By Dr. Larry Earl, NAOHP
As occupational health professionals, we play a pivotal role in facilitating reasonable accommodations for workers with medical conditions—while also recognizing the complex demands of essential, around-the-clock operations. Nowhere is this balance more challenging than when employees in 24/7 environments, such as first responders, healthcare workers, or transportation personnel, submit requests to be excused from night shifts.
These accommodations often stem from a range of medical conditions—diabetes, epilepsy, sleep disorders, and musculoskeletal issues being among the most commonly cited. Yet, night shifts are often core to the operational function of these roles. So how do we, as clinicians and advisors, help employers navigate these requests while remaining compliant, compassionate, and fair?
Understanding the Employer’s Duty
Under human rights legislation, employers have a duty to accommodate workers with disabilities to the point of undue hardship. This includes adjustments to work schedules where a legitimate medical need is identified. However, this duty is not absolute—especially if the accommodation would compromise safety, significantly disrupt operations, or require other employees to absorb unreasonable burdens.
Start with Functional Capacity, Not Diagnosis
A common mistake in evaluating accommodation requests is focusing on the diagnosis instead of functional limitations. For example:
- A worker with Type 1 diabetes may be fully capable of night shifts if their glucose is well-controlled and they can monitor regularly.
- A worker with controlled epilepsy may be able to work overnight if seizure-free for a defined period.
- A claim of “mechanical back pain” may not preclude night shift work unless it’s paired with functional restrictions that are incompatible with those shifts.
The key is to gather objective, medically supported information about the worker’s ability to perform the essential duties of their job during night hours.
Ask the Right Questions
When faced with a vague or restrictive note from a primary care provider (e.g., “no night shifts”), consider reaching out with respectful, structured questions:
- What are the specific functional limitations related to the condition?
- How do those limitations impact the ability to perform essential duties during night shifts?
- Is the restriction temporary or permanent?
- Are there treatments or supports that may enable future tolerance of shift work?
This documentation helps create a clear, defensible record and supports collaboration between all parties.
Avoiding a “Rubber Stamp” Approach
It’s not uncommon for treating providers to mirror a patient’s preferences—particularly in environments where “work-life balance” is top of mind. While well-intentioned, this can create workplace strain, particularly when night coverage must be redistributed to coworkers, increasing their fatigue and stress.
As occupational health professionals, we have a duty to act as impartial facilitators, focusing on evidence-based assessments rather than assumptions or advocacy.
Consider Reasonable but Creative Solutions
When a complete exemption from night shifts cannot be supported—or would cause undue hardship—consider intermediate options:
- Reducing the number of consecutive night shifts
- Limiting overtime or double shifts
- Ensuring access to meal breaks or rest areas
- Reassigning tasks that are physically incompatible with the worker’s condition
Each accommodation should be individualized, time-limited, and regularly reassessed.
The Importance of Documentation
Clear documentation—both medical and administrative—is crucial:
- Ensure requests are recorded formally.
- Maintain detailed notes on decision-making rationale.
- Document communications with providers, employees, and managers.
This not only protects all parties but also strengthens trust in the process.
Final Thoughts
Managing night shift accommodation requests is nuanced. It requires balancing the duty to accommodate with the realities of staffing, public safety, and organizational capacity. By asking the right questions, focusing on functional ability, and engaging in thoughtful dialogue with providers, occupational health professionals can help employers navigate these situations ethically, legally, and effectively.
At NAOHP, we’re here to support your leadership in this evolving space.
Members only resources
Guidance document: Evaluating Nightshift Accommodation Requests
Letter to Personal physician re: Nightshift Accommodation Request
