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A study examining the impact of 12-hour shifts on critical care staff
Journal of Nursing Management
Abstract
Twelve-hour shifts contribute to flexible patterns of work, but the effects on delivery of direct care and staff fatigue are important topics for deeper examination.
To examine the impact and implications of 12-hour shifts on critical care staff.
A staged dual approach using two focus groups (n = 16) and questionnaires (n = 147) with critical care staff from three critical care units.
Positive effects were found with planning and prioritizing care, improved relationships with patients/relatives, good-quality time off work and ease of travelling to work. Less favourable effects were with caring for patients in isolation cubicles and the impact on staff motivation and tiredness. Acceptable patterns of work were suggested for 'numbers of consecutive shifts' and 'rest periods between shifts'.
Most participants believed 12-hour shifts should continue. The challenge is to ensure existing systems and practices develop to improve on the less positive effects of working 12-hour shifts.
This study provides nurse managers with important and relevant staff views on the impact of working 12-hour shifts. In particular to those working within a critical care environment and suggests the challenge is to ensure existing systems and practices develop to improve on the less encouraging effects of working 12-hour shifts. It adds an understanding of the senior nurse's view on the positive and negative effects of managing and organizing staff off duty to safely run a department with 12-hour shifts.
... 11 Solo uno studio riporta che la qualità delle cure rimane invariata tra i due tipi di turno, 14 con una tendenza a migliorare nei turni di 12 ore. Aneddoticamente, alcuni infermieri riferiscono che durante i turni di 12 ore la qualità delle cure migliora grazie a un maggior tempo per portare a termine le attività di assistenza, [15][16][17][18][19] ma questi dati non sono confermati da dati empirici. 20 Nell'ambito della salute mentale gli infermieri riportano come i turni lunghi infl uiscano negativamente sulla qualità delle cure. ...
... 40,41 Nonostante un aumento della fatigue, gli infermieri ritengono che i turni lunghi permettano di programmare e completare meglio le attività di assistenza. 16,17,28,42 Sicurezza sul lavoro. Sono contrastanti anche i dati sulla sicurezza al lavoro. ...
... In altri studi questo tipo di turnistica aumenti i livelli di stress da lavoro. 52,53 Nella maggior parte degli studi i turni di 12 ore sono associati a una maggiore insoddisfazione lavorativa, 9,12,17,50,54 e per la carriera; 53 un unico studio ha riportato maggiore soddisfazione lavorativa. 14 In ambito pediatrico non sono state rilevate differenze tra le 8 e le 12 ore sull'insoddisfazione lavorativa. ...
... [23] In addition, the shifts beyond the eight hours have shown to associate with an increased risk of errors, accidents, and incidents. [8,24,25] The evidence accents that extended work hours have negative impacts on the health of employees [26] and raise the fatigue among shift-workers and reduce alertness and productivity. [27] We found in this study that the lower level of well-being is a predictor for increasing physical and psychological fatigue in nurses. ...
... Moreover, they are under stress to meet the patients and families' demands during their working in a shift of more than 8 hours. [25] The longer shift work has shown to be associated with an increased risk in accidents and neuropsychological deficits in nurses, in addition, has been found to relate to at least reported two hospital-wide Staphylococcus aurous epidemics. [32] Scrutinizing these epidemics revealed that the fatigued and under stress nurses with a high workload make frequent mistakes and procedural errors. ...
... For instance, melatonin levels and growth hormone are normally increased with darkness, but they are suppressed with working at night. [37] The effects of 12hour shifts on staff motivation and tiredness were showed by Richardson et al. [25] Falling asleep during working at night shift is common in nurses. [7] Approximately one-fifth of the nurses have reported that they struggle to stay awake during ...
Objective: The role of nurses’ shift-rotations in predicting adverse patient events has received little attention. The effect of fatigue on patient safety as a primary factor and the impact of shift-working on fatigue as a secondary factor in hospital-based nurses was investigated in the present study.Methods: In this cross-sectional study set in Iraqi Kurdistan in 2018, 71 nurses (Range: 20-44 years) were recruited purposively who worked in rotating shifts, in four multi-specialty hospitals.Results: The mean age of the nurses was 30.24 years (SD: 4.81; range: 20-44 years). The majority of nurses worked in the public sector (63.4%). The nurses worked in morning shift (26.8%) and shift-rotations (39.4%) for between 7.75 and 9.13 hours. In addition, 59.4% and 18.3% of nurses reported that they injured “sometimes” and “frequently” (respectively) patients in their care either directly or indirectly. Similarly, 19.7% of them reported that these were medication errors “sometimes” and “frequently.” Patient information was recorded incompletely or incorrectly sometimes by 18.3% and frequently by 35.2%. Also, 36.6% and 31.0% of them reported that they delayed care to patients frequently and sometimes, respectively. The mean values of physical and psychological fatigue were 8.77 of 21 and 3.42 of 12, respectively. The physical and psychological fatigue were escalated in case of lower total psychological well-being (p = .009 and p = .018, respectively). The study showed that single-shift working is a predictor of delayed patients care; 95.3% vs. 60.7%; p < .001).Conclusions: Hospital administrators must be aware that nurses are not able to work effectively on short roosters or extended shifts. Protocols for better nurse health surveillance and social support in respect to 24 hours shift work must be prioritized in order to avoid mental and physical significant impairment on nurses and adverse outcomes for their clients.
... In one of the few studies that focused on medical wards, and compared 8 hr and 12 hr shifts, Gillespie and Curzio (1996) identified no significant differences from an organisational perspective and 12 hr shifts increased opportunities for direct patient care. Several studies on critical care units indicated that 12 hr shifts positively affect planning and organisation of care (McGettrick & O'Neill, 2006;Richardson, Turnock, Harris, Finley, & Carson, 2007), with staff planning care across the whole 12 hr shift (Richardson et al., 2007;Wootten, 2000). In contrast, Reid, Robinson, and Todd (1993) found that 12 hr shifts were associated with less direct patient care on hospital wards; they suggested nurses were taking more unofficial breaks as a way of pacing themselves. ...
... In one of the few studies that focused on medical wards, and compared 8 hr and 12 hr shifts, Gillespie and Curzio (1996) identified no significant differences from an organisational perspective and 12 hr shifts increased opportunities for direct patient care. Several studies on critical care units indicated that 12 hr shifts positively affect planning and organisation of care (McGettrick & O'Neill, 2006;Richardson, Turnock, Harris, Finley, & Carson, 2007), with staff planning care across the whole 12 hr shift (Richardson et al., 2007;Wootten, 2000). In contrast, Reid, Robinson, and Todd (1993) found that 12 hr shifts were associated with less direct patient care on hospital wards; they suggested nurses were taking more unofficial breaks as a way of pacing themselves. ...
