Work Around the Clock

Introduction

Work Around the Clock (WAC) is a multicentre prevention project involving three partner hospitals, EOC, KSGR and RHNe, and aims to reach around 800 shift-working nurses. The project is aimed at nurses who work shifts, with the goal of improving their quality of life and mental health through targeted interventions that promote healthy sleep and prevent sleep disorders, in particular shift work sleep disorder (SWSD). WAC substantially extends the prevention measures currently available, which are limited to the periodic medical check-ups required by law for night workers.

Shift work sleep disorder is a circadian rhythm sleep-wake disorder characterised by insomnia or excessive sleepiness caused by working hours that overlap with the usual sleep period. It is common among shift workers: around one in four develops it.

The WAC prevention pathway: primary prevention for all (webinar and Cronopoli); medical check-up at the hospital; with symptoms or on request, cognitive behavioural therapy for insomnia (CBT-I); with suspected shift work sleep disorder, exemption from night shifts, sleep medicine assessment and occupational physician's decision on return to work.

Project components

Our prevention project is organised on three levels:

  1. Primary prevention
    • Webinar: an online course for all shift-working nurses, made up of 5–6 short videos (30–40 minutes in total). Topics include sleep physiology and chronobiology, sleep disorders, shift work and sleep, and sleep hygiene techniques.
    • Cronopoli: also open to all shift-working nurses, this gamified app lets wards within the same hospital compete against each other. Participants are presented with fictional shift-work scenarios and must decide which sleep hygiene strategies to adopt.
  2. Secondary prevention – Cognitive behavioural therapy for insomnia (CBT-I), at EOC and KSGR only. It is not intended for all shift-working nurses, but for those whose symptoms are identified during the medical check-ups at the hospital, or who request it voluntarily. Participants meet regularly with a psychotherapist and complete assignments on Moodle between sessions.
  3. Tertiary prevention – Timely care and recovery of fitness for duty, at EOC and KSGR only. Nurses with suspected shift work sleep disorder are temporarily exempted from night shifts and referred to the partner hospitals for a sleep medicine assessment. Diagnostic tests and consultations are fully covered by Swiss compulsory health insurance (LAMal/KVG). The aim of this level is to treat nurses and safely restore their fitness for night work. The final decision on their return lies with the occupational physician, with the aim of protecting staff health and retaining the most vulnerable professionals in the profession.

Note. In-person medical check-ups take place throughout the year at the hospitals. By law, anyone working 25 or more nights a year is entitled to a medical examination and advice, every two years and, from age 45, every year (Art. 44 ArGV 1, SECO – Medical examination and advice for night work). If symptoms of shift work sleep disorder are identified, or if the person wishes, they are referred to the online CBT-I programme.