Impact of nursing shift patterns on work-related musculoskeletal disorders: a systematic review and meta-analysis

Musculoskeletal disorders (MSDs) are among the leading causes of disability worldwide and substantially affect the nursing workforce due to high physical demands, biomechanical strain, and irregular work schedules. Growing evidence suggests that shift work, particularly rotating and night schedules, may contribute to work-related musculoskeletal disorders (WRMSDs); however, findings remain inconsistent across studies. This study aimed to examine, through a systematic review and meta-analysis of observational studies, the association between distinct nursing shift patterns (day, rotating, and fixed night shifts) and generalized or region-specific musculoskeletal outcomes among nurses. A systematic search was conducted in PubMed, Scopus, Web of Science, and CINAHL between December 2024 and August 2025. The review was prospectively registered in PROSPERO (CRD420250656652). Studies were eligible if they included samples comprising at least 50% practicing nurses, compared at least two shift types (day, rotating, or fixed night shifts), and reported musculoskeletal outcomes. Observational study designs were included without publication date restrictions. Methodological quality was assessed using the Newcastle-Ottawa Scale for cohort studies and the Joanna Briggs Institute checklist for cross-sectional studies. Risk of bias was evaluated using the ROBINS-E tool. Although the systematic review included a broad range of musculoskeletal outcomes, only musculoskeletal pain outcomes were sufficiently homogeneous to be included in the quantitative synthesis. Random-effects meta-analyses were conducted comparing day versus rotating shifts and day versus fixed night shifts. Twenty-four studies including 102,159 nurses were included in the systematic review, and thirteen studies were incorporated into the meta-analyses. No statistically significant associations were identified between rotating shifts and musculoskeletal pain compared with day shifts (pooled estimate = 1.15; 95% CI: 0.98-1.35; I² = 7.2%). Likewise, fixed night shifts were not significantly associated with musculoskeletal pain compared with day shifts (pooled estimate = 1.09; 95% CI: 0.94-1.27; I² = 81.1%). Stratified analyses across anatomical regions, including neck, back/lumbar, shoulder, and lower limb pain, also showed no statistically significant associations, although several pooled estimates tended to be higher among rotating shift workers. The available evidence suggests that the relationship between shift work and musculoskeletal pain among nurses is complex and likely influenced by multiple occupational, ergonomic, psychosocial, and organizational factors. Although no statistically significant associations were identified in the meta-analysis, rotating and fixed night shifts showed trends toward higher musculoskeletal pain estimates in several anatomical regions. Further longitudinal studies using more standardized definitions of shift work exposure and musculoskeletal outcomes are needed.