurses, though one study found that when registered nurse (RN) positions decreased by 9.2 percent, work-related injuries and illnesses among RNs increased by 65.2 percent. (Shogren & Calkins, 1997). Nurses face many occupational hazards; among the most common are musculoskeletal disorders (MSDs) and the transmission of bloodborne pathogens such as HIV and Hepatitis C through needlestick injuries. Extended work schedules increase the length of workplace exposure to hazards that lead to such injuries. To address the problem of extended work and its health impact on nurses, we will accomplish the following specific aims: 1) examine the nature and prevalence of extended work schedules (hours/day, hours/week, mandatory and voluntary overtime, breaks) among nurses in a variety of settings; 2) determine the relationship of extended work schedules to musculoskeletal pain/disorders (MSDs), measured longitudinally; 3) determine the relationship between extended work schedules and needlestick injuries, measured longitudinally. Survey data will be collected from a probability sample of 3500 actively licensed RNs in two states. Data on extended work schedules, exposures and injuries will be collected in Wave 1 and Wave 3, 12 months apart. To assess the stability of extended work schedules, we will measure this construct one additional time, after 6 months, at Wave 2. Wave 1 and 2 exposure data will be regressed on Wave 3 outcome data to examine potentially causal associations. This study of nurses, who are experiencing a multitude of extended work hour arrangements, will provide a comprehensive examination of the impact of such work arrangements on the health of nurses. Identifying organizational variables related to nurse's health that, if modified, could reduce the likelihood of worker injury is key to maximizing the quality of health care while maintaining a healthy workforce.
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