The Impact of Commutes, Work Schedules, and Sleep on Near-Crashes during Nurses' Post Shift-Work Commutes: A Naturalistic Driving Study

OCCUPATIONAL APPLICATIONS Driving and survey data were collected from nurses following the night-shift and analyzed with logistic regression and frequency analysis. The analyses showed that prior near-crashes and drive length contributed significantly to near-crashes. The frequency analysis showed that most near-crashes occurred on major roadways, including principal arterials, major collectors, and interstates, within the first 15 minutes of the drive. These results highlight the urgent need for countermeasures to prevent drowsy driving incidents among night-shift nurses. Specifically, nurses and hospital systems should focus on countermeasures that encourage taking a break on the post work commute and those that can intervene during the drive. This may include the use of educational programs to teach nurses the importance of adequate rest or taking a break to sleep during their drive home, or technology that can recognize drowsiness and alert nurses of their drowsiness levels, prompting them to take a break. TECHNICAL ABSTRACT Background: Night-shift nurses are susceptible to drowsy driving crashes due to their long working hours, disrupted circadian rhythm, and reduced sleep hours. However, the extent to which work, sleep, and on-road factors impact the nurses' commutes and the occurrence of near-crash events is not well documented. Purpose: A longitudinal naturalistic driving study with night-shift nurses from a large hospital in the United States was conducted to measure these factors and analyze the occurrence and location of near-crashes during post-shift commutes. Methods: An on-board data recorder was used to record acceleration, speed, and GPS coordinates continuously. Nurses also completed daily surveys on their sleep, work, and commute. Near-crashes were identified from the data based on acceleration thresholds. Data from a total of 853 drives from 22 nurses and corresponding surveys were analyzed using Poisson and negative binomial regressions for swerve and hard brake near-crash events, respectively. Results: Swerve events were increased by the length of the drive (RR = 2.59, LL = 1.62, UL = 4.16), and the occurrence of hard brakes (RR = 1.69, LL = 1.45, UL = 1.99), while hard brake events were increased by the occurrence of swerves (RR = 1.55, LL = 1.28, UL = 1.88). The majority of near-crashes occurred on principal arterials (n = 293), minor arterials (n = 71), and interstates (n = 51). Conclusions: The results demonstrate the high risk of near-crashes during post-shift commutes, which may present danger to nurses and other drivers, and highlight the need for countermeasures that address shift structures, sleep quality, and taking breaks.