... Similarly, though in cardiology, Wootten (2000) found that nursing staff paced their work during 12 hr shifts rather than "rushing" through all care in the morning. Several other studies on critical care units have indicated that 12 hr shifts positively affect planning and organisation of care (Dwyer, Jamieson, Moxham, Austen, & Smith, 2007;McGettrick & O'Neill, 2006;Richardson et al., 2007). On the ward piloting 8 hr shifts, staff described approaching the early shift in the way they did the 12 hr shift. ...
Aims and objectives
To investigate 1) How nursing care is organised on wards where nursing staff work different lengths of day shifts, and 2) How length of day shift affects the staffing of wards.
Background
Twelve hour shifts have become increasingly common worldwide but there are concerns about impact on care quality and safety. Eight hour shifts, and how day shift length affects how nurses organise their work, and staffing, have been little studied.
Design
Case study.
Methods
The setting was two older people's wards in an acute hospital in England. Nursing staff on one ward continued to work 12 hour day shifts; staff on the other ward worked 8 hour late and early day shifts, with an afternoon overlap, for 6 months. Qualitative interviews were conducted with 22 nursing staff. Semi‐structured observations were conducted from 12‐15.00 (5 X 3 hour episodes on each ward). Data analysis was conducted using the Framework approach.
Results
Theme 1: Organising nursing care and staff activities, (sub‐themes: Care delivery across a 12 hour shift; Care delivery on early and late 8 hour shifts; Staff communication and documentation; Staff breaks; Teaching, supervision and staff development); Theme 2: Staffing wards with different length of day shift (sub‐themes:: Adequacy of staffing and use of temporary staff; Recruitment and retention of staff after introducing 8 hour shifts).
Conclusion
Nursing staff organised care on 8 hour shifts similarly to 12 hour shifts but then felt dissatisfied with their care delivery and handovers. Nursing staff on both wards approached care in a task‐focused way. There were concerns that adopting an 8 hour shift pattern negatively affected recruitment and retention.
Relevance to clinical practice
Changing from 12h to 8h day shifts may affect nursing staff satisfaction with their care delivery and handovers, and have a negative effect on staffing wards.
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... 1 Although a number of studies have investigated various outcomes in 12-h shift patterns, these studies are generally of variable quality, as a result of the complex nature of the work patterns involved. [2][3][4][5][6] It is difficult to control extraneous variables, including shift sequence, overtime and break patterns. Age, grade and experience of the nurse may also influence study findings. ...
... 1-3 In a number of qualitative studies, 12-h shift patterns were seen as positive, contributed to staff satisfaction and also both a good recruitment and retention strategy. [1][2][3][4]11 In a single-centre Australian study, results highlighted a positive impact on physical and psychological well-being and increased work satisfaction, for the nursing staff working the 12-h shift pattern. Increased continuity of patient care was identified as a positive outcome of the 12-h shift. ...
... Limited previous research exists, examining outcomes in the critical care field and most existing studies are primarily qualitative in design. [1][2][3][4][5][6] The results of this study reported no difference in sickness rates between nursing staff working a 12-h shift pattern, in comparison to those working an 8-h shift pattern. Limited previous research has examined sickness rates between shift patterns as an outcome in critical care nursing. ...
The aim of this single-centre study was to investigate the impact of the introduction of 12-h critical care nursing shifts on healthcare provider and patient care outcomes. A single-centre, prospective service evaluation was completed over a two-year period, comparing the 8-h and 12-h shifts. Outcomes included number of clinical incidents, levels of burn-out, sick rates, personal injuries and training. There were no significant differences between the clinical incidents, sickness rates, personal injuries and staff training between the two data collection periods. The results of the burn-out analysis demonstrate that emotional exhaustion and depersonalisation improved, from the 8-h to 12-h shifts (both p < 0.05). In conclusion, the results of this service evaluation have demonstrated that 12-h nursing shifts can be introduced safely into the critical care environment, without any detriment to patient or healthcare provider outcomes.
... [6,7] Moreover, fatigue also impairs memory, problem solving, and decision making-abilities. [8,9] Fatigue problems are believed to cost the United States about 18 billion dollars in accidents and lost productivity, while 76,000 injuries among shift workers were reported. [6,10] With regard to sleepiness, several studies have indicated that the average of sleep duration from the 1910 to 2002 has decreased from 9 to 6 hours on workdays. ...
... Overtime, extended work shifts, and working for more than 8-hours can have an adverse effect on health, such as the risk of musculoskeletal disorders, cardiovascular symptoms, hypertension, injury, and the risk of diabetes, as well as increased mortality and morbidity rates, and a higher rate of accidents. [8,[23][24][25][26][27] Fatigue has been found to increase over the length of the duration of shifts among the healthcare professions, such as in 12-hour shifts. [3] Moreover, the quality of nurses' work suffered with long working hours (9 h and 12 h). ...
... The burnout in this study was assessed by means of the Maslach Burnout Inventory, [46] it was measured by emotional exhaustion, depersonalization, and personal accomplishment. The authors found that satisfaction with the free amount of time allowed by the shift system for social and domestic activities was higher among nurses with 12-hour shifts rather than 8 In addition, the authors examined the relationship between role stress and career satisfaction by using Pearson's Product-Moment correlation test with NSS and IWS scores. The findings indicated that high levels of stress decrease the level of career satisfaction, therefore, a crucial relationship between level of stress and career satisfaction was identified. ...
Objective: This review was conducted to investigate the impact of applying 12-hour shifts in comparison to 8-hour shifts on nurses’ health wellbeing and job satisfaction.Methods: MEDLINE, CINHALE, PsycINFO, EMBASE, Web of Science, and SCOPUS databases were searched, covering the period between 1980 to 2017. Studies were included if they concerned nurses working for 12-hour shifts in comparison to 8-hour shifts in hospital settings, based on observational/surveys studies.Results: In the yielded 12 studies, 3 studies reported that 12-hour shifts had an impact on nurses’ health and wellbeing, such as cognitive anxiety, musculo-skeletal disorders, sleep disturbance, and role stress; however, there was no significant difference between 12- and 8-hour shifts with digestive and cardiovascular disorders, psychological ill health, and somatic anxiety. Of the 4 studies measuring the impact of 12-hour shifts on fatigue, three studies showed that the nurses experienced more fatigue in the 12-hour shifts in comparison to 8-hour shifts; nevertheless, one study did not find a significant difference in fatigue and critical thinking performances between 12- and 8-hour shifts. Nine of the 12 studies measured job satisfaction in 12- and 8-hour shifts, 5 studies showed a greater dissatisfaction regarding 12-hour shifts, while 3 studies found that the nurses were more satisfied with 12-hour shifts than with 8-hour shifts; but one study pointed out that there was a difference between the two shifts considering pay and professional status.Conclusions: The findings of the review suggest that 12-hour shifts resulted in negative health concerns and job dissatisfaction; however, there is a need for more empirical evidence to support this.
