Shift rotation direction and sustained attention in nurses
Summary
This cohort study followed 144 Italian nurses to compare how forward-rotating schedules (morning → afternoon → night) versus backward-rotating schedules (afternoon → morning → night) affected sleep and attention. Both schedules were linked to poor sleep quality overall, but backward rotations were clearly worse: nurses reported higher levels of sleepiness and showed slower reaction times and more lapses on attention tests. Those on forward rotations performed better, and the advantage held even after accounting for age, years of employment, and baseline sleep quality.
Why It Matters For Night Shift Workers and Night Owls
Not all shift rotations affect the body the same way. This study shows that forward-rotating shifts are easier on attention and alertness than backward rotations, which make sleepiness and fatigue much harder to manage. Even though any rotating schedule can disrupt sleep, moving in the “natural” direction (morning → afternoon → night) helps workers stay more focused and less exhausted. For nurses and other shift workers, this evidence supports pushing for forward-rotation schedules as a safer and more sustainable option.