Bädda för Kvalitet

Recovery is a key factor for wellbeing and performance. During periods of high stress, the need for recovery increases. Paradoxically, during these periods, recovery tends to be impaired. The purpose of the research project Bädda för Kvalitet (AFA Dnr 150024) was to examine whether a proactive intervention aimed at supporting recovery and sleep among newly graduated nurses could prevent development of health problems and promote quality of work. The project was financed by AFA Försäkring.


For many nurses, the first time in the profession is a period characterized by high stress and multiple challenges. At the same time, working as a nurse often includes irregular working hours. All together, these circumstances affect the possibilities for recovery. Insufficient recovery, sleep disturbances and fatigue are risk factors for employee ill-health and poor patient safety.

In a longitudinal project (“LUST”, Longitudinell Undersökning av Sjuksköterskors Tillvaro), professor Petter Gustavsson's research group has followed nurses during the transition period from education into working life (up to fifteen years). Results from LUST show that sleep quality in general deteriorates for many nurses in the beginning of their careers, and approximately one-third of the nurses reported symptoms of burnout at some point during their first three years in the profession. Work-related stress is associated with sleep disorders, and sleep problems are common during episodes of burnout.

There is a bidirectional relationship between stress and sleep. Stress can be seen as the opposite of sleep, and high stress levels at bedtime might cause difficulties falling asleep and impaired sleep quality. Also, the other way around, too short or poor sleep can raise the body's stress levels.

However, in a work context, not only stress levels affect sleep; the working hours also affect the opportunities for sleep and recovery. In general, irregular working hours have been associated with sleep disturbances and accidents. For most people, poor sleep during a short, transient period does not pose any major health risks. However, lack of recovery and sleep for a longer time period might increase the risk of ill-health. Lack of sleep also impairs our cognitive ability. For example, executive functions such as planning, focusing and assessing risks are often impaired due to insufficient sleep. In other words, lack of recovery might constitute a risk for impaired work performance and safety.

The recovery programme Bädda för Kvalitet

The recovery programme was a group-administered proactive intervention based on techniques from cognitive behavioural therapy, motivational interviewing and research on sleep and work hours. The programme was tailored for nurses with less than one year’s work experience as a nurse, and was delivered during work hours within the introduction programmes for newly graduated nurses at eight hospitals in Sweden. The programme consisted of three group sessions (á 2.5 hours) covering the following themes: 1) unwinding from stress; 2) promoting sleep according to homeostatic and circadian sleep regulating factors; and 3) handling fatigue by increasing recovery behaviours.

During the group sessions, psychoeducation on sleep, stress and fatigue in relation to irregular work hours and possible recovery strategies was interspersed with discussions, reflections and exercises. Participants were encouraged to try strategies or make behavioural changes promoting sleep and recovery that suited their individual situation. The participants also got access to a web-based tool for evaluating working hours in relation to fatigue risk.


The effects of the recovery programme on sleep, stress, cognitive ability and well-being were evaluated in a randomized controlled trial including 207 newly graduated nurses. In summary, the results indicated that the recovery programme was helpful in promoting recovery among newly graduated nurses. For example, it was found to facilitate detachment from thoughts of work during free time, and to increase the quality of recovery during free time. The programme also prevented a negative development of somatic complaints, burnout and fatigue symptoms among nurses who participated in the recovery programme. Another important result was the positive effects on perceived cognitive ability and the experience of being able to work in a safe manner. Overall, the results suggest that the recovery programme is feasible and beneficial for work performance and health among newly graduated nurses. Reports and articles from the project can be found below.

Handbook in Recovery

Based on the recovery programme Bädda för Kvalitet, we have summarized important strategies for recovery in a working life context in a "Handbook in Recovery" (Handbok i Återhämtning). It can be downloaded here. (In Swedish)

Project status

The research project has ended and is summarized in reports and articles (see below). More results and scientific articles will be published continuously at this homepage. As a spin off from the project Bädda för Kvalitet, the recovery programme has now been implemented as an integrated part of the introduction programme for newly graduated nurses at Sahlgrenska University Hospital and at Astrid Lindgren Children's Hospital, Karolinska University Hospital.

Reports and scientific articles

Randomised control trial of a proactive intervention supporting recovery in relation to stress and irregular work hours: effects on sleep, burn-out, fatigue and somatic symptoms

Dahlgren A, Tucker P, Epstein M, Gustavsson P, Söderström M

Occupational and environmental medicine 2022;79(7):460-468

Sleep and fatigue in newly graduated nurses-Experiences and strategies for handling shiftwork

Epstein M, Söderström M, Jirwe M, Tucker P, Dahlgren A

Journal of Clinical Nursing 2020;29(1-2):184-194

Återhämtningsprogrammet Bädda för Kvalitet - Proaktiva strategier för återhämtning i främjandet av hälsa och arbetsprestation

Återhämtningsprogrammet Bädda för Kvalitet - Innehåll, Upplägg och Utvärdering

Arbetstider, återhämtning, hälsa och säkerhet bland nyutexaminerade sjuksköterskor

Working in this project

Anna Dahlgren

Principal researcher

Marie Söderström

Affiliated to research

Majken Epstein

Research coordinator
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