Working conditions among healthcare workers became more demanding during the COVID-19 pandemic, and new types of work hour schedules emerged. The aim of the study was to investigate how working hours in the Swedish healthcare sector were affected by the COVID-19 pandemic. Payroll data were extracted from one mid-size Swedish region, including 1,130,391 shifts worked by 3392 individuals between December 2018 and September 2023. Paired t-tests were used to compare working hours before and after the onset of COVID-19. There were few changes to the working hours during COVID-19. A new schedule (4 workdays, 2 days off) increased weekend work and decreased the proportion of quick returns and single free days. Exploratory analyses showed that overtime increased. In conclusion, the pandemic had few and weak effects on the ergonomic qualities of work hour schedules. More research is needed to explore whether the findings are representative of other contexts.

Background: Participatory working time scheduling (PWTS) is a form of self-scheduling involving collaboration between employees and employers. PWTS is common in Swedish health care, but its characteristics can vary substantially between workplaces. This study investigated whether the characteristics of PWTS were associated with (1) the ergonomic characteristics of the schedules that emerge from this process and (2) employee satisfaction with those schedules—two indices reflecting the sustainability of work hours.

Methods: Two hundred and forty-eight nurses, assistant nurses and care assistants (response rate 29%) from two Swedish hospitals completed a survey that asked about the respondents’ experience of how the scheduling process is managed and implemented, and their own priorities when planning their schedules. Participants’ realised work hours were derived from the hospitals’ administrative systems. Factor analysis was used to identify composite factors of PWTS characteristics. Logistic regressions then examined associations between PWTS characteristics and (1) the prevalence of ergonomically unsound work schedule characteristics and (2) indices of employee satisfaction.

Results: Six PWTS characteristics were identified: scheduling support and personal influence (SSPI), prioritising personal motives (PPM), usability of scheduling tools (UST), scheduling as a collective process (SCP), preference for compressing hours (PCH) and bad schedule warnings (BSW). SCP and PCH predicted the frequency of long (> 40 hours) working weeks. BSW predicted the frequency of long shifts (≥ 12 h). SSPI predicted satisfaction with work hours, satisfaction with influence over work hours and frequency of thoughts about leaving the workplace.

Conclusions: The findings indicated that, for PWTS to be perceived positively, there should be open communication between employees and managers/staffing assistants, fostering individual relationships with employees and promoting employee-voice in the scheduling process such that nurses feel able to influence their work hours. However, we found only limited evidence that PWTS characteristics affected the ergonomic characteristics of the schedules that emerged from this process.

Implications for Nursing Management: Priority should be given to allowing staff influence over their work hours while simultaneously providing those staff with support in the scheduling process. Managers need to be active in their leadership of work hours, so as to foster that communication and employee-voice. Managers should identify staff who choose to work longer work weeks and alert them to the potential risk to their own wellbeing and to patient safety. An important tool in this regard is scheduling software that warns of ergonomically unsound schedules.

As sleep restriction has negative effects on performance, ensuring sufficient sleep for shift workers is essential. Quick returns (< 11 h off between shifts) shorten sleep and are associated with increased fatigue and risk of accidents, but there is limited research on other aspects of cognitive performance and work performance. The aim of the present quasi-experimental field study was to investigate the effects of quick returns on objective and subjective measures of sleep, fatigue and cognitive performance. In total 36 newly graduated nurses were followed during two pre-scheduled work periods, with and without a quick return (evening–day–day vs. day–day–day). They kept diaries of sleep and work, wore actigraphy wristbands to record sleep and performed 3 × 3 min smartphone-based cognitive tests (simple reaction time, episodic memory and Stroop) several times daily. Quick returns were found to shorten sleep by 46 min on average, and participants felt less rested in the morning and sleepier throughout the day. Sleep fragmentation and sleep efficiency did not differ between conditions but participants reported poorer sleep quality. Although the nurses reported cognitive impairments after a quick return, the estimated effects on simple attention, episodic memory and Stroop were small and overlapped zero. There were also indications of lingering fatigue on the second day shift after a quick return, but estimates are uncertain. In sum, quick returns shorten sleep and decrease subjective alertness, which could contribute to increased fatigue-related risk at work, but people seem able to mobilise necessary resources to maintain performance on short cognitive tasks.

