Volume 28, Issue 2 (5-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(2): 103-111 | Back to browse issues page

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Fadae Aghdam N, Ameri M, Goli S, Imeni M. Relationship Between Sleep Quality and Job Stress of Nurses in Different Shifts Working. Avicenna J Nurs Midwifery Care 2020; 28 (2) :103-111
URL: http://nmj.umsha.ac.ir/article-1-2109-en.html
1- Instructor of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
2- Instructor of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran , amerimalihe@shmu.ac.ir
3- Assistant Professor of Biostatistics, Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
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✅  Finding the factors related to the sleep quality of nurses seems to be essential. Given the relationship between job stress and sleep quality, the necessary arrangements, including stress management workshops, should be considered by hospital managers to achieve the ultimate goal of providing high quality patient care.
Extended Abstract:   (1185 Views)

Stress means being exposed to stress [1] and because it is felt in the workplace, it can be said that all jobs are somewhat stressful [2]. This problem is a common and costly problem, and unfortunately it is so prevalent that it is difficult to find someone who has not experienced job stress [3]. Nurses, meanwhile, are more at risk for stress and burnout due to the stressful nature of their careers and the close and ongoing communication they have with patients and their caregivers [6, 7] and high levels of Endure job stress [8, 9].
On the other hand, nurses face more stress due to their job nature and the requirement to be in the hospital 24 hours a day. Shift work can affect a person's professional performance and sleep quality, thereby affecting his or her physical health and social life, leading to impaired adaptation to existing stress and crises [13]. Sleep and rest play a very important role in human life; as cell repair and physical and mental relaxation are achieved in sleep [14]. However, the working conditions of nurses are in conflict with this. The findings of a recent study suggest that a rotating work schedule, especially morning and night work, changes the quality of nurses' sleep [15] and endanger patients’ safety. Recent studies of the effects of shift turnover and nursing sleep have shown that more than 57% of people who work shifts suffer from sleep disorders [14].
According to studies, shift work can lead to poor performance of tasks, lack of adequate preparedness in acute and emergency conditions, and poor communication with the client, and delays the recovery of clients. Internal studies on the quality of sleep and job stress in various occupations of nursing work are low; therefore, by addressing this important issue, it is possible to identify work shifts that have low sleep quality and high job stress, and by providing the above information to nursing managers, a step can be taken to improve the job conditions of nurses. Therefore, considering the possible differences between the quality of sleep and job stress of nurses in different work shifts and the harmful physical, psychological and economic effects of low sleep quality and job stress in nurses, the present study aims to determine the relationship between sleep quality and job stress in nurses’ various work shifts in 2016.


Materials and Methods

In the present descriptive-cross-sectional study, the research population included all nurses working in hospitals affiliated with Shahroud University of Medical Sciences in 2016. A total of 139 nurses who were eligible to participate in the study were randomly assigned to study in the morning, evening, and night shifts by class sampling from different departments such as internal medicine, surgery, gastroenterology, ICU, and CCU. Data collection tools included a population demographic profile questionnaire, a Tafter and Anderson job stress questionnaire, and the Pittsburgh Sleep Quality questionnaire. After receiving the necessary permits from the Vice Chancellor for Research of Shahroud University of Medical Sciences, the written consent of the participants was obtained. The questionnaires were then given to the participants. Participants were asked to complete the questionnaires in the same shift, otherwise they were given a 7-day time to complete the questionnaires. The data were analyzed using SPSS software version 18 (SPSS Inc., Chicago, Ill., USA) and used descriptive statistics (mean, standard deviation) and statistical tests of coherence, independent t-test and one-way analysis and at the significance level of 0.05.



The mean score of total sleep quality of nurses was 7.04 ±3.2. The highest mean score belonged to the component of useful sleep duration (1.47 ±1.11) and the lowest to the component of hypnotic drug consumption (0.42 ±0.834). Pearson correlation test showed a significant relationship between the mean total score of sleep quality and job stress (r=0.176, P=0.036). There was no significant relationship between sleep quality and job stress in different work shifts (P<0.05). Among demographic variables, only tea consumption had a significant relationship with nurses’ sleep quality (P=0.043).

