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Considering the impact of shift working on health

08 February 2024
Volume 33 · Issue 3


Shift work is necessary for the provision of health services, especially in hospitals as it is the only way to provide continuous care to patients. Working at night is inconsistent with the body's biological clock and night shift working hugely disrupts the circadian and sleep wake cycles. In 2020, the World Health Organization classified night shift working as being a ‘probable’ class 2A carcinogen and a number of independent cohort studies of both night workers and shift workers have observed increased incidence of certain cancers. Altered sleep timing, food timing and light exposure typical for shift workers leads to an acute circadian disruption and misalignment of regulatory hormones. This straying from synchronisation has been shown to result in individuals being more vulnerable to a number of chronic health conditions. Night shift work disrupts the normal sleep–wake cycle, often leading to shortened sleep duration and excessive fatigue and the results of this are far reaching. This article will explore the full impact of shift working, questioning if current practices employed within the NHS should continue.

Shift working, particularly night shift working, has for many years been recognised as being harmful to health. For the lead author, the impact of night shift working is an area of interest as they have predominantly worked night shifts for over a decade. In 2020, the World Health Organization's International Agency for Research on Cancer (IARC) classified night shift working as being a ‘probable’ class 2A carcinogen (IARC, 2020). In 2007, IARC classified all shift work involving circadian rhythm disruption as probably carcinogenic to humans, but following a meeting in 2019 this changed to specifically target night shift working (Erren et al, 2019). IARC concluded that night shift work is probably carcinogenic to humans based on limited evidence from human epidemiological studies and sufficient evidence of cancer and strong mechanistic evidence in animals (IARC, 2020).

Shift work is necessary for the provision of health services, especially in hospitals as it is the only way to provide continuous service and care to patients (Turchi et al, 2019). Working at night is inconsistent with the body's biological clock.

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