The relationship between shift work and the quality of family and social life among nurses: a comparison between outpatient and inpatient care

Introduction

Healthcare professionals represent a substantial proportion of the shift-working population, comprising approximately one-third of all shift workers. Nurses are employed across a range of healthcare settings. In Poland, most of the nurses work in hospital wards, primary healthcare, and long-term care facilities. Regardless of the diversity in workplace settings, a significant proportion of the nursing workforce are engaged in shift work. To maintain high standards of care and ensure patient safety, the provision of round-the-clock nursing services is essential. However, this requirement disrupts both social and biological rhythms, thereby increasing health risks for nursing staff [1-3].
According to the European Agency for Safety and Health at Work, nursing is consistently ranked among the most stressful professions – a finding supported by numerous international studies. Many studies confirm that nurses frequently perceive their work as highly stressful [4-12].
Shift work has been linked to a range of adverse health outcomes. The frequent transition between day and night shifts disrupts the alignment between the body’s internal circadian clock and externally imposed sleep–wake schedules. This misalignment is considered a primary factor in the short-term negative consequences of night work. These include, among others, decreased quantity and quality of daytime sleep and reduced alertness during night shifts.
Over time, chronic disruption of circadian rhythms can contribute to the development of cardiovascular, psychiatric, and metabolic disorders, as well as sleep disturbances and an elevated risk of cancer [13-16].
Afternoon and night shifts also require individuals to adopt activity and rest cycles that often conflict with those of their families. This misalignment limits opportunities for shared time and can lead to conflicts in fulfilling social and familial roles [10]. Despite a substantial body of research on the consequences of shift work, continuous updates are necessary considering ongoing societal changes and the evolving expectations of future generations of nurses. Night shift work can strain family dynamics and social relationships. Shift work is typically categorised as non-standard due to its irregular hours and its disruptive impact on non-work time, especially when compared to conventional daytime employment [17-19].
The authors focused on the issue of shift work due to the still insufficient number of publications addressing the impact of this work pattern on employees and their families. Nursing personnel, who play a crucial role in the healthcare system, should be aware of the risks associated with shift work. Employers, in turn, should implement measures aimed at minimising these risks, thereby safeguarding the health and safety of their staff.
This study aims to examine the impact of shift work on social and family life. The study group includes members of nursing personnel. The study distinguishes between those working in outpatient care (primary healthcare, ambulatory care) – daytime work without night shifts – and those working in inpatient (24-hour) care – shift work including night shifts.

Material and methods

The study was designed and conducted in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting observational research. A quantitative research design was employed, utilising a diagnostic survey method with a proprietary questionnaire. The survey instrument was developed based on the Standard Shiftwork Index (SSI), incorporating items from the “Social and Home Life” section. The tool was validated by researchers from the Department of Ergonomics at the Department of Occupational Medicine, Jagiellonian University Medical College.
The final questionnaire consisted of 25 single- and multiple-choice questions. These addressed socio-demographic characteristics, type of work schedule, number of working hours per month, number of night shifts, and elements related to family and social functioning. A cross-sectional study was conducted during the second quarter of 2025. Data were collected using an online survey distributed via social media platforms dedicated to nursing professionals, through a shared survey link. Participation in the study was voluntary, based on informed consent, and anonymity was fully ensured. Inclusion criteria were active employment as a nurse with direct patient care responsibilities, provision of informed consent, and completion of the entire questionnaire. Exclusion criteria included being on maternity or parental leave during the study period, incomplete questionnaire submission, and employment duration of less than 6 months.
A total of 203 completed surveys were returned. Following data screening, 150 responses met the eligibility criteria for analysis. Among the respondents, 60.67% were employed in inpatient care settings, while 39.33% worked in outpatient care facilities.
All ethical principles of research involving human participants were upheld. In accordance with applicable Polish regulations, ethical approval from a Bioethics Committee was not required, because the study did not constitute a medical experiment.
Data analysis was performed using IBM SPSS Statistics for Windows, version 29.0 (IBM Corp., Armonk, NY, USA), and Microsoft Excel. Descriptive statistics (means, standard deviations, percentages) were calculated. The chi-square test of independence and Spearman’s rank correlation coefficient were used to assess relationships between ordinal variables. A significance level of a = 0.05 was adopted. Results of significance tests were reported as p-values using conventional thresholds: p < 0.05, p < 0.01, and p < 0.001.

