The lights are bright? Debating the future of the permanent night shift

Debates a controversial issue in healthcare management, that is, whether internal rotation (day-night) or permanent night shifts is an appropriate shift system for nursing staff. A multidisciplinary approach draws together international research from the fields of occupational psychology, management, ergonomics and medicine. Explores evidence on sleep, physical and mental health, job satisfaction, performance, absenteeism, and social and domestic disruption, all important factors in considering appropriate shift patterns. Suggests that both nurse choice (or non-choice) of shift and adjustment, or otherwise, of circadian rhythms are important causal factors influencing the debate. As no unequivocal picture emerges, recognizes some of the real and potential limitations of a paper of this kind; however, the balance of argument tends to favour the maintenance of permanent night shift nurses as opposed to the further extension of internal rotation systems. This is especially the case as many nurses will still be given a choice of shift pattern which may, in itself, negate some of the potential ill-effects of night working. Decisions further to extend internal rotation may, in the light of the complex, ambiguous and equivocal evidence, be informed by partial knowledge and influenced by a managerial perspective.