Let's Talk Schedules
April 9, 2020
Want a topic that provokes discussion instantly?
Try “shift work.”
Shift work is a given in emergency dispatch, and the optimal shift length tends to dominate the conversation and, as it seems, totally up to personal preference. In other words, is it an 8-hour, 10-hour, or 12-hour shift that provides the best quality time away from the console? It’s up to the individual.
“There’s no way around shift work and no way of saying what works for everybody,” said Melissa Swope, Communication Supervisor, Rankin County Sheriff’s Office, Mississippi (USA). “Everyone is different. Everybody handles shift work the best way they can to accommodate their lives.”
For some 12-hour shifts offer liberty and convenience. Yes, 12 hours are a tough haul, but the benefits can outweigh the negatives. Days off compared to days on are a great motivator (182 days on and having 183 days off and then taking 24 hours paid time off and ending up with seven days off straight). At centers guaranteeing every other weekend off (with exceptions for massive emergencies and staffing) and the number of days off between shifts make the longer shift worth it.
EMD Katie Fletcher, East Midlands Ambulance Service (EMAS), NHS Trust, UK, does not mind the 12-hour shifts because of the shorter work week (four days on, rather than five).
“Some staff find the lengths of shifts a struggle, but we are open and honest with staff during the recruitment process,” Fletcher said. “If a staff member wants to adjust their shifts, the Trust will attempt to meet their needs whilst considering the service levels required of us and needs of business.”
A phasing in process mitigates the shock to the system for newcomers. Shift lengths are adjusted to eight-hour days for the first month while in training, and gradually increase to two weeks of 10-hour shifts, and finally to the 12-hour shifts “to ease the trainees into the pattern of working we desire,” Fletcher said.
Chantal Wiley, Polk County Sheriff’s Emergency Communication Center, Winter Haven, Florida (USA), said she “couldn’t see going back” to a routine 8-hour day shift like she had prior to emergency communications.
“That [a routine 8-hours] would not adapt to my life,” said Wiley, who left aspirations to run a daycare center when she made the transition to emergency dispatch 13 years ago. “This is the life for me. I love emergency dispatch. Some people think we’re receptionists at a call center. We’re not. We are literally on the phone about somebody’s life.”
Others might feel disoriented outside of routine. Out-of-sync body rhythms for night shift workers is comparable to flying between the U.S. and Europe every night, working, and flying back. It’s hard to get sleep on the opposite side of the clock. The time warp jumbles feelings of falling asleep or staying alert. Noise, daylight, and the anxiety of missing out on family time affect sleep quality and quantity.
Granted, it takes time to adjust, said Wiley. In fact, she found it more difficult in the merger nine years ago to a system which dispatches for 25 agencies throughout the county.
“Merging with the county was harder getting used to,” she said. “There were lots of changes, but if this is what you want, you work at it, and that’s the same I tell dispatchers coming in.”
What is shift work?
According to the National Sleep Foundation (NSF),1 shift work is work that takes place on a schedule outside the traditional 9 am–5 pm day. It can involve evening or night shifts, early morning shifts, and rotating shifts. Many industries rely heavily on shift work, and millions of people work in jobs that require shift schedules.
Shift schedules differ, of course.
EMDs at East Midlands Ambulance Service (EMAS) normally work rotating shifts, depending on which roster pattern they are working. EMAS has two core rosters - one with annual leave built in and the other in which staff book their own leave. Relief shifts are scheduled around the core areas for newer staff, or for those unable to work full day or night shifts due to health issues.
At the expense of suggesting yet another occupational hazard to emergency dispatch, personal experience and research indicate not all is well in shift work. Reasons involve a multitude of interacting factors and the focus is shifting to what can be done to alleviate the risks when eliminating shift work is simply not an option.
A lot of the problems are associated with night or rotational shift work throwing a curve ball to our circadian cycles.
Disrupted sleep patterns
Shift workers are significantly more likely to sleep fewer than six hours on workdays. They labor at night when others usually sleep, potentially disrupting their circadian rhythms. Disrupted (misaligned or de-synchronized) sleeping patterns can evolve into the chronic condition circadian rhythm sleep disorder. With shift work disorder, the individual experiences a hard time sleeping when sleep is desired, needed, or expected.
The neurological disorder Restless Legs Syndrome (RLS) characterized by an irresistible urge to move the limbs is significantly higher in rotational shift workers (15%) than workers with permanent morning work schedule (8.5%).4
Shift work disorders
Circadian rhythms are an internal clock operating on a roughly 24-hour schedule that signals when to feel sleepy or alert. Symptoms of shift work disorder can be present even if technically sleeping enough hours during the day because the body’s internal clock continues to send “you’re getting sleepy” signals during the night (as it is naturally programmed to do).
