Examination of healthcare workers’ response to rotating shift work during the COVID-19 pandemic in Greater Victoria care sites
Date
2021-08-16
Authors
Harrington, Marisa
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Abstract
Nurses are already exposed to plenty of stressors while at work, one of which
being the unavoidable nature of rotating shift work scheduling which can have profound
physiological effects carrying heightened long-term health risks. Working on the
frontlines of the COVID-19 pandemic has introduced new stressors while further
exacerbating the effects of pre-existing ones in this already understudied group of
essential workers. The purpose of this research was to examine physiological markers of
stress and health in nurses during the COVID-19 pandemic. Nine subjects (mean age
32.11 ± 7.25 years) from two hospitals in the Greater Victoria region collected data over
an eight-day shift roster consisting of two 12-hour day shifts, two 12-hour night shifts,
and four days off in two separate collection periods; remote data collection was used to
adhere to COVID-19 safety guidelines. Salimetrics ELISA kits were used to conduct
analyses for salivary cortisol, melatonin, and interleukin-6 (IL-6) content. Frequency
domain heart rate variability (HRV) was collected with a Polar H10 Chest Strap and
Polar Ignite Activity Tracker. A salivary sample and 5-minute HRV recording were
obtained upon waking or shortly thereafter on each day; a second saliva sample was
obtained after work for the four working days. The Expanded Nursing Stress Scale
(ENSS) was completed at the end of the last night shift in each period. There were no
significant differences between IL-6 concentrations across the eight days within each period; the same was observed for cortisol. Additionally, no difference was apparent
between the morning and evening salivary cortisol concentrations, thus demonstrating a
blunting of the diurnal release pattern. Evening salivary cortisol concentrations remained
elevated near the level of morning samples and were consistently above reference values
for the population age group. Morning salivary melatonin concentrations significantly
differed by day (F(5, 25) = 6.626, p < 0.001) but not period; melatonin concentrations
were lowest following night shifts, showing a suppression in release due to participants
being exposed to light at night with shift work. No statistically significant differences
were apparent between any frequency domain HRV parameters in either Period 1 or
Period 2. Perceived occupational stress was heightened in comparison to previously
published pre-pandemic research using the ENSS. The results of this research reveal
alterations to the circadian nature of cortisol and melatonin alongside elevated perceived
occupational stress; these physiological and psychological effects can compound the risk
for adverse health outcomes. While it is difficult to discern the root cause of these
responses, it nevertheless reveals insight into the effects of nurses working during the
COVID-19 pandemic and raises concern for potentially related disease risk.
Description
Keywords
nurse, nurses, covid-19, pandemic, hospital, coronavirus, stress, physiology, endocrine, heart rate variability, autonomic, cortisol, melatonin, interleukin 6, il-6, occupational, victoria, heart, enss, expanded nurses stress scale, polar, salimetrics, circadian