... Οι έννοιες αυτές αλλά και οι παράγοντες που οδηγούν στην επαγγελματική εξουθένωση τους νοσηλευτές των μονάδων εντατικής θεραπείας θα μελετηθούν πιο κάτω. προσφερόμενης νοσηλευτικής φροντίδας (Παπαγιαννοπούλου, και συν., 2008), κυρίως λόγω των επιπτώσεων στην προσφερόμενη φροντίδα των ασθενών που μπορεί να προκύψουν (Cho, et al., 2007;Richardson, et al., 2007). Τα αποτελέσματα ερευνών κατέδειξαν πως οι νοσηλευτές που εργάζονται στις μονάδες εντατικής θεραπείας εμφανίζουν το σύνδρομο της επαγγελματικής εξουθένωσης (Meltzer & Huckabay, 2004;Bakker, et al., 2005;Poncet, et al., 2007;dos Santos, et al., 2009;Isaksson, et al., 2010). ...
... Η πολύωρη εργασία του νοσηλευτικού προσωπικού και η συνεχής φροντίδα των ασθενών, καθώς επίσης και η επικοινωνία και στήριξη των συγγενών του ασθενή αποτελούν στοιχεία τα οποία προσθέτουν άγχος, κούραση αλλά αποτελούν μέρος της νοσηλευτικής φροντίδας και οδηγούν στην εξουθένωση των νοσηλευτών της ΜΕΘ Επίσης σύμφωνα με την έρευνα των Hansen et al. (2009), οι αυξημένες απαιτήσεις του οργανισμού αλλά και του διοικητικού προσωπικού από τους νοσηλευτές αυξάνουν τις πιθανότητες εμφάνισης επαγγελματικής εξουθένωσης. Η φροντίδα των ασθενών στις μονάδες εντατικής παρακολούθησης απαιτεί συνεχή προσοχή, παρατήρηση και αξιολόγηση κάθε κλινικής ένδειξης εκ μέρους του ασθενή η οποία μπορεί να επηρεάσει είτε θετικά είτε αρνητικά την υγεία του ασθενή που βρίσκεται σε κρίσιμη ή σοβαρή κατάσταση (Richardson, et al., 2007). ...
... Το νοσηλευτικό προσωπικό που εργάζεται στις Μονάδες Εντατικής Θεραπείας χρειάζεται αρκετό χρόνο ξεκούρασης όπου κατά την διάρκεια του χρόνου αυτού να έχει την δυνατότητα για διασκέδαση και ευχάριστες ενασχολήσεις (Richardson, et al, 2007). ...
... The majority of papers focus upon the impact of long shifts on nurse fatigue, with contradictory evidence provided. Several studies found nurses report increased fatigue during 12 h shifts (McGettrick and O'Neill, 2006;Nelson and Blasdell, 1988; Richardson et al., 2007;Simunic and Gregov, 2012;Szczurak et al., 2007), and extended shifts have been associated with increases in physical fatigue (Barker and Nussbaum, 2011;Todd et al., 1993), acute fatigue, chronic fatigue and inter-shift recovery (Chen et al., 2014;Iskra-Golec et al., 1996), mental fatigue and burnout (Estryn-Behar and Van der Heijden, 2012;Stimpfel et al., , 2012. However, other studies have found no significant differences (Fields and Loveridge, 1988;Hazzard et al., 2013;Takahashi et al., 1999;Washburn, 1991) and some have noted a reduction in fatigue when changing from 8 to 12 h schedules (Eaton and Gottselig, 1980;Freer and Murphy-Black, 1995;Gillespie and Curzio, 1996;McColl, 1982). ...
... Most studies evaluating extended working hours conclude that nurses prefer working 12 h shifts or/and like having the choice to work extended hours (Bloodworth et al., 2001;Campolo et al., 1998;Dwyer et al., 2007;Eaton and Gottselig, 1980;Gillespie and Curzio, 1996;Lea and Bloodworth, 2003;Richardson et al., 2003Richardson et al., , 2007Stinson and Hazlett, 1975;Breeding, 2005). The majority of studies also focus on the beneficial aspects of extended working hours for nurses, though some have reported negative findings. ...
... Fewer staff working 12 h shifts feel that the timing of shifts/travelling to and from work threatens their personal safety compared with those working 8 h shifts (Freer and Murphy-Black, 1995). Decreased spending on travel due to the reduction in days worked are also an important benefit of extended shift working for some staff (Freer and Murphy-Black, 1995;Richardson et al., 2007). However, once again it is notable that in many of the above mentioned studies, 12 h shift working was optional and/or was implemented or supported by nursing staff (Bloodworth et al., 2001;Breeding, 2005;Campolo et al., 1998;Dwyer et al., 2007;Eaton and Gottselig, 1980;Freer and Murphy-Black, 1995;Gillespie and Curzio, 1996;Niemeier and Healy, 1984;Richardson et al., 2003). ...
Objectives:
To provide a comprehensive scoping review of evidence of the impact and effectiveness of 12h shifts in the international nursing literature, supplemented by a review of evidence in other, non-nursing related industries.
Data sources:
A search of the academic literature was undertaken in electronic databases (AMED, MEDLINE, CINAHL, PsychInfo, Scopus, HMIC, the Cochrane Library, Business Source Premier, Econ Lit, ASSIA and Social Policy and Practice).
Review methods:
A total of 158 potentially relevant nursing research papers and reviews were published between 1973 and 2014. Two reviewers independently reviewed the articles, leaving 85 primary research studies and 10 review papers in the nursing field to be included in the scoping review. Thirty-one relevant primary research papers and reviews were also identified in the non-nursing related industries literature.
Results:
Research into 12h nursing shifts fell within five broad themes: 'risks to patients', 'patient experience', 'risks to staff', 'staff experience' and 'impact on the organisation of work'. There was inconclusive evidence of the effects of 12h shift patterns in all five themes, with some studies demonstrating positive impacts and others negative or no impacts. This also mirrors the evidence in other, non-nursing related industries. The quality of research reviewed is generally weak and most studies focus on the risks, experience and work/life balance for staff, with few addressing the impact on patient outcomes and experience of care or work productivity.
Conclusions:
There is insufficient evidence to justify the widespread implementation or withdrawal of 12h shifts in nursing. It is not clearly understood where there are real benefits and where there are real and unacceptable risks to patients and staff. More research focusing on the impact of 12h nursing shifts on patient safety and experience of care and on the long term impact on staff and work organisation is required.
... Two cross-sectional surveys found that nurses working 12-h shifts reported reduced access to continuing educational opportunities and to less opportunity for discussions around patient care with colleagues compared to those working 8-h shifts. Rather than reducing information loss by eliminating a handover, nurses working long shifts were more likely to report that important patient information was being lost during handovers [39,40]. While the ultimate value of such work for safe and effective patient care should not be assumed, nor should the opportunity for staff to discuss care and to engage in professional development be readily dismissed as unproductive. ...