The brain is the body’s primary circadian clock; however, other body tissues also have circadian clocks, including the liver, which regulates blood glucose levels.Each of the body’s circadian clocks operates on its own schedule to perform its necessary functions. Ideally all the body’s clocks should work on their correct schedules. But, as anyone who has ever been on a graveyard or swing shift knows, the ideal is seldom reality.
A study out of the State Key Laboratory of Biotherapy and Cancer Center at West China Medical Center of Sichuan University (China) found that women who pull the night shift regularly might be at greater risk for a number of cancers.5 For the study, the researchers conducted a review of 61 studies involving almost 4 million people from North America, Europe, Australia, and Asia to look for an association between long-term night shift work and the risk of developing 11 types of cancer. Results indicated that wee hours in the long term was associated with a 19% greater risk among women.
Looking at specific types of cancer, researchers found the risk of skin cancer jumped 4%, the risk of breast cancer increased 32%, and the odds of developing gastrointestinal cancer was 18% higher.
The caveat: The study did not prove that night shift work caused the risk of these cancers to rise. Results, according to the researchers, might help establish effective measures to protect female night shift workers.
Heart and stroke risk
Shift work—especially working nights—increases the risk of heart attack and stroke, according to a Canadian-led study in the British Medical Journal. About a third of Canada’s full-time labor force does shift work and the study pooled results from 34 studies (published from the 1960s to 2012) involving more than two million people to determine whether there is an increased risk or no association whatsoever.
The study found shift work correlated with a 23% increase in the risk of heart attack, a 5% increase in the risk of stroke, and a 24% increase in the risk of unstable angina, coronary artery disease, and other coronary events. Night work was associated with the sharpest increase in risk—41 percent —for major vascular problems.6 Just how the erratic schedules might heighten heart attack and stroke risk wasn’t clear from the study, but several mechanisms were thought to come into play. Blood pressure, heart rate, and even cholesterol levels all return to low levels during sleep while the body rests. Diets centering on fast foods high on carbohydrates and fats and a sedentary lifestyle could also contribute to the increase in heart attack and stroke.
Another factor cited in the same study was the exposure to electric light at night, which, up until a decade years ago, was a recent and rarely studied phenomenon.
Blue light special
Night isn’t night so much anymore. In fact, the distinction between day and night is disappearing in the most heavily populated regions of the earth, creating a rapid shift with consequences for human health. Adding to the problem is blue light wavelength emitted by various gadgets (smartphone and computer screens), which suppresses melatonin, the hormone that maintains a normal sleep cycle.
Blue light—picked up by light sensitive receptors in the eyes—goes to the biological clock. As explained by Andrew Moore-Ede, Director of Client Services, Circadian Light, the effect of blue light is hereditary, offering advantages that are repeated over and over again in our DNA. Moore-Ede's comments were made during a podcast moderated by the IAED.
“Ancient cells in the eyes looked up to the sky for blue light to tell us how to maintain our biological rhythms,” said Moore-Ede, whose father Martin Moore-Ede led a team at Harvard Medical School that located the suprachiasmatic nucleus, the biological clock in the human brain that controls the timing of sleep and wake, and conducted research on how the human body can safely adapt to working around the clock and sustain optimum physical and mental.7
Lifestyle changes have impinged upon the advantages. We don’t sit around the campfire at night, snuffing out the light to be awakened by morning. Evening exposure to blue light wavelengths important for color perception and being alert during the day has been shown to disrupt the melatonin that regulates circadian rhythms, making it hard to sleep.
Most Americans spend less than 10% of their lives outdoors, and inside they depend on TV, computers and tablets, smartphones, and incandescent lighting. Blue light emitted from these devices has a different wavelength than the blue light channeled from the sun. Wavelengths that put us at risk are between 400 and 430 nanometers and most digital devices produce blue light wavelengths above 430 nanometers. Prolonged exposure and the eyes start to give out. Text blurs. Headaches creep up. Errors occur more frequently and go unnoticed. Conventional blue pump LED light at night disrupts circadian rhythms and suppresses melatonin which is associated with an increased risk of obesity, diabetes, and breast and prostate cancer.8
Basically, Moore-Ede said, we are “throwing the music off our biological rhythms.”
Since shift work is unavoidable, Moore-Ede said the focus shifts to staying healthy in a 24-hour environment. “It takes committing to the shift work lifestyle,” he said.
Commit to the lifestyle
Rest is when our bodies repair things. Rest helps us stay healthy and disruption in sleep-wake patterns and daytime darkness affect our ability to recover.
Can anything be done to curtail the negative effects of shift work?