Results

A total of 150 individuals participated in the study. Among them, 14% were male and 86% female. The average age was M = 37.21 ±11.19 years. Most were married (44%) or in a partnership (28%). Only 2.67% were widows or widowers. More than half of the respondents (57.33%) held a master’s degree. A slightly smaller proportion of respondents held a bachelor’s degree (29.33%), while the lowest percentage had attained only secondary education (13.33%). Three-quarters of respondents (74.67%) were employed based on a standard employment contract. Contract-based workers comprised 18.67%, while only 6.67% worked under a mandate (task-specific) contract. In the study group, 60.67% of respondents were employed in inpatient care (including night shifts), while 39.33% worked in outpatient care (without night shifts). Among the respondents, the most common number of night shifts was 6-10 per month, reported by 42%. Only 4% had more than 11-night shifts.
For employees working in a shift system, the more night shifts they have in a month, the fewer opportunities they have for socialising. For individuals working in outpatient care, this relationship proved statistically insignificant (Table 1).
Spearman’s correlation coefficient was also used. Negative correlations were observed between the number of monthly working hours and satisfaction with the amount of free time available for selected personal activities among nurses working in a shift system (inpatient care). The more hours of work, the less satisfaction reported. A high number of monthly working hours negatively impacts satisfaction with the time available for family life and social interactions (Table 2).
Positive correlations were observed between monthly working hours and the frequency of problems caused by work in selected aspects of life among nurses working shifts (in inpatient care). The more hours of work, the more often such problems arise (Table 3). In this case, the chi-square independence test was applied. The relationship between the variables was statistically significant. Among outpatient care workers, the dominant answers were “rarely” and “never” (both at 40.68%). Among inpatient care workers, “often” was the most frequently selected response (43.96%) (Table 4).
A significant majority of outpatient care workers reported being satisfied with their personal relationships (81.36%), compared to only 50.55% among inpatient care workers (Table 5).
Employees working in outpatient care most often did not perceive work as affecting their ability to maintain and develop social relationships (62.71% of outpatient respondents). In contrast, in the second group, work was most frequently reported to somewhat hinder these relationships (53.85% of respondents) (Table 6).

