Night shifts and ICU healthcare workers: A critical healthcare challenge

Abstract Repetitive night shift work among intensive care unit (ICU) healthcare workers creates significant health risks while potentially compromising patient safety. This critical commentary synthesizes recent evidence from randomized controlled trials, meta-analyses, and systematic reviews (2020–2025) examining the multi-faceted impacts of night shift work on ICU doctors and nurses. The evidence demonstrates substantial physical health consequences, including a 26% increased risk of cardiovascular disease and 57% increased risk of metabolic syndrome. Mental health impacts are equally concerning, with cognitive performance declining significantly (working memory capacity decreasing from 11.3 ± 0.3 to 9.4 ± 0.3, P < 0.001) and burnout affecting 50% of ICU personnel. Patient safety implications remain controversial, with some studies showing 44% higher error rates among sleep-deprived nurses, while major trials like ROSTERS paradoxically found increased errors when extended shifts were eliminated. Evidence-based interventions show promise, including strategic napping (20–30 min), light therapy (improving sleep time by 32.54 min), and melatonin supplementation (3 mg doses). However, intervention evidence remains limited by methodological quality concerns. Healthcare organizations must urgently address these challenges through comprehensive fatigue risk management systems while recognizing the essential nature of continuous ICU care. Future research should prioritize ICU-specific interventions and standardized outcome measures to optimize both healthcare worker wellbeing and patient safety.