Table1. Demographic characteristics of the nurses under study

Variable N (%)
Employment status Project (25.2) 35
Contract (46) 64
Official (28.7) 40
Job stability
Yes (71.9) 100
No (28.1) 39
Dominant shift
Morning (32.4) 45
Evening (31.7) 44
Night (36) 50
The ward
General (67.2) 94
Special (32.8) 45
Taking sleeping pills Yes (9.4) 13
No (90.6) 126
Table 2. Average score of sleep disorders components
Mean & SD The component of sleep disorders
0.723± 1.22 General description of sleep quality
0.873±1.39 Delay in falling asleep
1.11± 1.47 Useful sleep duration
0.429± 0.104 Useful sleep
0.584± 1.16 sleep disorders
0.834± 0.42 The amount of sleeping pills used
0.886± 1.28 Daily dysfunction
Table 3. The relationship between the average score of total job stress and the quality of sleep of nurses with different work shifts
Variable Mean & SD P-value
Total Morning shift Evening shift Night shift  
Stress 19.87± 85.28 2.63±88.11 3.44± 86.20 2.65± 81.92 0.29
Sleep quality 3.02± 7.04 0.41± 7.28 0.44± 6.84 0.47± 7 0.78




The aim of this study was to determine the relationship between sleep quality and job stress of nurses in different work shifts working in hospitals affiliated with Shahroud University of Medical Sciences in 2016. Most studies conducted in Iran confirmed that, in general, most nurses have poor sleep quality [20, 30]. However, in some domestic studies, the overall sleep quality of nurses has been reported to be optimal [13]. The results of studies abroad also indicated poor sleep quality in nursing [31, 34]. Considering the contradictory results available, in the present study, an attempt was made to re-evaluate the quality of nurses' sleep by emphasizing more comprehensiveness and selection of research units from different work environments; therefore, according to the researchers, the quality of nurses' sleep in this study was reported to be at an unfavorable level. Compared to other occupations where the nature of work can affect employee sleep quality, nurses reported higher mean sleep quality scores, which confirms that nurses' sleep quality is undesirable [35, 36].
The results showed that the quality of sleep and job stress of nurses in different work shifts is not statistically significant. Beebe et al.'s study also found no statistically significant difference between work shift and sleep quality [31], but in studies where the number of samples studied is higher than the present study, statistically significant difference between sleep quality and different work shifts has been reported [26 25, 22], which shows that nurses who are on duty at night shifts have lower quality of sleep. In the above studies, in fact, with increasing night shift, the quality of sleep decreases, which can be due to disruption of circardin rhythm. In the present study, nurses reported the prevailing shifts in which they worked, and nurses whose shifts were mostly in the morning generally had lower quality of sleep and higher job stress. Of course, no significant relationship was reported; while the results of Rocha and Martino's study showed that morning shift nurses have more job stress and lower sleep quality [16].



The results of the study indicated the effects of job stress, especially in the morning shift on the quality of sleep of nursing staff. Given the importance of sleep quality, it seems necessary to find relevant factors so that hospital managers, knowing the above factors and holding stress management workshops, plan to improve the factors affecting sleep quality and improve the clinical performance of nurses. However, the present study did not find a link between many of the factors studied and nurses' sleep; however, longitudinal studies are recommended to identify factors affecting sleep quality.


Thanks to all the nurses who spent their precious time participating in this study. The present study is the result of an approved research project No. 9417 at Shahroud University of Medical Sciences, and researchers consider it their duty to appreciate the full support of the esteemed Vice Chancellor for Research at Shahroud University of Medical Sciences.

Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Original Research | Subject: Nursing
Received: 2019/11/28 | Accepted: 2020/03/19 | Published: 2020/03/25

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