While nothing beats a normal night’s sleep, shift workers have options. The first and obvious solutions are to focus on improving the quality of daytime sleep by reducing ambient noise and light and avoiding caffeine in the latter parts of the shift. It’s also advisable to curtail other unhealthy habits, such as eating foods high in carbohydrates. Establishing routines and patterns for getting ready for bed helps as does turning off cellphones and computers. Scheduling regular physical exams and cancer screenings is recommended.
Other solutions include the adoption of LED lights for indoor and outdoor use. LEDs use a fraction of the electricity of traditional incandescent lights. Circadian Light conducted a series of tests to determine optimally safe lighting. Unable to find a light on the market (sufficiently low blue light that did not create the neon yellow light in the absence of less than 2% blue light), they tested different light-source spectra on subjects working 12-hour day and night shifts and, as a result of their findings, created white LED lights which maximize Circadian Potency during daytime and minimize the disruptive effect of light at night.
For Fletcher, 12-hour shifts complement a better work/life balance and they devise ways to work around the few negatives. For example, her team gets around working through the Christmas holiday by celebrating the holiday on another day. Other negatives involve travelling to and from shifts in the dark, and frequently in poor weather conditions (rain, wind, snow, fog and ice are not uncommon in a UK winter).
That’s just part of the job, Fletcher said.
“This is an Emergency Service and the expectation is that we will work unsociable hours and most staff come into the job with their eyes open to that eventuality.”
Family support and engaging outside the communication center are imperative.
Wiley has three children and while they have visited the communication center on “Family Day” and she talks to them about emergency dispatch, she doesn’t tell them the details of their calls. At the end of her 12-hour shift she uses the 15-minute drive time home to de-compartmentalize. It’s her zone time.
“I am calm, relaxed, and ready for the next round in my day,” she said. “I don’t take the baggage from work home. I leave everything behind for quality time with family. A movie, homework, whatever they want to do, we do.”
As a supervisor, Swope rotates her shift among the shifts schedule to keep tabs on the well-being of staff and handle concerns as they arise, rather than hearing secondhand in her absence. She talks to her seven-year-old son about the challenges of her profession and the reasons she has stayed going on 12 years.
“I like what I do,” Swope said. “My co-workers. The calls. The ability to help people. So, I press on. Not everyone can do emergency dispatch. It’s my feeling that since I can, it’s the place I should be.”
1 National Sleep Foundation. “Four Things You Need to Know About Shift Work.” https://www.sleepfoundation.org/articles/four-things-you-need-know-about-shift-work (accessed Oct. 29, 2019).
2 “Work Schedules: Shift Work and Long Hours.” National Institute for Occupational Safety and Health (NIOSH). Centers for Disease Control and Prevention. 2018; Aug. 29. https://www.cdc.gov/niosh/topics/workschedules/default.html (accessed Oct. 29, 2019).
3 See note 1.
4 Sharifian A, Firoozeh M. Pouryaghoub G, Shahryari M, Rahimi M, Hesamian M, Fardi A. “Restless Legs Syndrome in shift workers: A cross sectional study on male assembly workers.” Journal of Circadian Rhythms. 2009; Sept. 14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749800/ (accessed Nov. 1, 2019).
5 Night shift work may raise women’s odds for cancer.” Poughkeepsie Journal (Poughkeepsie, New York). 2018; Jan 28. https://www.newspapers.com/image/378924086/?terms="shift%2Bwork (accessed Nov. 1, 2019).
6 Kirkey S. “Shift work increases heart stroke risk: study.” The Vancouver Sun (Vancouver, British Columbia, Canada). 2012; July 27. https://www.newspapers.com/image/497879614/?terms="shift%2Bwork (accessed Nov. 1, 2019).
7 Moore-Ede M. Circadian Light. https://circadianlight.com/about-us/visionaries/item/33-ceo-martin-moore-ede-md-phd (accessed Nov 2, 2019).
8 AEDR Editorial Team. “Shedding Light on Shift Work with Martin Moore-Ede.” 2019; Aug. 20. https://www.aedrjournal.org/shedding-light-on-shift-work-with-andrew-moore-ede/ (accessed Oct. 30, 2019).
According to labor statistics2:
- Almost 15 million Americans work full time on evening shift, night shift, rotating shifts, or other employer-arranged irregular schedules.
- According to U.S. National Health Interview data from 2010, almost 19% of working adults work 48 hours or more per week and over 7% worked 60 hours or more.
- Most shift workers are in service occupations, like protective service (such as police and firefighters), food preparation and serving, healthcare, and transportation.
First, what are the problems associated with shift work?3
Associated Life Disruptions3
- Approximately 10% of night and rotating shift workers are thought to have a sleep disorder known shift work disorder.
- Between roughly 25–30% of shift workers experience symptoms of the disorder such as excessive sleepiness or insomnia.
- Shift work is also linked to additional problems with physical and mental health, performance, and safety.