title: Characteristics of shift work and their impact on employee performance and wellbeing: A literature review.
abstract: OBJECTIVE
  To identify the characteristics of shift work that have an effect on employee's performance (including job performance, productivity, safety, quality of care delivered, errors, adverse events and client satisfaction) and wellbeing (including burnout, job satisfaction, absenteeism, intention to leave the job) in all sectors including healthcare.
  
  
  METHODS
  A scoping review of the literature was undertaken.
  
  
  METHODS
  We searched electronic databases (CINAHL, MEDLINE, PsychINFO, SCOPUS) to identify primary quantitative studies.
  
  
  METHODS
  The search was conducted between January and March 2015. Studies were drawn from all occupational sectors (i.e. health and non health), meeting the inclusion criteria: involved participants aged ≥18 who have been working shifts or serve as control group for others working shifts, exploring the association of characteristics of shift work with at least one of the selected outcomes. Reference lists from retrieved studies were checked to identify any further studies.
  
  
  RESULTS
  35 studies were included in the review; 25 studies were performed in the health sector. A variety of shift work characteristics are associated with compromised employee's performance and wellbeing. Findings from large multicentre studies highlight that shifts of 12h or longer are associated with jeopardised outcomes. Working more than 40h per week is associated with adverse events, while no conclusive evidence was found regarding working a 'Compressed Working Week'; working overtime was associated with decreased job performance. Working rotating shifts was associated with worse job performance outcomes, whilst fixed night shifts appeared to enable resynchronisation. However, job satisfaction of employees working fixed nights was reduced. Timely breaks had a positive impact on employee fatigue and alertness, whilst quick returns between shifts appeared to increase pathologic fatigue. The effect of shift work characteristics on outcomes in the studies reviewed is consistent across occupational sectors.
  
  
  CONCLUSIONS
  This review highlighted the complexity that encompasses shift work, but many studies do not account for this complexity. While some consistent associations emerge (e.g. 12h shifts and jeopardised outcomes), it is not always possible to conclude that results are not confounded by unmeasured factors.
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Highfield, Southampton SO17 1BJ, UK. Electronic address: C.Dall'ora@soton.ac.uk.
authors.forename: Chiara
authors.initials: C
authors.lastname: Dall'Ora
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Highfield, Southampton SO17 1BJ, UK. Electronic address: jane.ball@soton.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Ball
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Highfield, Southampton SO17 1BJ, UK. Electronic address: A.Recio-Saucedo@soton.ac.uk.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Recio-Saucedo
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Highfield, Southampton SO17 1BJ, UK. Electronic address: peter.griffiths@soton.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
mesh_terms: D002055:Burnout, Professional; D005221:Fatigue; D006801:Humans; D007588:Job Satisfaction; D061214:Patient Safety; D010563:Personnel Turnover; D011787:Quality of Health Care; D014940:Work Schedule Tolerance
keywords: Absenteeism; Burnout, Professional; Job performance; Job satisfaction; Patient safety; Personnel turnover; Quality of health care; Shift length; Shift work