Survey of shift work disorders and occupational stress among nurses: A cross-sectional study


Background: Shift working has the potential of negatively influencing the quality of work life among nurses. Objective: The aim of this study was to investigate the outbreak of shiftwork-related disorders and the relationship between shift work, occupational stress, and job satisfaction among in a hospital in Iran, to help identify potential strategies for improving the quality of life among shift-working nurses. Materials and Methods: In this cross-sectional study, 100 shift-working nurses from three hospitals in Iran were randomly selected. Survey of Shift worker questionnaire was used as the main study tool. The nurses’ demographic and work condition data were collected using a research-made questionnaire. Furthermore, Cooper’s job stress questionnaire was used for collecting stress-related information. Chi-square and One-way ANOVA tests were used for the inferential analysis of data. Results: The most prevalent shiftwork-related problem was found to be psychological disorder (96.4%), followed by social life (84.5%) and digestive problems (81%). Nurses who had chosen shift work voluntarily showed significantly higher job satisfaction as compared to those who were forced to work on shifts (P < 0.05). Moreover, the 1st year of work was reported as the most stressful year of their works in terms of conflict with colleagues and lack of enough experience for doing the given tasks. Conclusions: To reduce the associated disorders and increase job satisfaction among nurses, our study recommends that shift work be assigned preliminarily to the nurses who voluntarily choose to work on shifts. Furthermore, to reduce the nurse’s occupational stress, the least conflict with colleagues is recommended.

Keywords: Hospital management, job satisfaction, nurse, shift work

How to cite this article:
Khammar A, Amjad RN, Rohani M, Yari A, Noroozi M, Poursadeghian A, Hami M, Poursadeghiyan M. Survey of shift work disorders and occupational stress among nurses: A cross-sectional study. Ann Trop Med Public Health 2017;10:978-84


How to cite this URL:
Khammar A, Amjad RN, Rohani M, Yari A, Noroozi M, Poursadeghian A, Hami M, Poursadeghiyan M. Survey of shift work disorders and occupational stress among nurses: A cross-sectional study. Ann Trop Med Public Health [serial online] 2017 [cited 2021 Apr 14];10:978-84. Available from:



Research has shown that shift-work, as well as occupational stress, may cause several difficulties such as higher risk of concerns and anxiety, sleeplessness, depression and sadness, and chronic fatigue, as well as different cardiovascular and gastrointestinal disorders on the health-care professionals.[1],[2]

Job satisfaction and satisfaction with shift work as well as the lack of stress in working environments, contribute greatly to employments and organizational goals.[3],[4] Furthermore, studies have shown that job satisfaction along with calm work environment, can directly influence the quality of work life and satisfaction of employees.[4],[5],[6]

A high proportion of nurses are involved in shift work, with some working “straight-shifts” of the day, afternoon, or night-shifts and rotating shift patterns. Although some nurses tolerate shift working conditions comfortably without issues, many others encounter serious problems as a result of shift working.[7],[8] Hospital nurses who do shift work can experience induced tension and stress,[4],[5] family life disturbance,[9] and interruption of normal food schedules and this could at the long run affect their job satisfaction.[10] Their stress is mostly about lack of job guarantee, dissatisfaction with the managers’ evaluations, lack of enough knowledge, experience and skill for the job, anxiety about making mistakes, emergence of new roles for nurses, new management principles, new rules and instructions, and changes in their educational and training methods, and as much as a given task is more urgent, the more stress will be applied on the nurse.[10],[11]

In addition, night shift-work could have long-term significant effects on the sleeping patterns, resulting in higher cardiac sympathetic regulation.[11] Shift work is a recognized occupational stressor and is noted to have had the potential of affecting the consent of job satisfaction among hospital nurses.[10],[11] Some studies have indicated that shift work can lead to metabolic syndromes.[11],[12] Among different patterns of shift work, night shift-work, in particular, has been shown to have more serious health risks. Increased risk of cardiovascular diseases among nurses who worked rotating shifts for more than 6 months has been observed in a survey of prospective, longitudinal data from the nurses’ health study when compared with nurses who never rotated shifts or who had worked rotating shifts for fewer years.[11],[13] In the study conducted by Ruggiero, nurses who worked during night-shifts expressed more fatigue and were in the depressed mood more than their counterparts who had day shifts.[14] It has been reported that chronic fatigue in nurses do not only decreases the quality of patient care but also increases the nurses’ risk of health problems, such as depression.[11],[15],[16] Furthermore, occupational and environmental stresses can have adverse effects on nurses and consequently, can affect the cure and healing of the patients.[9]

Despite the numerous studies conducted on the health-related and occupational consequences of shift work and occupational stress, the physical and psychological response to shiftwork and stress among hospital nurses is not well understood, particularly in developing countries, and this necessitates further investigations.