Background: Newly graduated nurses often face demanding working conditions including high workload, stress, and irregular working hours. During the first years of practice, burnout symptoms are common. Recovery, including sleep, can be seen as a key protective factor in the associations between stress, shift work and negative health outcomes. Previously, a proactive, group-based intervention (recovery programme) for new nurses, promoting individual strategies for recovery, decreased burnout and fatigue symptoms post-intervention and showed preventive effects on somatic symptoms over time. To optimise the implementation and outcomes of an intervention, it is important to understand its mechanisms of impact (i.e., how it produces change) as well as to identify contextual factors influencing its implementation. Objective: To deepen the understanding of the recovery programme’s mechanisms of impact and to explore how its implementation, including participants’ opportunities for recovery and the feasibility of recovery strategies, was influenced by the context. Design: Qualitative descriptive design. Participants and setting: Twelve nurses (nine women) who had participated in the intervention at four Swedish hospitals, between 12 and 25 months (M = 19) after participation. Methods: Semi-structured individual telephone interviews were conducted and analysed using thematic analysis. Results: The programme’s proposed mechanisms of impact, including increased knowledge about sleep, enhanced motivation for behavioural change, and the use of recovery strategies, were confirmed. Motivation to apply recovery strategies was supported by a shift in mind-set regarding the importance of self-care; to improve readability; and follow-up on the behavioural change process during sessions. Contextual factors influencing recovery opportunities and the feasibility of strategies were related to both the work context and the individual. These factors included demanding schedules, extended and disrupted working hours, workload, opportunities for recovery at work, social norms, the organisation of work procedures, private life circumstances, and the deprioritisation of personal recovery needs. Booster sessions and reminders were suggested to facilitate the continued use of recovery strategies after the programme. Conclusions: When supporting nurses in developing individual recovery strategies, it is important to provide opportunities to share experiences with other new nurses and to follow-up on their behavioural change process. Importantly, several organisational factors should also be considered. Organisations should work systematically with the planning and management of working hours that promote recovery, create opportunities for recovery during work shifts, organise work procedures with recovery in mind, and continuously monitor and manage employees’ stress and fatigue symptoms. Together, such efforts could promote a social norm that supports recovery.

Introduction: In 2023, Sweden effectively banned quick returns (<11 hours of rest between shifts), which had previously been common in care-sector workers’ schedules. Quick returns are associated with insufficient recovery and sick leave but are also regarded by some as having beneficial effects e.g., facilitating better information transfer between shifts. This study investigated factors predicting employees’ attitudes toward the rule-change, post-implementation, and how those attitudes related to employees’ health and wellbeing.

Methods: A survey was emailed to a random selection of half of the members of a trade union working in elderly-care (≈61 000). Of those 52% opened it, and 14% of those participated (N = 4319). The survey assessed attitudes toward work hours and the rule- change, experiences of its implementation and impacts on professional and personal life. It also evaluated perceptions of workload, work environment, leadership, health, sleep and work-life balance. Preliminary descriptive analysis of responses has been conducted. On-going regression analyses, to be presented at the conference, will examine whether attitudes toward the rule-change are predicted by their experience of its implementation, or by other organisational, managerial, or individual factors; and whether respondents’ attitudes toward the rule-change predict their health and wellbeing.

Results: Thirty percent of respondents rated work hours negatively and 75% reported a negative impact of the rule-change upon their work hours. Most reported an increase in working three consecutive evening shifts (72%) and changes in the scheduling of weekend work (65%). Most (76%) reported that their ability to influence the planning of work hours had been impaired by the rule-change, as was the possibility to amend already planned schedules (82%). Many were negative to the new rules before the implementation (49%) but more were negative after implementation (74%). Additionally, 28% reported that derogations from the new rules occurred frequently after the rule-change. During the implementation, 72% felt that management had not listened to employees’ suggestions concerning the rule-change. Most reported negative effects of the rule-change on their work (e.g., less job satisfaction 63%, more conflicts in the work group 55%, impaired information transfer between shifts 58%) and personal life (e.g., more work-life interference 72%, impaired sleep 59%; impaired recovery in free time 71%).

