title: Short sleep duration is dose-dependently related to job strain and burnout in nurses: a cross sectional survey.
abstract: OBJECTIVE
  Lack of sleep is a common problem amongst nurses. Short sleep duration has been related to stress and burnout. However, in nurses, the effects of short sleep duration on job strain and burnout are controversial and a clear relationship has been lacking. This study aims to assess whether short sleep duration is related to job strain and burnout statue, and whether such relationship is in a dose-dependent manner.
  
  
  METHODS
  A cross-sectional survey among female nurses in secondary referral health centers in Taiwan, using a self-administered structured questionnaire. Stratified sampling by region and patient bed number category was done to select representative centers for this survey. Approximately 10% of all secondary referral centers were randomly selected from each stratum. Non-linear dose-response relationship between sleep duration and job strain and burnout scores was assessed by general additive models (GAM), adjusting for personal characteristics, work condition, and family situation.
  
  
  RESULTS
  Among the 2268 full-time nurses in 39 hospitals invited to participate in this study, 1384 (61%) satisfactorily completed the questionnaire. There were 169 nurses (12.2%) who slept less than 6 h per working day. Among the participants, 37% (n=512) were classified into high strain group. The mean scores of personal, work-related, and client-related burnout were 59.4 (SD=22.0), 54.6 (SD=21.7), and 42.3 (SD=18.6). Compared to those slept longer than 7 h, nurse who slept less than 6 h per working day had higher risk for job strain (adjusted odds ratio, AOR=1.8, 95% confidence interval, CI=1.2-2.7), personal burnout (AOR=3.0, CI=1.7-5.2), work-related burnout (AOR=3.4, CI=2.0-6.0), and client-related burnout (AOR=2.0, CI=1.2-3.6). GAM analysis found a linear relationship between sleep duration and job strain, and client-related burnout. For personal and work-related burnout, a linear increase in burnout score between 7 h and 5 h of sleep was observed, followed by a leveling off for durations of less than 5 h.
  
  
  CONCLUSIONS
  Our study found sleep duration at working days was inversely associated with female nurses' job strain and burnout in a dose-dependent manner. Further studies on work factors which affecting sleep duration are warranted.
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University School of Public Health, Taipei, Taiwan.
authors.forename: Weishan
authors.initials: W
authors.lastname: Chin
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University School of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan.
authors.forename: Yue Leon
authors.initials: YL
authors.lastname: Guo
authors.affiliation: Department of Biological Science and Technology, College of Medicine and Life Science, Chung Haw University of Medical Technology, Taiwan.
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Hung
authors.affiliation: Department of Health Business Administration, Hung-Kuang University, Taichung, Taiwan, ROC.
authors.forename: Chiu-Yueh
authors.initials: CY
authors.lastname: Yang
authors.affiliation: Department of Nursing, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan. Electronic address: scshiao@ntu.edu.tw.
authors.forename: Judith Shu-Chu
authors.initials: JS
authors.lastname: Shiao
mesh_terms: D000328:Adult; D002055:Burnout, Professional; D003430:Cross-Sectional Studies; D006801:Humans; D009740:Nursing Staff / Q000523:psychology*; D012890:Sleep
keywords: Burnout; Job strain; Night shift work; Nurses; Sleep duration