[How are leisure activity and shiftwork schedule associated with recovery from fatigue in shiftwork nurses?]

The period of leisure is an appropriate time to recover from work-induced fatigue, though some recovery takes place during rest breaks at work. Recently, much attention has been paid to the critical role of leisure activity in recovery. However, the findings relevant to shiftwork nurses who cannot take a day-off regularly are limited. This study explored how leisure activity during days off and shift work schedule are associated with recovery from fatigue in nurses working rotating shifts.

A total of 426 nurses working rotating shifts at a university hospital returned a questionnaire regarding leisure activity and fatigue (response rate: 81.5%). Nurses were eligible for this study if they were female, worked 2 or 3 shifts, and had no missing data. A total of 390 respondents satisfied the inclusion criteria. A factor analysis classified their responses on how to spend an assumed period of two consecutive days off into three activity types: outdoor-, sleep-, and indoor-oriented. Fatigue (recovery from fatigue, accumulated fatigue, burnout), work conditions (working time, overtime, nightshift napping), sleep (sleep duration before day shift or day off, sleepiness) were measured. These data were analyzed using a two-way mixed model analysis of covariance (type [outdoor, sleep, indoor], shift schedule [two or three-shift system]). Covariates included age, length of career, partner, children, and hospital ward. Multiple regression analyses were performed to examine the factors determining the level of fatigue.

Outdoor-oriented nurses showed significantly faster fatigue recovery, lower accumulated fatigue and less burnout symptoms than others, regardless of the shiftwork schedule. In contrast, sleep-oriented nurses showed significantly slower recovery from fatigue. Besides, their level of fatigue deteriorated more when they worked under a 3-shift system (counter-clockwise) compared with under 2-shift system (with mainly 16-hour nightshift). Multiple regression analysis indicated that sleep-oriented type of leisure activity, workload perception of working time, work-induced insomnia and length of nightshift naps were significantly related to fatigue-related outcomes.

The primary finding of this study suggests that the level of fatigue is associated with the type of leisure activity, especially sleep-oriented activity, during shiftwork nurses' days off. Also, ensuring sufficient nightshift nap time may be one of the most important nightshift-related factors for recovery from fatigue. The present findings may have implications for appropriate activities during days off as factors facilitating recovery from work, though further investigations are needed to examine the causal links.