Conclusion: The response rate was low, so the negative experiences of the rule-change reported here may not be representative of the whole workforce. However, data from this large sample will be used to examine the factors that prompt negative attitudes toward changes in working time rules, and how negative attitudes relate to health and wellbeing. These findings will provide valuable insights into how to successfully manage the implementation of such changes in the future.

Introduction: Entering working life as a new nurse is stressful and often an introduction to shiftwork, which has been associated with impaired sleep and recovery. In a randomized controlled trial, we previously examined the effects of a proactive ‘sleep and recovery intervention’ for new nurses showing preventive effects on somatic symptoms, decreased burnout and fatigue symptoms but no significant effects on sleep ratings. The aim of this study was to examine the effects of the intervention on day-to-day sleep, detachment and stress.

Methods: 209 new nurses were recruited at eight Swedish hospitals and randomly assigned into an intervention or control group (Clinical Trial NCT04246736). The intervention included three 2,5h group sessions, with psychoeducation on strategies enhancing sleep and recovery, based on cognitive behavioral therapy techniques modified for shiftworkers. A subsample of participants (64 in the intervention group, 74 in the control group) wore an actigraph and filled in a diary for one week before (baseline) and after (follow up) the intervention. The diary contained questions from the Karolinska Sleep Diary; sleep quality index, anxiousness at bedtime, questions about detachment (difficulties stopping thinking about work during free time), satisfaction with leisure time and feeling tense. Sleepiness (Karolinska Sleepiness Scale) and stress were rated during the day. Regression analysis estimated the effect of treatment on outcomes, controlling for baseline scores.

Results: The mean age was 27 years (SD=5.2), 86% were women with an average of 3.1 months (SD=2.5) experience in the profession. Measures during days off showed that at follow up, the intervention group reported significantly less problems with detachment (-0.59, 95% CI -0.87- -0.3) and exhibited -3.39 percentage points less fragmented sleep (95% CI -6.76- -0.02). A significant interaction indicated that those who had more problems detaching at baseline also had a greater benefit of treatment (-0.41, 95% CI -0.7 - -0.13, t = -2.9, p = 0.004). The intervention had no significant effect on other measures of sleep, satisfaction with leisure time or feeling tense during days off. Measures during workdays showed that at follow-up, the intervention group reported less problems with detachment (-0.47, 95% CI -0.76- -0.17), felt less tense (-0.25, 95% CI -0.48- -0.03) and reported higher satisfaction with their leisure time (-0.22, 95% CI -0.43- -0.01). The intervention did not affect sleep outcomes during workdays. There were no significant effects on sleepiness or stress ratings either during workdays or days off.

Conclusion: Results were promising showing that detachment was improved during workdays and days off, indicating that the intervention could promote better conditions for sleep and recovery for new nurses. Sleep was only improved during days off, which might indicate that organisational factors affect the use of sleep-improvement strategies during workdays. This should be examined further in future studies.

Introduction: Participatory working time scheduling (PWTS) is a common working time model in Swedish healthcare, but its characteristics can vary a lot between workplaces (e.g., division of responsibilities, scheduling guidelines, technical support, use of vetoes, leadership and employee engagement). The primary aim of this study was to investigate whether these characteristics of participatory scheduling were associated with (1) the ergonomic characteristics of the schedules that emerge from this process, and (2) employee satisfaction with those schedules. The study also explored whether any such associations were contingent upon sufficiency of staffing levels.