... Despite the frequency with which the claim of improved recruitment and retention is made, we often found chains of citation where papers cited others in support of the assertion, which in turn cited other sources with none providing substantive empirical evidence. For some examples, see [18,40,52,53]. The available evidence instead focuses on perceptions of small samples of nurses already employed in a setting who pilot 12-h shifts [54]. ...
The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses’ wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses.
... The introduction of 12-h shifts into rostering/scheduling systems has been one approach implemented in workplaces with the intention of improving the flexibility of work hours for nurses. The approach has proven popular, with many proponents citing good quality time off work, ease of travel to work, improved relationships with patients, and better family time as benefits (Estryn-Bé har et al., 2012;O'Connor, 2011;Richardson et al., 2007). However, there is significant debate in the literature regarding the disadvantages of 12 h or longer shifts with some authors claiming extended shifts cause increased fatigue, greater risk of errors, greater risk of injury to self, and negative physiological outcomes (Chen et al., 2011;Estryn-Bé har et al., 2012;Geiger-Brown and Trinkoff, 2010;Rogers et al., 2004;Scott et al., 2006), others claiming no difference in patient outcomes (Stone et al., 2006), and yet others attributing greater risk of error to poor scheduling practices rather than length of shift (Estryn-Bé har et al., 2012). ...
... At present, 12 h shifts are a commonly used approach to rostering systems in many hospital settings. Many nurses themselves are particular advocates of this system, claiming it leads to improved relationships with patients, easier travel to work, better quality time off, and better family time (Estryn-Bé har et al., 2012;O'Connor, 2011;Richardson et al., 2007). However, the findings from this study suggest the risk of error is higher where nurses have worked at least 12 h on a single shift. ...
To determine the effect of working 12h or more on a single shift in an acute care hospital setting compared with working less than 12h on rates of error among nurses.
Systematic review.
A three-step search strategy was utilised. An initial search of Cochrane, the Joanna Briggs Institute (JBI), MEDLINE and CINAHL was undertaken. A second search using all identified keywords and index terms was then undertaken across all included databases (Embase, Current contents, Proquest Nursing and Allied Health Source, Proquest Theses and Dissertations, Dissertation Abstracts International). Thirdly, reference lists of identified reports and articles were searched for additional studies. Studies published in English before August 2014 were included.
Following review of title and abstract of 5429 publications, 26 studies were identified as meeting the inclusion criteria and selected for full retrieval and assessment for methodological quality. Of these, 13 were of sufficient quality to be included for review. Six studies reported higher rates of error for nurses working greater than 12h on a single shift, four reported higher rates of error on shifts of up to 8h, and three reported no difference. The six studies reporting significant rises in error rates among nurses working 12h or more on a single shift comprised 89% of the total sample size (N=60,780 with the total sample size N=67,967).
The risk of making an error appears higher among nurses working 12h or longer on a single shift in acute care hospitals. Hospitals and units currently operating 12h shift systems should review this scheduling practice due to the potential negative impact on patient outcomes. Further research is required to consider factors that may mitigate the risk of error where 12h shifts are scheduled and this cannot be changed.
Copyright © 2015 Elsevier Ltd. All rights reserved.
... Alternative work schedules, such as flexible and compressed work schedules, had positive effects on workrelated criteria including productivity and job satisfaction [3,4]. Conversely, sustained work during long working hours was associated with an increased risk of errors and decreased work performance [5,6,7,8,9]. In the field of software engineering, multiple studies have examined the relationship between code quality and the time when the work is performed. ...
The temporal patterns of code submissions, denoted as work rhythms, provide valuable insight into the work habits and productivity in software development. In this paper, we investigate the work rhythms in software development and their effects on technical performance by analyzing the profiles of developers and projects from 110 international organizations and their commit activities on GitHub. Using clustering, we identify four work rhythms among individual developers and three work rhythms among software projects. Strong correlations are found between work rhythms and work regions, seniority, and collaboration roles. We then define practical measures for technical performance and examine the effects of different work rhythms on them. Our findings suggest that moderate overtime is related to good technical performance, whereas fixed office hours are associated with receiving less attention. Furthermore, we survey 92 developers to understand their experience with working overtime and the reasons behind it. The survey reveals that developers often work longer than required. A positive attitude towards extended working hours is associated with situations that require addressing unexpected issues or when clear incentives are provided. In addition to the insights from our quantitative and qualitative studies, this work sheds light on tangible measures for both software companies and individual developers to improve the recruitment process, project planning, and productivity assessment.
... As it improves capacity to recruit and keep nursing staff, provide more days off, which enhance worklife balance, fewer travel and parking expenses, more chances to see family and friends, and cheaper childcare (Pfeifer, 2022). Twelve -hour shift is flexible patterns of work, but it has an impact on several aspects of patient care and staff nurses as delivery of care, nurses' motivation and fatigue, nurses' wellbeing, communication, nurses' lifestyle and travelling to work and planning, organization, and management of work (Richardson et al., (2007), Dwyer et al., 2007). The first aspect is delivery of care in which intensive care nurses are frequently overworked during their whole shift particular during twelve-hour shifts due to the high acuity of patients, the present nursing shortage and long-time span that may affect quality and continuity of nursing care (Mayo et al., 2022). ...
... Traditional eight-hour shifts for hospital nurses are becoming a thing of the past [3]. Nurses increasingly work twelve-hour shifts; this schedule gives nurses a three-day work week, potentially providing better worklife balance and flexibility [4,5]. Sleep is a vital necessity in which the body renews itself and represents foundation of a healthy physical and mental life which directly impacts the person's quality of life [6]. ...
This study investigated the effect of long hour shift on hospital nurses', increase risk of committing errors, patients' outcomes and satisfaction. A descriptive research design was utilized in this study to investigate the effect of long hour shift on female hospital nurses' and patients' care outcome and satisfaction Questionnaire was systematically distributed to nurses in each of the twenty eight wards and units of the University of Maiduguri Teaching Hospital. One hundred and ninety four respondents returned the questionnaire. The study revealed that long hour shift affects the nurses' wellbeing and the care they provide to their patients. The study also revealed that it affects their social life. This study therefore recommends eight to ten hour shift to reduce the burden on the nurses so as to provide positive patient care outcomes.
... Direct bedside nurse staff measures may also exclude additional nursing roles, such as advanced practice clinical nurse consultants and nurse educators, nursing support such as renal replacement therapy, and non-nursing roles, such as allied health or specialist therapists for physiotherapy and ventilation management, device technicians, and ancillary support for essential care delivery and pressure area prevention management. Changing workforce patterns of work, such as the 12-hours shift has also been found to have divisive benefits and issues around worker flexibility, economics, and the health and safety of both employees and patients (Richardson et al., 2007). Nursing workload during the COVID-19 pandemic increased, with activities identified such as following isolation precautions and positioning patients prone (Hoogendoorn et al., 2021;Lucchini et al., 2020). ...