Discussion

The conducted research and literature review clearly show that shift work significantly impacts employees’ social and family lives. A work system involving night shifts, weekend and holiday duties, and irregular hours significantly affects family and social life.
Our research indicates that shift-working nurses report significant impacts of their work on time spent with family and friends, supporting the thesis that non-standard working hours are strongly correlated with disruptions to private life. Non-standard working hours – particularly weekend and holiday shifts – significantly limit opportunities for spending time with family and friends, which escalates tensions between professional responsibilities and private roles. The study “Parents’ shift work in connection with work-family conflict and mental health” also indicates that irregular work patterns escalate work-family conflicts, decreasing satisfaction with social and family life, particularly among parents working night shifts. This is also confirmed by a study published in the Journal of Family and Economic Issues conducted by Maume and Sebastian. The authors report that working non-standard hours, particularly at night, negatively impacts the quality of marital and family relationships by hindering the effective reconciliation of professional and private roles. Considering the presented data and the results of our research, it is evident that shift work severely limits the maintenance of family and social relationships, which may lead to escalating conflict between professional and private roles [20, 21].
Many studies indicate that excessive working hours negatively affect functioning in the workplace and personal life. Those findings are in line with the results of this study. The analysis revealed a positive correlation between the number of hours worked per month and the frequency of problems in social life, home functioning, and partner relationships. In other words, the more hours respondents worked, the more often they experienced problems in these areas. Similar results were reported in a study conducted in South Korea, which showed that long working hours (> 40 hours/week) are significantly associated with increased tensions in family life, sleep disorders, and occupational burnout. Empirical evidence shows that the conflict between professional and private life is a mediating mechanism for the negative impact of long working hours on mental health. Japanese researchers reported that fathers who work more than 65 hours per week exhibit reduced involvement in daily parental responsibilities. Research by NIOSH (The National Institute for Occupational Safety and Health) also indicates that shift work and long working hours can lead to sleep deficit, exhaustion, and mood deterioration, which negatively affects family relationships. Researchers in the UK found that people who work more than 60 hours a week are less likely to talk to their children, which may lead to family problems. Our results support previous findings showing that excessive work hours negatively affect personal and social life [22-26].
Another aspect discussed in the study is satisfaction with personal and family relationships. The results show apparent differences between nurses working in outpatient care and those working in inpatient care. The respondents from the former group were more likely to report satisfaction with the quality of their interpersonal relationships, which may be attributed to a more predictable work schedule compared to inpatient care. Research conducted by Karasek and Theorell in 1990 shows that a high workload combined with a low degree of control is a risk factor for chronic occupational stress, which in turn negatively impacts social and family relationships. Furthermore, Khatatbeh et al. conducted studies on nurses in 2021 and proved that working in the conditions of an intensive care unit promotes occupational burnout, which shows a strong relationship with the deterioration of the quality of personal life. The literature review and the present study indicate that work in inpatient care negatively affects personal life relationships, probably due to the irregular and long shifts that make it challenging to maintain a good work-life balance [27, 28].
The results of the analysis indicate that a nurse’s primary workplace affects the extent to which they forgo important family events. Respondents employed in outpatient care, compared to those in inpatient care, are much less likely to forgo participation in family celebrations or time spent with their children. This response structure may result from a more structured work schedule in outpatient settings, where shifts are typically fixed and set in advance. Studies conducted by Flo et al. and Smith et al. confirm that working in a shift system, predominant in inpatient care, is associated with irregular hours and greater schedule variability, making it more difficult to organise free time and contributing to more frequent family conflicts. Extended and irregular working hours are recognised risk factors for sleep disturbances and increased fatigue, which in turn impair functioning in both family and social domains, as confirmed by Åkerstedt and Folkard and Tucker in their studies. Furthermore, as argued by Rogers et al., the constant need for patient supervision in inpatient care creates greater psychological and physical burdens, which may also contribute to reduced engagement in family responsibilities. In contrast, in outpatient care, where daytime work in fixed hours is more common, employees have greater potential to maintain a good work-life balance, which translates into higher satisfaction and a reduced need to miss important family events, as observed by Bakker et al. and Geiger-Brown et al. Differences in work organisation characteristics between outpatient and inpatient healthcare settings clearly affect the employees’ family functioning. Both our research and the literature review indicate that work in outpatient care is characterised by greater regularity and predictability of working hours, which facilitates planning and spending time with family and friends. In contrast, work in inpatient care involves variable working hours, leading to a higher intensity of duties and more frequent disruptions to family life, negatively affecting the balance between work and personal life [29-37].
To sum up, shift work in nursing requires a high degree of mental and physical resilience. Such work organisation significantly impacts employees’ family and social life. That is why appropriate support is required from employers and the immediate environment to minimise negative effects and improve the quality of life of these professionals.

Conclusions

Nurses employed in outpatient care settings (without night shifts) report a better work-life balance.
Employment in inpatient care (involving night shifts) is associated with more frequent absences from important family events compared to outpatient care.
More night shifts correlate with reduced engagement in social gatherings and social events.
Higher monthly working hours negatively impact satisfaction with time devoted to family life, social contacts, and hobbies.
Nurses working in inpatient care more often report that the organisation of work hinders maintaining and developing social relationships.
Nurses in outpatient care are more likely to report satisfaction with their personal and family relationships than those in inpatient care.
Both the number of working hours and the organisation of the work system significantly impact the quality of nurses’ private lives because they can lead to physical and mental fatigue, reduced time with family, and a disrupted work-life balance.

Limitations

The survey was distributed via social media, which may have limited accessibility for some nurses who are less active online. This may have resulted in an over-representation of younger or more digitally engaged individuals. Additionally, the lack of control over the conditions for completing the survey may have impacted the quality of the data.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References