chapter 12 | Promoting a Healthy Workplace 187withdrawn. A more serious form of TB, mutidrug-
resistant tuberculosis (MDR-TB) is on the rise.
Nurses often come in contact with persons with
active TB. At times, patients do not know they are
infected until coming to the hospital with another
complaint. As with SARS, the CDC provides cur-
rent information and guidelines for dealing with
TB in the workplace (cdc.gov/nchstp/tb/pubs/
TB_HIVcoinfection/default).
Enhancing the Quality of Work Life
The continued nursing shortage enforces an aware-
ness to “treat with kindness” the nurses who remain
in the workforce.
Rotating Shifts
Safety in the workplace involves nurses working
rotating shifts. Nurses who work permanently at
night often readjust their sleep-wake cycle.
However, even permanent night-workers may be
subjected to continuous sleep deprivation. Nurses
who randomly rotate shifts throw off their circa-
dian rhythm. Fatigue, the primary complaint of
these nurses, is the result of the body never get-
ting the chance to adapt to changing sleep-wake
cycles. The literature links some of the world’s
worst disasters, such as the Chernobyl nuclear
reactor catastrophe and the Exxon Valdez oil
spill, to rotating shift work and the changes in
circadian rhythm. Other effects of shift work
include a higher risk of miscarriage and prema-
ture labor, menstrual and digestive problems, and
respiratory irritation. One of the most serious
results of rotating night shifts is the increasing
number of nurses affected by coronary heart dis-
ease (CHD). Studies indicate that nurses who
rotate to nights for 6 years have a 70% greater
risk of developing CHD than nurses who never
rotated shifts due to the circadian effect of lower-
ing of blood pressure and heart rate at night
(Trossman, 1999b). Suggestions for nurses who
rotate shifts:
■Try to schedule working the same shifts for an
entire scheduling period instead of rotating
different shifts in one schedule.
■Try to schedule to same days off within the
schedule.
■If you become sleepy during the shift, take a
walk or climb stairs.
■Limit caffeine intake, especially toward the end
of the shift.
■If you work evenings or nights, do not eat a big
meal at the end of the shift. This interferes with
sleep.
■Try to sleep a continuous block of time instead
of catching a few hours here and there.
■Make the room you are sleeping in as dark and
noise-free as possible.
■Maintain good nutrition and an exercise
program.
■Negotiate your schedule with your manager.
If you and your colleagues feel strongly about
eliminating rotating shifts, work together to
make changes (Trossman, 1999b).Mandatory Overtime
When nurses are forced routinely to work beyond
their scheduled hours, they can suffer a range of
emotional and physical effects. As patient acuity
and workloads increase, nurses working overtime
put both patients and nurses at greater risk.
Mandatory overtime is seen by nurses as a control
issue. Working overtime should be a choice, not a
requirement. In some facilities, nurses are being
threatened with dismissal or charge of patient aban-
donment if they refuse to participate in mandatory
overtime (nursingworld.org/tan/98mayjun/ot).
The ANA presented the following message to
the 107th Congress in 2001: “ANA opposes the use
of mandatory overtime as a staffing tool. We urge
you to support legislation that would ban the use of
mandatory overtime through Medicare and
Medicaid law. Nurses must be given the opportuni-
ty to refuse overtime if we believe that we are too
fatigued to provide quality care” (nursingworld.org
/gova/federal/legis/107/ovrtme). Dembe, Erickson,
Delbros, and Banks (2005) analyzed the occurrence
of occupational injury and illness between 1987
and 2000. After a review of 10,793 participants
working at least 12 hours per day, working overtime
was associated with a 23% increased work hazard
and a 61% higher injury hazard rate compared with
jobs without overtime. More recently, Rogers et al.
(2004) found that nurses’ error rates increase signif-
icantly during overtime, after 12 hours and over
more than 60 hours per week. Currently, there are
no regulations governing nurses’ work hours. About
half of staff nurses are scheduled routinely to work
12-hour shifts, and 85% of staff nurses routinely
work longer than scheduled hours.