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Background
The work schedule and working time are important work characteristics. Many organizations impose shift work on their employees in order to maintain productivity and permanence in an organization. The concept of shift work covers a variety of working time arrangements including working outside daytime hours (e.g. night shifts), overtime work and irregular or rotating work schedules. Shift work is common in many health care organizations and nurses in particular are confronted with working in different shift systems and inflexible shift schedules which may cause unique stress and demands. Earlier research has documented that shift working can be detrimental for employees' social life leading to difficulties finding a good balance between their work and private life. Moreover, a number of studies showed that an inadequate work planning and a poorly organized shift schedule may have an adverse effect on employees' health and well-being, resulting in both less quality and quantity of sleep, poorer physical and mental health and reduced quality of performance. Besides affecting employees' self-rated health, all these adverse consequences may influence the perceptions employees have of their capabilities to cope with their perceived demands at work (i.e. work ability).
But shift work also provides opportunities. The European Nurses Early Exit (NEXT) Study has shown that most nurses were satisfied with their work schedule even when working shifts. 72% of all nurses (N = 36.492, 9 countries) were satisfied with their work schedule with respect to their wellbeing and 64% with respect to their private life. Interestingly, the figures were substantially higher for nurses working "nights only" (74% and 80%, respectively; data on 6 countries, similar patterns in all countries). This may indicate that many nurses working nights only have – in the course of their professional life – chosen their preferred work pattern that best fits their individual and private needs. The findings of Oginska support this: their cross sectional NEXT data analysis showed that not only the shift system itself but more importantly the discrepancy between the individual's shift schedule preferences and his/her actual work schedule affected nurses' intent to leave the nursing profession.
A desire to change shift schedule may develop due to nurses' work/family incompatibilities but may also be due to perceived low work ability or simply because of health problems. Being denied or being allowed to change to the preferred shift schedule might thus evoke different effects on workers' work ability and health. However, research investigating the effect of requested, forced and denied change in shift schedule on health care workers' work ability and self-rated health is lacking.
Work ability and health are not identical concepts. This differentiation is crucial because both concepts may – when adverse – require different preventive targets and actions. Work ability refers to both individual and occupational factors that are essential to a person's ability to cope in working life. The work ability concept is based on the assumption that the ability of a worker to perform job tasks successfully depends on the equilibrium between physical and mental job demands with individual capacities, determined by health, professional knowledge and competencies, values, attitudes and motivation to work. The concept of work ability can be illustrated by the 'house of work ability' which consists of 4 floors where the employees' general health constitutes the basis for work ability, the ground floor.
However, employees suffering from poor self-rated health do not necessarily have poor work ability. In fact, Hasselhorn and colleagues have found high self-reported work ability among 191 (37%) of 512 nurses with self reported very poor health. This underlines that work ability is not only a result of health and functional capacity, but may also reflect other aspects such as work demands and work organizational factors. The overall question investigated in this paper is how requested, forced and denied shift schedule change affected nurses' work ability and health.
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