Evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long-term care

AIM: This study aimed to investigate differences in activity and body movements for the different 8-hour shifts and extended 12-hour shifts at a long-term healthcare facility. The secondary aim will focus on determining the impact of shift work time of day on musculoskeletal injuries causing days of...

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Main Authors: Ryan L. Bellacov, Kermit G. Davis, Chunhui He
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Human Factors in Healthcare
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Online Access:http://www.sciencedirect.com/science/article/pii/S2772501425000053
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author Ryan L. Bellacov
Kermit G. Davis
Chunhui He
author_facet Ryan L. Bellacov
Kermit G. Davis
Chunhui He
author_sort Ryan L. Bellacov
collection DOAJ
description AIM: This study aimed to investigate differences in activity and body movements for the different 8-hour shifts and extended 12-hour shifts at a long-term healthcare facility. The secondary aim will focus on determining the impact of shift work time of day on musculoskeletal injuries causing days off. Background: Nursing assistants have heavy physical workloads, which results in high turnover and musculoskeletal pain. Methods: The research team observed 240 shifts for 54 nursing assistants in five long-term healthcare facilities. The researchers completed direct observations of posture through the utilization of an ergonomic evaluation tool using the Rapid Entire Body Assessment using a random sampling (equivalent of 12 times per hour). An activity monitor continuously captured the time spent sitting, standing, and walking, along with the associated energy expenditure while working. Results: The most significant results were in physical activity, with an 8-hour day percent of total time walking being double the amount at 48.4% compared to night shifts at 23.1% (total steps per hour: 1704 compared to 763, respectively). REBA scores for the upper body on the day shift are more ergonomically challenging (risk rating: 7 to 5, respectively). The 12-hour shifts negatively impact on the lower back and shoulder, causing injuries in long-term care. Conclusion: Overall, an 8-hour day had the most impact on energy expenditure. In addition, 8-hour shifts had a higher incidence of lower back pain, resulting in the most frequent loss of work. The incidence of loss of workdays affects employee well-being, productivity, and medical associated costs. Nearly 20% of the nurse assistants' observations had poor posture with medium to high risk. Implications: Healthcare managers could help the physical strain that nursing assistants endure by targeting footwear, poor posture, and fatigue. While the higher workload in this study did not equate to higher musculoskeletal pain, the complexity of the normal work tasks likely resulted in complex demands on the nursing assistants.
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spelling doaj-art-0714dfabf41f453ea7677d788a5a08ea2025-08-20T03:09:18ZengElsevierHuman Factors in Healthcare2772-50142025-06-01710009410.1016/j.hfh.2025.100094Evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long-term careRyan L. Bellacov0Kermit G. Davis1Chunhui He2Corresponding author.; College of Medicine, University of Cincinnati, Cincinnati, OH, USACollege of Medicine, University of Cincinnati, Cincinnati, OH, USACollege of Medicine, University of Cincinnati, Cincinnati, OH, USAAIM: This study aimed to investigate differences in activity and body movements for the different 8-hour shifts and extended 12-hour shifts at a long-term healthcare facility. The secondary aim will focus on determining the impact of shift work time of day on musculoskeletal injuries causing days off. Background: Nursing assistants have heavy physical workloads, which results in high turnover and musculoskeletal pain. Methods: The research team observed 240 shifts for 54 nursing assistants in five long-term healthcare facilities. The researchers completed direct observations of posture through the utilization of an ergonomic evaluation tool using the Rapid Entire Body Assessment using a random sampling (equivalent of 12 times per hour). An activity monitor continuously captured the time spent sitting, standing, and walking, along with the associated energy expenditure while working. Results: The most significant results were in physical activity, with an 8-hour day percent of total time walking being double the amount at 48.4% compared to night shifts at 23.1% (total steps per hour: 1704 compared to 763, respectively). REBA scores for the upper body on the day shift are more ergonomically challenging (risk rating: 7 to 5, respectively). The 12-hour shifts negatively impact on the lower back and shoulder, causing injuries in long-term care. Conclusion: Overall, an 8-hour day had the most impact on energy expenditure. In addition, 8-hour shifts had a higher incidence of lower back pain, resulting in the most frequent loss of work. The incidence of loss of workdays affects employee well-being, productivity, and medical associated costs. Nearly 20% of the nurse assistants' observations had poor posture with medium to high risk. Implications: Healthcare managers could help the physical strain that nursing assistants endure by targeting footwear, poor posture, and fatigue. While the higher workload in this study did not equate to higher musculoskeletal pain, the complexity of the normal work tasks likely resulted in complex demands on the nursing assistants.http://www.sciencedirect.com/science/article/pii/S2772501425000053Shift workExtended work shiftLong-term healthcareCertified nursing aide
spellingShingle Ryan L. Bellacov
Kermit G. Davis
Chunhui He
Evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long-term care
Human Factors in Healthcare
Shift work
Extended work shift
Long-term healthcare
Certified nursing aide
title Evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long-term care
title_full Evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long-term care
title_fullStr Evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long-term care
title_full_unstemmed Evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long-term care
title_short Evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long-term care
title_sort evaluating the impact of shift work length and time of day on musculoskeletal disorders among nursing assistants in long term care
topic Shift work
Extended work shift
Long-term healthcare
Certified nursing aide
url http://www.sciencedirect.com/science/article/pii/S2772501425000053
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AT chunhuihe evaluatingtheimpactofshiftworklengthandtimeofdayonmusculoskeletaldisordersamongnursingassistantsinlongtermcare