The aim of this systematic review was to examine the association of nursing workload on patient outcomes in intensive care units. The primary outcome measure was patient mortality, with adverse events (AE), the secondary outcome measures. Electronic search of databases including MEDLINE, CINAHL, Cochrane, EMCARE, Scopus, and Web of Science were performed. Studies were excluded if they were in non‐ICU settings, pediatric, neonatal populations, or if the abstract/full text was unavailable. Risk of bias was assessed by the ROBINS‐I tool. After screening 4129 articles, 32 studies were identified as meeting inclusion criteria. The majority of included studies were assessed as having a moderate risk of bias. The nursing activities score (NAS) was the most frequently used tool to assess nursing workload. Our systematic review identified that higher nursing workload was associated with patient‐focused outcomes, including increased mortality and AE in the intensive care setting. The varied approaches of measuring and reporting nursing workload make it difficult to translate the findings of the impact of nursing workload on patient outcomes in intensive care settings.
... Interestingly, the number of consecutive working days appears to be more important than the actual length of each shift [22]. Other factors that could affect an emergency physician's wellbeing include workload, infrastructure resources, and number of staff members working per shift [23]. ...
Background: Currently, the demand for emergency medicine physicians is much higher than the available workforce. To overcome this issue, some institutions have increased their working hours. No previous study in Saudi Arabia addresses this issue and its impacts on physicians.
Aim of the study: this study evaluates physicians health, social life, and decision making in 12 hours shifts compared against regular 8 hours.
Methods: This cross-sectional study was conducted in various cities and hospitals in the Kingdom of Saudi Arabia using a questionnaire that surveyed 173 emergency physicians working in different hospitals across Saudi Arabia.
Results: There were many similarities and differences between the participants who worked 12-hour shifts and those who worked 8-hour shifts. The most significant differences were that those who worked 12-hour shifts were more likely to be male than female and more likely to be married than unmarried. In addition, the 12-hour working physicians had more nonworking partners than the 8-hour group. Furthermore, they had less time for socialization with friends. Changes in blood sugar levels and headache were more common in the 12-hour group. Both groups had a similar incidence of COVID-19, physical illnesses, and the use of sedative medications. The two groups showed almost the same decision-making abilities. On the other hand, only 8.1% of those working 12-hour shifts wanted to continue working 12-hour shifts, and 69.1% in the 8-hour group wanted to continue working 8-hour shifts.
Conclusion: Both 8- and 12-hour shifts appear feasible and safe. [SJEMed 2021; 2(3.000): 244-249]
... Subsequently, workload was reviewed by the in-charge, and resources were allocated to minimize staff concerns. Similar findings were reported by Richardson et al. (2007) who found that nurses could safely work maximally three consecutive 12hr day shifts or four consecutive 12-hr night shifts. ...
Aim
To explore and understand the culture of nurses' multidimensional “caring-for” practice in intensive care unit (ICU).
Design
A focused ethnography.
Methods
Data were collected from 35 Registered Nurses through participant observations, field notes, documentation reviews, interviews, informal conversations and Participants' additional information forms over 6 months in one ICU. Thematic data analysis was used.
Findings
Different dimensions of nursing caring in ICU were found. The inclusivity of a culture of nurses' “caring-for” involved the following: oneself, patients and their families, different colleagues, and caring as ecological consciousness in the ICU environment and organization.
... The wards having a 12-hr nursing shift tended to have less turnover in the LTC industry. Richardson et al. (2007) pointed out that a 12-hr shift provides better work-life balance and flexibility from the nurses' viewpoint. In addition, it could improve the continuity of care with patients seeing fewer different faces each day (Josten et al., 2003). ...
Aim:
To explore the association between the ward-level nurse turnover rate and the ward's organizational, patient and nurse characteristics in long-term care (LTC) hospitals.
Background:
Nurse turnover adversely impacts not only LTC hospitals through higher recruitment and replacement costs but also resident health outcomes.
Methods:
This study employed a cross-sectional design with secondary analyses. Participants were 199 ward managers and 2,508 nurses in LTC hospitals across Japan. Data collected between September and November 2015.
Results:
The wards with higher nurse turnover were significantly associated with a non 12-hour work shift, higher rate of patients with intravenous hyperalimentation (IVH), lower average of nurse emotional exhaustion, lower average of nurse-perceived quality of the care process, and lower rate of employment stability as the reason for choosing the workplace.
Conclusions:
Actual ward-level nurse turnover can be influenced by factors related to the organisation (e.g. shift style and employment stability), patient (e.g. patients with IVH), and nurse attributions (e.g. burnout, perceived care quality).
Implications for nursing management:
To minimize nurse turnover in LTC hospitals, multi-factorial ward-level interventions would be possible, such as adjusting for shift work, attending to medical procedures, or improving nurses' emotional exhaustion and perceptions regarding care quality.
... Furthermore, these patients disclosed that they would not recommend the hospital services to friends and family. These results in form of hospital reputation has been relevant to policy makers, administrators, nurses and patients (Richardson et al., 2007;Stimpfel, 2011). Likewise, in a survey enrolled 7905 members of the American College of Surgeons in June 2008, it was found that 700 (8.9%) reported concern they had made a major medical error in the preceding 3 months. ...
This research represents a collection of existing data about mental health problems among healthcare workers in Egypt. Mental health disorders as one of the five main non-communicable diseases require special attention particularly among HCPs who themselves are needed to contribute toward minimizing the disease burden itself. Mental health morbidity among the Egyptian healthcare workers has multiple risk factors as the stressful work environment, working hours per week and long shifts especially the night shifts, increasing number of patients, unfairness in working conditions, lack of opportunities for professional development and feeling insufficiently trained for the job. Though the results show strong evidence and magnitude of the problem particularly burnout, other conditions remain under studied such as depression, anxiety and substance abuse disorders. Empirical studies focusing on these including interventional studies are needed to further explore this public health issue including the feasibility of strategies. Such evidence could be made aware to and be acknowledged by the relevant stakeholders in Egypt for further planning of necessary policies and decision-making processes to improve the quality of life among HCPs in Egypt.
... for the last 6 months, imputed to work. Other studies also report similar results, with carers believing that the organization of the working day is facilitated over a 12-hr shift, which limits the sensation of leaving unfinished tasks to co-workers over the following time slot (Richardson et al., 2007). ...
Aim
To evaluate the impact of 12‐hr shifts on health status, working conditions and satisfaction among nurses and healthcare auxiliaries in medical and surgical intensive care units in a general hospital.
Design
This study was a descriptive and prospective questionnaire study of personnel involved in the organization of 12‐hr shifts.
Methods
The EVREST questionnaire was used, with the addition of two questions on respondents' health status and five questions on their job satisfaction. The study consisted of a first phase immediately before work was organized in 12‐hr shifts and a second within 7–9 months of application of this organization.
Results
Positive effects were found among day nurses including decreased periods of pressure during the working day and improved work–life balance. Conversely, night nurses, who are not in favour of 12‐hr shifts, reported dissatisfaction caused by a deterioration both in working conditions and in work–life balance.