Methods: 248 (response rate 29%) nurses and assistant nurses from 12 units in 2 hospitals answered a survey between November 2022 and September 2023. The survey included questions about the respondents’ experience of how the scheduling process is managed and implemented, and their own priorities when planning their schedules. Participants’ realized work hours were derived from the hospitals’ administrative systems, for the 3 months prior to the completion of the survey. Principal components analysis (PCA) was used to identify composite factors of PWTS characteristics. Logistic regressions then examined: (1) associations between PWTS characteristics and the prevalence of ergonomically unsound work schedule characteristics; (2) associations between PWTS characteristics and satisfaction with work hours. These analyses also examined the potential moderating role of staffing levels.

Results: PCA identified four PWTS characteristics: Management Support & Personal Influence (MSPI); Usability of Scheduling Tools (UST); Prioritising Personal Motives (PPM); and Preference for Compressing Hours (PCH). UST and PCH predicted the frequency of long (> 40 hours) working weeks (adj.OR = 1.64; 95% CI = 1.17, 2.32; p < 0.05; adj.OR = 1.76; 95% CI = 1.20, 2.58, p < 0.05, respectively). No other work schedule characteristics were predicted by participatory scheduling characteristics. MSPI predicted satisfaction with workhours (adj. OR = 1.79; 95% CI = 1.24, 2.59, p < 0.01), satisfaction with influence over work hours (adj.OR = 2.01; 95% CI = 1.31, 3.07, p < 0.01) and frequency of thought about leaving the job (OR = 2.11; 95% CI = 1.45, 3.07; p < 0.001). None of the associations were moderated by staffing sufficiency.

Conclusion: The findings indicated that, for PWTS to be perceived positively and promote sustainable work hours, nurses should feel supported by their managers, with whom they can have clearer and open communication; that the process is fair; that there is shared sense of responsibility within the team; and that they are able to influence their work hours. However, we found only very limited evidence that PWTS characteristics affected the ergonomic characteristics of the schedules that emerged from this process.

Introduction: Quick returns (<11h between shifts, QRs) result in shortened sleep length (~5–6h) and increased sleepiness and are thus likely to have a negative impact on work performance. Previous registry studies and field studies utilizing retrospective ratings have associated QRs with an increased risk of accidents and mistakes, but there is a shortage of studies that have adopted an experimental design to assess the acute effects of quick returns on work performance. The aim of the present experimental field study was to investigate differences in objective and subjective measures of sleep, sleepiness and cognitive performance between QRs and day-day transitions.

Methods: In the years 2018–2023, 67 newly graduated nurses were recruited from the introductory program at 3 Swedish university hospitals. In total, 35 completed participation and were followed during two pre-scheduled work periods, with and without a quick return (evening-day versus day-day). Both conditions were preceded by a day off work, and the order of the two conditions was randomized across participants. The participants wore an actigraphy watch during sleep and kept a sleep diary (Karolinska Sleep Diary) and a work diary throughout the day. In addition, the participants performed smartphone based cognitive tests three times a day on the KarolinskaWakeApp. The cognitive tests measured simple attention, episodic memory (memorizing a list of words) and cognitive conflict (Stroop). The data has been analyzed using Bayesian linear mixed models. Pre-registered analysis plan and priors can be found here: https://osf.io/kr4su.

Results: Nurses were estimated to sleep on average 6h 57min (95% Compatibility Interval [6h40m, 7h15m]) during day-day transitions and 49 minutes (95% CI [70,27]) shorter during quick returns. Sleep fragmentation did not differ between conditions, but the participants were more anxious at bedtime (-1.19, 95% CI [.89, 1.47]). Following a QR, participants felt less rested (0.64, 95% CI [0.32, 0.93]) in the morning and sleepier (0.52, 95% CI [0.11,0.90]) during daytime. The estimated effects of working a QR, for attention (95% CI [-6, 17]ms), incongruent stroop-trials (95% CI [-25, 68]ms), and the probability of misremembering words (95% CI[-0.02, 0.02], were small and overlapped zero.

Conclusion: Quick returns shorten sleep and are a source of fatigue among nurses. The sleep deprivation caused by QRs (compared with day-day transitions) were, however, approximately one hour and did not manifest in worse attention, conflict processing or memory impairments. The effects of QRs on subjective ratings of safety and performance will be analyzed and presented at the conference. This study indicates that the cognitive consequences of a single QR are not substantial, but future studies should investigate the effects of repeated QRs on cognitive performance and potential safety consequences.

