The Night Shift is Bad for Providers’ Health: Circadian Lighting May Be Just What the Doctor Ordered.
Night shift work is disruptive to circadian rhythms, but critically important to hospital operations. How do we minimize its impact to safeguard the health and wellbeing of caregivers working the night shift? Lighting design can be a key tool for ensuring that caregivers receive the type of light they need to do their work while maintaining their normal wake/sleep schedule. In this post we discuss four design strategies for circadian lighting that promote wakefulness where and when it's needed.
It’s well documented that night shift work wreaks havoc on the circadian system, causing health complications such as insomnia and excessive daytime sleepiness. Night shift work has even been linked to metabolic disease, and labeled a probable carcinogen by the International Agency for Research on Cancer (IARC). Physicians and nurses are no strangers to overnight work, which ensure continuity of care but also leads to these problems.
Despite the serious adverse effects on providers’ health, more attention is typically paid to lighting’s impact on patients. I think it’s time for that to change. Design solutions that prioritize circadian lighting—lighting that reinforces the body’s natural 24-hour cycle—could help decrease burnout and turnover among night shift staff and positively impact patients as well.
A Complicated Riddle: Lighting for Night Shift Care Teams
There are two distinct approaches to provide lighting for night shift workers. Both have merit, but the right approach is determined by the lifestyle each employee wants to keep outside of work:
Perpetual Night Shifters
For employees who work at night, and then continue that same schedule outside of work, a high light level during key portions of the night promotes alertness and shifts staff’s circadian rhythm to a nighttime schedule.
Night-to-Day Shifters
For employees who want to maintain a “normal” schedule out of work, minimizing the circadian-effective light stimulus during the evening hours helps keep a person’s biological rhythm day-centric while using other means to promote alertness.
To address this riddle, we propose a lighting solution that “does no harm,” allowing individuals to adjust and supplement based on what is most appropriate to their lifestyle needs. A good place to start is to create a lighting environment that minimizes the light stimulus for the general population, supporting the night-to-day shifters, then offer supplementation for perpetual night shifters. With that in mind, here are four strategies for creating environments that work for everyone:
1. Don’t Just Dim the Lights
General ambient lighting affects everyone, but research shows that the circadian system is particularly sensitive to light in the cyan/bluish spectrum at night. So, reducing the radiant energy in that spectrum is critical in areas that aren't occupied solely by perpetual night shifters. Dimming ambient lighting is the most important first step: most modern lighting control systems can be programmed to lower the light level during the night shift. However, the light level needs to be quite low and in healthcare environments it’s important to remember that the need for dimmer lights must be balanced with the need for visual acuity to perform tasks.
2. Shift to Warm, White Light
An upgrade that allows a higher overall light level but still reduces the biological effect is to simultaneously shift the color of the lighting to warm white light (3000K or 2700K CCT) or even an amber reminiscent of dimmed incandescent light. Some companies offer specialized spectrums that tune the light for the circadian system. These spectrum shifting options require more specialized light fixtures and a control system to match, which can add cost but allow for a bit higher light level for visual tasks while reducing the impact on the circadian system.
3. Supplement with Extra Light
High brightness table lamps designed to comfortably push light to the eyes would supplement for perpetual night shifters, but minimally impact night-to-day shifters. There are many different brands and options for this type of lamp, from those that incorporate spectrum tuning technology, to simple fabric or paper table lamps with enough output to be circadian effective. Alternatively, nap rooms could be fitted out with supplemental lighting to double as “bright light” rooms. Which approach is appropriate will depend on the work culture of the institution. For night-to-day shifters, early research indicates that red light stimulus might help promote alertness without impacting the circadian system, but more studies are needed to fully understand this effect.
4. Get Users on Board
More doctors and health researchers are calling for a new approach to lighting due to the growing evidence that improving light exposure in healthcare settings positively impacts the circadian system, sleep, mood, and productivity. However, human-centric lighting systems are often more costly, and it can be difficult to achieve client buy-in, especially in an uncertain economic climate. Though the benefits to long-term employee health and satisfaction that investments in lighting solutions can provide are difficult to quantify, the research is compelling and should be a starting point for creating buy-in.
Getting staff buy-in is also important. Staff may have become accustomed to certain light levels and changing the lighting condition dramatically often requires education and perhaps even testing to find the best solution. An open dialog between the lighting designer, client, and user groups to determine priorities, understand possible approaches, and find the best fit light solution is key. It is important for staff to understand why the lighting in their environment is changing and give feedback during the design process. Mockups and testing on a small scale in existing facilities can help develop test cases before implementing solutions. Lastly, coaching staff on how to optimize their light exposure outside of work can also help maximize the benefits of a human health-centric lighting design in the hospital.
Night shift work is necessary in healthcare settings but is inherently disruptive—humans are diurnal and we've evolved to sleep at night. A growing body of experts are advocating for new approaches in lighting to help reduce the negative effects and promote better health. Strategies and technologies that provide higher light levels for visual tasks while reducing melatonin suppression can help blunt dips in alertness—which can have far-reaching benefits to organizations and those they care for. By implementing a lighting solutions that benefits the greatest number of people and getting users on board, organizations can reap these benefits.
