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Publication Date



2021 prov rn wa; 2021 prov rn poster; washington; spokane




Background: Working night shift is a physical and emotional stressor related to negative health outcomes. Cortisol is a biomarker that has been related to an increased risk for metabolic syndrome among adults. Cortisol levels follow a circadian rhythm in humans; levels reach a peak in the early morning and drop to the lowest level in the late evening. Changes in cortisol levels have been related to changes in mood or sleep and to exposure to stressful situations. In a group of Registered Nurses, the impact of consecutive 12-hour night shifts on relationships between cortisol levels, sleep, stress, and mood, was not well-defined.

Purpose: To determine relationships between cortisol, sleep, and self-reported mood and stress among nurses working 12-hour night shift after a third consecutive day of work and after a third consecutive day of rest. Methods: Nurses working 12-hour shifts were recruited from two major hospitals in an urban city in the Pacific Northwest to participate in a variety of tests immediately after finishing a third consecutive 12-hour shift and again after a third consecutive day off work. Nurses wore wrist actigraphs for 72 hours prior to both test sessions as an objective measure of sleep. During each test session, nurses completed self-report questionnaires to describe mood, stress, and sleep quality and also provided saliva samples from which cortisol levels were measured. Results: A total of 44 night shift nurses met criteria for data analysis. After a third consecutive 12-hour shift, nurses were significantly more likely to have a normal cortisol level as sleep quality (p<0.01) and efficiency (p<0.01) increased. Expected relationships between cortisol and stress, mood, and sleep were stronger when nurses were tested after the third consecutive day of work versus after the third consecutive day of rest.

Conclusion: We provide preliminary evidence that improving sleep hygiene for nurses may reduce negative health effects associated with working night shifts. Furthermore, nurses may be able to recover from the stress of night shift work after three consecutive days of rest.

Implications for practice: Registered Nurses need to provide 24-hour care to hospitalized patients, and further research should uncover strategies to support positive health outcomes for these clinicians. While our sample was small, we hypothesize that improving sleep hygiene for nurses working consecutive 12-hour night shifts may support health outcomes. Future studies with more frequent cortisol measures are needed to examine time-sensitive changes in cortisol levels.



Conference / Event Name

2021 Providence RN Conference


Virtual Conference

Relationships between Cortisol, Sleep, Stress, and Mood among Night Shift Nurses

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Nursing Commons