BACKGROUND: Shift work disorder is common among nurses, marked by circadian rhythm disruption, excessive sleepiness, and cognitive impairment. It increases the risk of cardiovascular and metabolic diseases and contributes to clinical errors from fatigue, endangering patient safety. Its prevalence is notably higher in nurses than in other shift-working populations.
OBJECTIVES: This systematic review and meta-analysis aimed to determine the prevalence of and risk factors for shift work disorder among nurses. The ultimate aim was to provide evidence-based guidance for optimizing scheduling system and developing health intervention strategies.
METHODS: Nine databases were comprehensively searched up to February 20, 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used for the meta-analysis, which was performed using Stata software. The quality of the studies was evaluated using the Joanna Briggs Institute (JBI) tool, and heterogeneity was assessed using the Itest. Publication bias was examined using funnel plots and the Egger test. 2
RESULTS: A total of 24 observational studies involving 15,479 nurses were included for analysis. The pooled prevalence of shift work disorder among nurses was 45.5 % (95 % CI: 39.2-51.8 %). Subgroup analysis revealed that Africa (51.0 %) and Asia (46.5 %) had the highest prevalence rates, with a 61.7 % prevalence among nurses working in a "three-shift" model. Risk factors for shift work disorder included high stress (OR = 1.019, 95 % CI: 1.003-1.036), the number of night shifts in the past year (OR = 1.010, 95 % CI: 1.010-1.020), increasing age (OR = 1.025, 95 % CI: 1.002-1.047), the number of quick shifts (OR = 2.593, 95 % CI: 1.979-3.397), anxiety (OR = 1.073, 95 % CI: 1.039-1.108), depression (OR = 1.178, 95 % CI. 1.135-1.223) and fatigue (OR = 1.145, 95 % CI: 1.096-1.197). Heterogeneity analysis of the assessment tools revealed that scales and questionnaires (54.2 %) yielded higher prevalence rates than did the International Classification of Sleep Disorders -3 (40.2 %) and International Classification of Sleep Disorders -2 (32.9 %) criteria.
CONCLUSIONS: The prevalence of shift work disorder in the nurse population is high although there is substantial heterogeneity across studies. The risk of shift work disorder should be reduced by decreasing the frequency of rapid shifts and night shifts, optimizing scheduling stability, enhancing mental health support, and using standardized assessment tools. The findings provide key evidence for healthcare organizations to develop evidence-based intervention strategies.
REGISTRATION: This review was registered with PROSPERO (CRD 42023494210).
Circadian Biology