... increased accidents, fatigue, adverse effects on health and wellbeing, and absenteeism (Dall"Ora et al., 2016). Research highlights potential benefits to employers (fewer handovers, less overtime) and to workers (less travel time and longer periods between shift patterns (Dwyer et al., 2007;Richardson et al., 2007;Knauth, 2007), and perceptions of better organisation and delivery of care (Baillie and Thomas, 2019). However, a 2015 review concludes insufficient evidence for either benefits, nor a detrimental impact, of 12-hour shifts and the complexity of the issue is poorly understood (Harris et al., 2015). ...
Background
Against a backdrop of increasing demand for mental health services, and difficulties in recruitment and retention of mental health staff, employers may consider implementation of 12-hour shifts to reduce wage costs. Mixed evidence regarding the impact of 12-hour shifts may arise because research is conducted in divergent contexts. Much existing research is cross sectional in design and evaluates impact during the honeymoon phase of implementation. Previous research has not examined the impact of 12-hour shifts in mental health service settings.
Objective
To evaluate how employees in acute mental health settings adapt and respond to a new 12-hour shift system from a wellbeing perspective.
Design
A qualitative approach was adopted to enable analysis of subjective employee experiences of changes to organisation contextual features arising from the shift pattern change, and to explore how this shapes wellbeing.
Setting(s)
Six acute mental health wards in the same geographical area of a large mental health care provider within the National Health Service in England.
Participants
70 participants including modern matrons, ward managers, clinical leads, staff nurses and healthcare assistants.
Methods
Semi-structured interviews with 35 participants at 6 months post-implementation of a new 12-hour shift pattern, with a further 35 interviewed at 12 months post-implementation.
Results
Thematic analysis identified unintended consequences of 12-hour shifts as these patterns changed roles and the delivery of care, diminishing perceptions of quality of patient care, opportunities for social support, with reports of pacing work to preserve emotional and physical stamina. These features were moderated by older age, commitment to the public healthcare sector, and fit to individual circumstances in the non-work domain leading to divergent work-life balance outcomes.
Conclusions
Findings indicate potential exists for differential wellbeing outcomes of a 12-hour shift pattern and negative effects are exacerbated in a stressful and dynamic acute mental health ward context. In a tight labour market with an ageing workforce, employee flexibility and choice are key to retention and wellbeing. Compulsory 12-hour shift patterns should be avoided in this setting.
... Longer shifts have grown popular due to greater flexibility in scheduling, continuity of patient care, and more days off per week (Ferguson & Dawson, 2012). And yet longer shifts may pose significant risks to patients and nurses alike (Richardson et al., 2007;Dorrian et al., 2006). Long night shifts are especially concerning. ...
Background
Due to the 24hr nature of society, shift work has become an integral part of many industries. Within the literature there exists an abundance of evidence linking shift work-related sleep restriction and fatigue with errors, accidents, and adverse long-term health outcomes.
Objective
The study goal was to physiologically measure sleep patterns and predicted cognitive decline of nurses working both 12hr day and night shifts to address the growing concern about sleep restriction among healthcare workers.
Design
This study presents the results of a quasi-experimental, mixed between-within design where the sleep of 12hr day and night shift nurses was measured using ReadiBand wrist actigraphs. The between groups component was comprised of day v. night shift nurses. The within groups component was comprised of two separate measurement periods for each nurse—once for three consecutive days while they were working shifts (on duty) and once for three consecutive days off work (off duty).
Setting
Participants wore the wrist actigraph at home and in the hospital, and were instructed to adhere to their regular sleep schedule.
Participants
Participants were recruited from two hospitals in Washington State (n=90). Participants were 48 night- and 42 day-shift nurses. All participants worked 12-hour shifts.
Methods
Sleep was measured using ReadiBand wrist actigraphs, which are licensed with the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTEtm) Alertness Score model, a biomathematical model that predicts cognitive effectiveness based on sleep/wake schedule. ReadiBands also calculate sleep quantity, sleep efficiency, and sleep latency. Results were analysed in SPSS (v26) through multilevel modelling.
Results
Differences were observed in sleep quantity, efficiency, and latency based on shift type (day vs. night) and shift duty (on vs. off). The most extreme differences, however, were noted in cognitive effectiveness (SAFTEtm), whereby night shift nurses experienced substantial decline—frequently into the “high risk” zone—throughout their shifts compared to day shift nurses.
Conclusions
The present study identifies sleep characteristics that differ between day and night nurses working 12-hour shifts using objective measurements of sleep. Biomathematical modelling can offer a novel method to estimate hours of greatest cognitive decline, and have implications for policy around shift duration, timing, and overtime allocation.
... This investigation likewise showed that working for six or less hours for each day brought down the requirement for recuperation time. Extra minutes, broadened work moves, and working for over 8-hours can adversely affect wellbeing for example, the danger of musculoskeletal issue, cardiovascular manifestations, hypertension, damage, and the danger of diabetes, as well as expanded mortality and bleakness rates, and a higher rate of mishaps (Banakhar, 2017;Richardson, Turnock, Harris, Finley, & Carson, 2007;Trinkoff, Le, Geiger-Brown, & Lipscomb, 2007). ...
... An 8-h work pattern starting in the morning is the least onerous for nurses. Our results indicate that, after 7 h, the level of fatigue increases, as does the risk of sudden death at work and the relative accident risk index [20,22]. An increase in the number of accidents at work is observed when the number of hours per week is increased. ...
Background
Work patterns are important factors in employees’ decisions to change their job or leave their profession. The majority of
nurses in Poland are women who play other social roles besides work. For this reason, satisfaction with their work patterns including
input into work schedules, has a particularly significant impact on considering the idea of quitting their job.
Material and Methods
The
study was conducted in 2008–2011 in 8 out of 10 higher education institutions which train nurses. Data obtained from 1045 questionnaires
collected from a total of 1049 respondents from 3 randomly selected higher education institutions was used in this research paper.
The relationship between the qualitative features and dichotomus quality features under examination was assessed using univariate and
multivariate logistic regression models.
Results
The results of the univariate logistic regression indicate that the risk of quitting increases
to the highest extent with a mixed work pattern; it is lower for 12/24 h, and slightly lower for 2 day/night shifts.
Conclusions
A pattern with
a single day shift was adopted as the reference level to reduce the risk of Polish nurses’ quitting their job. Med Pr. 2018;70(2):145–53
... Indeed, two studies that compared the opinions of staff working 8-and 12-hour shift systems (Freer and Murphy-Black;1995;Gillespie and Curzio, 1996) found a higher reported level of tiredness, fatigue or lethargy in those working the shorter shifts. Freer and Murphy-Black (1996) do not report on the shift pattern of those continuing to work shorter shifts, but as others have reported as many as ten consecutive 8-hour shifts (Gillespie and Curzio, 1996;McGettrick and O'Neill, 2007;Richardson et al, 2007), it could be argued that it is perhaps not the shift length, but the shift pattern and ability to take rest breaks that contribute to tiredness and fatigue. When staff have been able to schedule their own shifts (thereby determining the number of consecutive shifts worked) and have been able to take a range of rest breaks during the shift, no high levels of fatigue have been found (Hazzard et al, 2013). ...