Introduction: Previous studies have associated quick returns (less than 11 hours of rest between shifts) with shortened sleep duration and increased sleepiness but have failed to find an association with sleep quality or stress. However, most previous work has relied on subjective measures of sleep which are limited. Thus, despite previous null results, an association with sleep quality cannot be ruled out. The aim of the present study is to examine how objective and subjective measures of sleep duration, sleep quality, sleepiness and stress are affected by quick returns compared with day- day transitions, in a sample of nurses and assistant nurses. The results have been published in the Scandinavian Journal of Work Environment and Health.

Methods: 225 nurses and assistant nurses wore actigraphy wristbands and kept a sleep and work diary for seven consecutive days. Sleep length was measured with actigraphy data. Sleep quality was assessed with both actigraphy data (sleep fragmentation index) and complementary subjective ratings (Karolinska sleep quality index, 1= poor, 5 = good). Participants also rated their stress and sleepiness (Karolinska sleepiness scale) levels every third hour throughout the workday and during leisure time (07AM-22PM). Quick returns and control conditions (day-day transitions) were identified from the reported working hours. As intra- individual differences were of interest, the data were analyzed in a linear mixed model where all participants acted as their own control. Thus, the final sample (N = 90) included those with at least one observation of both a quick return and a day-day transition.

Results: Quick returns were associated with shortened sleep length (-1 hour, 95% CI [-1.23, -0.81]), and a reduction in subjective sleep quality (-0.49, 95% CI [-0.69, -0.31]) compared with day-day transitions. The participants also experienced increased anxiety at bedtime (-0.38, 95% CI [-0.69, -0.08]) and increased worktime sleepiness during quick returns (0.45, 95%CI [0.22, 0.71]). No difference in sleep fragmentation and stress ratings was found.

Conclusion: Quick returns result in shortened sleep length, reduced subjective sleep quality and increased sleepiness during work, but do not seem to have an impact on perceived stress levels or sleep fragmentation among nurses and assistant nurses. Thus, managers, scheduling staff and employees should be cautious and consider the risk of fatigue when scheduling quick returns.

Inadequate sleep is common and contributes to poor health outcomes. Physical activity has a positive impact on sleep outcomes, however the prevalence of physical inactivity is increasing, coupled with the rise of sedentary behaviour at work. Interventions that promote physical activity and reduce sedentary behaviour are essential, as they can improve sleep. The current study investigated the effects of breaking up prolonged sitting with physical activity during the day or night, compared to not breaking up sitting, on sleep architecture during a 9 h or 5 h sleep opportunity. Participants (n = 125, 51% male, 23.4 ± 4.8 years of age) completed an in-laboratory sleep study, with five simulated shifts during the day or night. Sleep opportunities were either 9 h or 5 h following each shift. Participants were allocated to one of six conditions: Sit9D or Break9D (sedentary or breaking up sitting day and 9 h sleep opportunity), Sit5D or Break5D (sedentary or breaking up sitting day and 5 h sleep opportunity), or Sit9N or Break9N (sedentary or breaking up sitting night and 9 h sleep opportunity). Sleep was monitored using polysomnography. In the analysis of day shifts, mixed model ANOVAs demonstrated a significant physical activity *sleep opportunity interaction for total sleep time (p < 0.001), sleep onset latency (p < 0.001), time spent in N2 (p < 0.001) and N3 (p = 0.03). Post-hoc analyses revealed that participants in the 9 h sleep opportunity conditions had longer total sleep time, shorter sleep onset latency, and more slow-wave sleep (N3) during sleep opportunities 1–4 but not sleep opportunity 5. There were no significant differences in sleep architecture between physical activity condition for the nightshift conditions. Better sleep quality was seen in the 9 h condition compared to the 5 h condition, and breaking up sitting did not affect sleep. Given the benefits of breaking up sitting on health, our findings suggest a breaking up sitting intervention can be promoted without detrimental impacts on sleep.