To help close this gap and with regards to nursing job as one of the most stressful occupations, this study seeks to investigate the prevalence of shift work disorders and job stressors and their relationship with different aspects of quality of life among nurses serving in selected teaching hospitals of University of Medical Sciences.

Materials and Methods

The cross-sectional study was conducted in 2017 in a hospital of Iran. The study population included nurses in this hospital.

Study instruments and data collection

The survey of shift (SOS) Questionnaire (SOS workers) was used to collect data on nurses’ job satisfaction, type of shift-work system, sleep time, insomnia, musculoskeletal disorders, sedative drugs, adverse effects of shift work on the individual lives, adverse effects of shift work on social their lives and adverse effects of shift work on their personal lives as well as gastrointestinal, cardiovascular, and mental health problems.[17] The collection of participants’ demographic and professional information that may affect sleep quality and job satisfaction of the nurses who were on rotating shifts was done using a Personal Information Form which was developed by the researchers.

Simultaneously, the Cooper’s questionnaire for assessing stress in job environment and intense work was used through a descriptive-analytical study was temporarily conducted to collect data from the subjects’ stress terms. Data were collected by consensus, such that questionnaires were administered to the participants and they were expected to fill them. A record form was prepared for entering the following information about nurses in order to investigate the relationship between stress and the demographic characteristics of the nurses involving: Age, gender, educational level, marital status, previous records of employment, the amount of salary and extra pays, job position, name of the section and the hospital, and the work shift.[18] The Cooper’s questionnaire of stress in job environment is greatly used in several countries as a measure for job stress. This questionnaire includes 32 questions which determine the presence of signs of job stress. Four degrees are considered for each group. The examine chooses nearer choices to his/her experience in the last month among the four choices. Each question has four possible answers: never, sometimes, often, and always. The scores range from 0 to 3 and for each choice, the lowest and highest scores are 0 and 3, respectively. Total scores lower or equal to 39 are assigned with low stress, scores ranging from 40 to 62 shows a medium level of stress and scores equal or higher than 63 shows a high level of stress.

To administer data collection tools, researchers had direct meetings with the nurses. The time and venue for questionnaire completion were determined by the nurses themselves. There was no restriction for the time of completion of questionnaires.

Data analysis

Descriptive statistical methods were used to summarize data. Chi-square was employed in testing the relationship between variables. SPSS Version 16 Software Package (SPSS Inc., Chicago Illinois, United States of America) was used for statistical analyses.


Based on selected demographic and work-related characteristics. The ages of the participants ranged between 24 and 50; the mean age was approximately 35 years. Most of the participants were married (64%). Approximately half of the participants (56%) were female. Work experience of the participants was between 1 and 30 years, and the mean work experience was approximately 11.52 years.

Results of shift working and job satisfaction

[Table 1] shows the frequency distribution and shiftwork-related disorders among the nurses. Prevalence of musculoskeletal complaints in all three hospitals within the 1-month period was 53.5%. Most complaints were related to pains in the leg and knee regions of the body (69%), followed by the back pains (61.9%), pains in the shoulder (41.7%), and that of the legs and knees (41.7%). Results have also revealed that shift work causes very common problems among nurses. Emotional and mental problems were the highest prevalence rate (96.4%), followed by social life (84.5%) and digestive problems (81%), respectively.

Table 1: Frequency distribution and incidence of disorders due to shift work

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Sleep disorders were more prevalent in staff working at night or on shifts than those working on a regular day-time schedule. While nurses who have voluntarily chosen the shift work were satisfied with the shiftwork system, a majority (77.5%) of them who were forced to choose the shift work expressed their dissatisfaction with shift working. Chi-square test showed a significant correlation between choosing the shiftwork system voluntarily and becoming satisfied with it (P = 0.008).

Based on the findings, 23.4% of the study population of nurses who were satisfied with the shift work system had personal life disorders. Nurses who were satisfied with shift work showed significantly lower personal-life disorders as compared to their counterparts who were dissatisfied (P = 0.01).

According to the findings in this research, 52% of nurses who were satisfied with their shift work was satisfied with the amount of time they spent with their families together. For this reason, Chi-square identified a significant correlation between satisfaction with shift work and the time nurses spent with their families (P = 0.003).

Among the study population of nurses who were satisfied with shift work system, 81.5% did not find any trace of undesirable effects of shift work on their family lives, and this was confirmed by Chi-square test (P = 0.002).