Midwives continue to experience high levels of work-related stress. Challenges in staffing and demands on services may contribute but there are also indications that shift length or working practices may also be a factor, especially if midwives regularly work beyond their contracted hours or miss rest breaks. In the nursing literature, longer shifts have been associated with higher levels of fatigue, yet this has also been found in nurses working 8-hour shifts, due to the high number of consecutive shifts worked, suggesting that working practices also contribute to fatigue. Longer shifts have also been linked to poorer quality of care, yet this only appears significant when shifts exceed 12 hours. There are mixed views on job satisfaction, which may be due to personal preferences or the availability of flexible working. However, the findings of many studies are often limited by poor quality designs and cannot easily be applied to midwifery settings, where there continues to be a lack of research in this area. Further research is required to understand the impact of shift length and working practices on the wellbeing of midwives and their ability to safely delivery care.
... This was also supported by the interaction analysis in the present study, where having long working hours in combination with a higher total number of shifts was associated with more subsequent sick leave days in the following 3 months, compared to having long working hours in combination with fewer total number of shifts. Furthermore, there are also reports to suggest that healthcare workers experience less stress and more satisfaction with long working hours compared to 8-h schedules (Dwyer et al. 2007;Kalisch et al. 2008;Knauth 2007;Stone et al. 2006) and that long shifts permit more time to plan, prioritise, and execute the work tasks (Ingstad and Amble 2015; Richardson et al. 2007). Another possible explanation to the reduced sick leave among these workers is that they may possess characteristics that facilitate adaptation to long working hours. ...
Purpose
The aim of this study was to investigate the effects of long working hours (≥ 12 h shifts) on sick leave using objective records of shift work exposure and of sick leave.
Methods
A total of 1538 nurses (mean age 42.5, SD 12.0; response rate 42%) participated. Payroll and archival sick leave data over a 4-year period were retrieved from employers’ records and aggregated over every third calendar month. A multilevel negative binomial model was used to investigate the effects of exposure to long working hours, on subsequent sick leave rates the following 3 months. Covariates included prior sick leave, number of shifts worked, night and evening shifts, personality, and demographic characteristics.
Results
Exposure to long working hours was associated with fewer sick leave days in the subsequent 3 months [adjusted model, incidence rate ratio (IRR) = 0.946, 95% CI 0.919–0.973, p < 0.001]. The interaction long working hours by a number of work days showed that sick leave days the subsequent 3 months was higher by long shifts when number of shifts was high compared to when number of shifts was low [adjusted model, IRR 1.002, 95% CI 1.000–1.004, p < 0.05].
Discussion
Long working hours was associated with fewer sick leave days. The restorative effects of extra days off with long working hours are discussed as possible explanations to this relationship.
... Many other studies investigated the hazard of this type of schedule and how EW workers may endanger their lives and other people's lives (31). On the contrary, a study conducted by Richardson et al on nurses postulates that 12-hour shifts on critical care staff result in an increase in the quality of care and an improvement in dealing with patients or relatives (32). Another narrative review suggested that sleep problems are not necessarily caused by extending the shift interval from eight to twelve hours (33). ...
Healthcare professionals (HCPs) bear a huge responsibility of taking care of patients 24 hours a day and for the whole week. Although HCPs help patients get over their sufferings, these workers endanger their lives and cause themselves health problems including sleep disturbances. Since most of these disturbances are related to the timing or the schedules of these workers, the aim of this mini-review is to shed the light on how these shift schedules are different and how they can affect the sleepness and/or wakefulness of the workers in the health sector.
... An 8-h work pattern starting in the morning is the least onerous for nurses. Our results indicate that, after 7 h, the level of fatigue increases, as does the risk of sudden death at work and the relative accident risk index [20,22]. An increase in the number of accidents at work is observed when the number of hours per week is increased. ...
Family nursing has a rich history written in various books and articles. According to these, it owes its most important development to the pioneers of social nursing in England, Canada and the United States of America. Following the example of other countries, an attempt to apply the rules of patient care in their own place of living has taken place in Poland, too. Here, the most important part of the development of family nursing took place in the second half of the 80s of the 20th century. Earlier though, representatives of various other jobs expressed a positive opinion about the nurse's position in the therapeutic team within health centres. This is best reflected in the words of M. Kacprzak: "All health centre managers are talking about the important role of the community nurse, univocally agreeing that the nurse is the soul of the team, and that without them, there is no centre. The nurse has to find the patient, see him/her to the health centre and look after him/her in every aspect. The nurse can do the most for the communication between the society and the centre. The tasks include conducting interviews, without which there is no prophylactic action. The number of interviews is one of the most important indicators of a centre, because it tells about the penetration of the home life, which in itself is - from the point of view of success - condition sine qua non".
... It appears that better organization of work schedules with adequate rest periods and a regular practice of leisure activities improve the professional well-being of hospital staff. The recent implementation of 12-h shifts seems to support this [42]. The development of functional, ergonomic and adapted work environments could also contribute to the reduction of occupational stress in hospitals. ...
Objectives:
This study measures the association between hospital staff's job strain (JS), mental quality of life (MQL) and how they are influenced by the organization models within emergency and critical care units.
Material and methods:
This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL.
Results:
Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer's efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score.
Conclusions:
If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented.
... We hypothesize that even shorter shifts in 36-h work weeks leave time for individuals with different demographics and chronotypes to adapt to irregular shifts. This approach favours the benefits of a reduced and more evenly spread workload over a potential decline of continuity and is in contrast to the system of continuity of care with prolonged, but often exhaustingly long shifts [15,16]. In the study reported here, we assessed the effects of chronotype and other demographics on night shift performance in a Dutch ICU where 8-h work shifts are common. ...
In general, sleeping and activity patterns vary between individuals. This attribute, known as chronotype, may affect night shift performance. In the intensive care unit (ICR), night shift performance may impact patient safety. We have investigated the effect of chronotype and social demographics on sleepiness, fatigue, and night shift on the performance of nurses.
This was a prospective observational cohort study which assessed the performance of 96 ICU night shift nurses during the day and night shifts in a mixed medical-surgical ICU in the Netherlands. We determined chronotype and assessed sleeping behaviour for each nurse prior to starting shift work and before free days. The level of sleepiness and fatigue of nurses during the day and night shifts was determined, as was the effect of these conditions on psychomotor vigilance and mathematical problem-solving.
The majority of ICU nurses had a preference for early activity (morning chronotype). Compared to their counterparts (i.e. evening chronotypes), they were more likely to nap before commencing night shifts and more likely to have young children living at home. Despite increased sleepiness and fatigue during night shifts, no effect on psychomotor vigilance was observed during night shifts. Problem-solving accuracy remained high during night shifts, at the cost of productivity.