In addition, among nurses who were satisfied with shift work, 20.3% were of the view that shift work has had undesirable effects on their social lives, but 79.7% of them thought otherwise, and this was also confirmed using Chi-square test (P = 0.01).

Results of occupational stress

According to the data presented in [Table 2], females constituted 56% of the study population, and 44% of them were males. As shown in the table, the male gender had the lowest percentage of low-stress people, whereas their female counterparts had the highest percentage. According to the above table, there was no significant difference between stress levels of the two genders (P = 0.479 and t = 0.7).

Table 2: Average level of stress by age in the studied group

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According to [Table 3], 36% of the study population were single, 64% of them were married. Furthermore, no significant differences were observed between the stress levels by marital status (P = 0.565 and t = 0.57).

Table 3: The average level of stress by marital status in the studied group

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The level of education among the study population of nurses was also examined in this research. According to [Table 4], 89% of nurses had Bachelor’s degree and 11% of them had Master’s degree. No significant differences were seen between the stress levels by the level of education (P = 0.857 and t = 0.18).

Table 4: The average level of stress by level of education in the studied group

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From [Table 5], 37% of the study population of nurses had <5 years of employment records, 13% of them had 5–10 years of employment records, 36% had 10–20 years, and 14% of them had it for more than 20 years. There was a significant difference between stress levels by previous records of employment (P = 0.026).

Table 5: The average level of stress by previous records of employment in the study population of nurses

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From [Table 6], 80% of the study population was nurses, 13 of them were working as senior nurses, and 7% of them were supervisors. According to the above table, no significant differences were observed between the stress levels by current job position (P = 0.0447 and F = 0.812).

Table 6: Average stress level by current job position in the study population of nurses

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Judging from the [Table 7], there are significant relationships between three stress-causing factors and the average level of stress.

Table 7: Determination of relationship between partial stress scores with the total score

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According to the levels of stress in the subjects, the male gender had the lowest percentage of low-stress, and the females had the highest percentage of low-stress. Both genders had the same percentage of persons with a medium level of stress, and the female gender contained the highest percentage of persons with high-stress levels. In fact, it can be assumed that the female gender suffers from more severe stresses. Another parameter investigated in this study was the level of education in the studied nurses. Results show that the lowest percentage of persons with low levels of stress and also the highest percentage of persons with high levels of stress belong to the group comprised nurses with Master degree. In addition, results of this study showed that there was no significant difference in the degree of stress by the level of education.

Using one-way analysis of variance test to determine the difference in average degree of stress by previous record of employment, a significant difference in average degree of stress by previous record of employment was revealed, in a way that in the beginning of the employment and before the first 5–10 years, the degree of stress increases with time, and after the 10th year of employment it takes a decreasing trend with time. Our results showed that the lowest and the highest percentages of persons with low-stress levels belonged to nurses and the group of supervisors, respectively. Likewise, the highest and the lowest percentages of persons with high-stress levels belonged to nurses and the group of supervisors, respectively. However, no significant difference was observed in the average level of stress by the current job position (P = 0.447). Furthermore, those who had never had conflict with nurses had the lowest percentage of persons with low-stress levels, and those who always had conflict with their colleague nurses, allocated the highest percentage of persons with high-stress levels. Furthermore, the highest percentage of persons with high-stress levels belonged to nurses who have always had stress due to the lack of enough stress in providing nursing services. Conflict among colleagues had a direct effect on the prevalence of stress, in a way that Ross believes that the relations among colleagues and their support from each other are among the factors which reduce the level of job stress. Obviously, stress in either positive or negative form is part of everyone’s occupational life. Some job stress-causing factors are so severe that require an immediate response from the person.[19] Results indicated that nurses who have always had a conflict with physicians and other nurses suffered from 100% severe stress. Similarly, in a study by Sadock et al. on job stress among nurses, the conflict among colleagues was identified as the most important job stress-causing factor.[20] In the same way, Tayebe Mehrabi’s study showed that among all of the stress-causing factors, the factor of conflict with physician showed the highest statistical correlation with the total job stress (P < 0.001, r = 0.753). No significant difference was observed between the average degree of stress by the mean work shift of nurses (P = 0.26). In other word, the average stress levels can be considered the same in all work shifts. However, some differences in the average stress level by the work shift are seen.[21] The one-way analysis of variance test showed that there is a significant relationship between the average level of stress derived from the “lack of enough skill for providing the nursing services” and the average of “total stress”(P = 0.022), which is in line with Tayebe Mehrabi’s results.[21]

Results from the shift work and job satisfaction indicated an inverse significant relationship between satisfaction with shift work and undesirable effects of shift work on nurses’ personal, family, and social lives. Results from Choobineh et al.’s work on the investigation of shiftwork-related problems of technicians of the operating room are similar with those of this study.[22]

Previous researches have indicated that shiftwork may have several effects including psychological and digestive problems on different aspects of life. The effect of shift work is highly prevalent among nursing staff. Lack of conformity to the body’s biological cycle with the schedule of shift work system may be attributed to the high prevalence of this effect of shift work.[23]

Several studies that have shown significant roles for shift work in the emergence of digestive disorders,[16],[24] such significant relationships were not observed in this survey (P > 0.05). The discrepancy may be as a result of environmental, organizational, and cultural differences as well as the nature of shift work system, working hours per week, employment status, and the level of education in the different communities. In addition, mental/psychological disorders have been shown to be effective in the emergence of digestive problems.[25]

Study results from this research have shown that nurses who had voluntarily chosen shiftwork were more satisfied with their jobs, as compared with those who have been obliged to work on shifts. Bohle et al.’s study had similar results.[26]

This study indicated that shift-working nurses were less satisfied with their daily sleep and this has been confirmed by a study conducted by Ohida et al. in Japan. Only 8% of the two-shift nurses and 6% of 3-shift nurses had a good sleep quality in his research.[27]

Shift workers may encounter many problems as a result of improper daily sleeping. According to the Sleep Disorders Committee of the American Academy of Otolaryngology, sleep disorder can cause the incidence of medical error by the health-care professionals including nurses.[27],[28],[29] Gold et al. investigated associations between night shiftwork and sleep disorders among nurses, and found that nurses who worked during the nights or worked irregular shifts had the tendency to doze off more often while driving or working, as compared to their counterparts who worked normal day shifts.[15],[17],[27],[29]

An overall prevalence of 53.5% for musculoskeletal disorders during this study which is lower than that of a previous Swedish study, where 84% of professional nurses suffered neck, shoulder, upper back, or lower back musculoskeletal disorders was observed.[30] The findings in this regard are also in contrasts with another investigation conducted in the US, in which 72.5% of nurses have reported a musculoskeletal disorder of some description.[31] Moreover, the prevalence period of shoulder disorders in this study was 41.7%, slightly higher than that in Trinkoff et al.’s study (35.1%) in US,[31] similar to a the survey conducted by Botha and Bridger in South Africa (41%),[32] and lower than studies carried out in Australia (60%)[33] Discrepancies in the results of various investigations may be due to the differences in study populations, educational backgrounds, and data collection methods.

According to the results obtained, 70.2% of the shift workers were dissatisfied with the time they spent together with their families, and this correlates well with the results from previous studies.[34]

It is required that nurses up-date their skills due to the ever emerging and increasing advances in medical care and the technology associated with them. Nurses often work in mentally stressful environments due to occupational errors or accidents that have a direct and perhaps critical influence on a patient’s life and prognosis.[24],[35],[36] For improve in mood and cognitive performance in Shift worker recommended bright light exposure.[37],[38],[39] The results of the study, among the limited studies conducted in this field within Iran can be used by policy makers and managers for the development of effective interventions that aim at improving the shift-working programs and the quality of work life of staff in various health care professions.


In this study, the authors investigated the prevalence of shift-work related disorders among nurses and its impact on their quality of life. Emotional and mental problems, social life problems, digestive problems, and sleep disorder were among the most frequent shift-work related problems among the surveyed nurses. In addition, the majority of shift-working nurses were dissatisfied with the time they spent with their families together. These findings can guide the development of modified shift-working programs aiming at improving the quality of life among shift-working nurses. A critical finding of this study was that the prevalence of shift-work related factors that led to reduced quality of life was less prevalent among nurses who had voluntarily chosen shiftwork as compared to their counterparts who were under obligation to work on shifts. Therefore, this study recommends that shift work be assigned preliminarily to the nurses who voluntarily choose to work on shifts to reduce the associated disorders and increase their job satisfaction. Conclusively, our findings have shown the severity of stress in the years of employment among nurses with low records of employment, and after 10 years of employment, there was a reduction in stress level. Conflict with other nurses and physicians, and lacking adequate skills for performing nursing services, were the main causes of the prevalence of stress among nurses.


The authors would like to thank authorities and personnel of the University of Social Welfare and Rehabilitation Sciences for their valuable cooperation and unflinching support for this study.

Financial support and sponsorship

This study was supported by grant No 1893 in University of Social Welfare & Rehabilitation Sciences.

Conflicts of interest

There are no conflicts of interest.



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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_305_17


[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]

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