Most of the ICU night shift nurses assessed here appeared to have adapted well to night shift work, despite the high percentage of morning chronotypes, possibly due to their 8-h shift duration. Parental responsibilities may, however, influence shift work tolerance.
Aim
To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time.
Design
A cross‐sectional survey of nursing staff working across the UK and Ireland collected quantitative and qualitative responses.
Methods
We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis.
Results
Eight hundred and seventy‐three survey responses were collected. When nurses worked long shifts and rotating shifts, lower proportions reported being satisfied with their shifts and working their preferred shift length and pattern. Limited advantages were realised when comparing different shift types; however, respondents more frequently associated ‘low travel costs’ and ‘better ability to do paid overtime’ with long shifts and ‘healthy diet/exercise’ with short shifts; aspects related to rotating shifts often had the lowest proportions of agreement. In the qualitative analysis, three themes were developed: ‘When I want to work’, ‘Impacts to my life outside work’ and ‘Improving my work environment’. Reasons for nurses' shift preferences were frequently related to nurses' priorities outside of work, highlighting the importance of organising schedules that support a good work‐life balance.
Relevance to Clinical Practice
General scheduling practices like adhering to existing shift work guidelines, using consistent and predictable shift patterns and facilitating flexibility over working time were identified by nurses as enablers for their preferences and priorities. These practices warrant meaningful consideration when establishing safe and efficient nurse rosters.
Patient or Public Contribution
This survey was developed and tested with a diverse group of stakeholders, including nursing staff, patients, union leads and ward managers.
Reporting Method
The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross‐sectional studies was used to guide reporting.
Interpersonal spoken communication is central to human interaction and the exchange of information. Such interactive processes involve not only speech and spoken language but also non-verbal cues such as hand gestures, facial expressions, and nonverbal vocalization, that are used to express feelings and provide feedback. These multimodal communication signals carry a variety of information about the people: traits like gender and age as well as about physical and psychological states and behavior. This work uses wearable multimodal sensors to investigate interpersonal communication behaviors focusing on speaking patterns among healthcare providers with a focus on nurses. We analyze longitudinal data collected from 99 nurses in a large hospital setting over ten weeks. The results indicate that speaking pattern differences across shift schedules and working units. Moreover, results show that speaking patterns combined with physiological measures can be used to predict affect measures and life satisfaction scores. The implementation of this work can be accessed at https://github.com/usc-sail/tiles-audio-arousal.
The work of nurses is often associated with elevated anxiety, negative affect, and fatigue, all of which may impact both the quality of patient care and their own well-being. It is critical to understand behavioral patterns, such as human movement, that may be associated with these workplace challenges of nurses. These movement behaviors include location-based movement patterns and dynamical changes of movement intensity. Particularly, we investigated these movement-related patterns for 75 nurses, using wearable sensor recordings, collected over a continuous period of ten weeks. We first discover the location of movement patterns from the Bluetooth proximity data using topic models. We then extract the heart rate zone features from PPG readings to infer the intensity of physical movement. Our results show that the location movement patterns and dynamical changes of movement intensity offer key insights into understanding the workplace behavior of the nursing population in a complex hospital setting.
Objective
There is currently a lack of data that records how midwives are expected to work in hospital settings. The aim of this study was to determine the prevalence of 12-hour shifts and current working practices of hospital-based midwives.
Design
An online survey conducted between December 2018 and March 2019. Descriptive data are summarised regionally and nationally.
Setting
NHS Trusts providing maternity services in hospital settings in the UK
Participants
The link to the survey was emailed to Heads of Midwifery in 155 NHS Trusts
Findings
Responses were received from 94 of the 155 NHS Trusts (60.65%). Some responses included data for more than one hospital, so results are summarised for 97 hospitals. 12-hour shifts were the most prevalent shift length, with only 4.1% of hospitals still routinely operating shorter shifts. 55% of hospitals limit the maximum number of consecutive shifts to three, but this can be influenced by different factors. More than half of midwives (55.67%) will be rostered to start a day shift within 24-hours of finishing a night shift. 70% of hospitals do not currently record the number of midwives working beyond their contracted hours, but 68% report formal methods of recording missed rest breaks. Regional differences were seen in the use of other personnel to support the midwifery workforce.
Conclusions
Shift schedules and the lack of formal methods to record the number of midwives working beyond their contracted hours may be a cause for concern due to the potential impact on recovery times. Further research is required to explore how working practices may affect midwives and their ability to provide care for women and their babies.
Aim:
To assess 12-h shift Intensive Care Unit (ICU) nurses' fatigue and identify the associated demographic factors.
Background:
Literature reveals inconsistencies as to whether 12-h shifts decrease or increase nurse fatigue levels.
Methods:
A cross-sectional survey of 67 ICU nurses working 12-h shifts was undertaken to determine their fatigue levels in two hospitals. The Occupational Fatigue Exhaustion/Recovery Scale (OFER), Spearman's correlation, ANOVA, t-tests, and Chi-Square were used for analyses.
Results:
57 out of 67 participants experienced low to moderate chronic fatigue; 36 of those exhibited low to moderate acute fatigue levels; 46 reported low to moderate inter-shift fatigue. Age (ρ = 0.03, r2 = -0.28), number of family dependents (ρ = 0.03, r2 = -0.27), and years of nursing experience (ρ = 0.03, r2 = -0.27) were moderately negatively correlated with acute fatigue, while frequency of exercise per week (ρ = 0.01, r2 = -0.31) was moderately negatively correlated with chronic fatigue. Hospital A had higher chronic fatigue levels than Hospital B. Age (ρ < 0.01), age group (ρ = 0.03), shift schedule (ρ = 0.02), and nursing experience (ρ = 0.03) were significantly related to the difference in chronic fatigue levels between the two hospitals.
Conclusions:
More than half of the 12-h shift ICU nurses studied in both hospitals had low to moderate fatigue levels. Age, number of family dependents, years of nursing experience, and frequency of exercise per week were identified as key factors associated with fatigue. The difference in chronic fatigue levels between hospitals suggests that implementing more support for younger and/or less experienced nurses, better strategies for retaining more experienced nurses, and fewer rotating shifts could help reduce fatigue.
Background:
Internationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older people's hospital wards.
Objectives:
1) To explore how length of day shift affects patient care in older people's wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older people's wards DESIGN: A mixed method case study.
Settings:
The study was based on two older people's wards in an acute hospital in England. One ward was piloting two, overlapping 8h day shifts for 6 months while the other ward continued with 12h day shifts.
Participants and methods:
Qualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n=279). Twenty hours of observation of nursing staff's interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations.
Results:
There were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8h day shift pattern, in a hospital that had a 12h day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience.
Conclusions:
There was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older people's wards.
The twelve-hour shift system, first introduced in the U.S. in 1967 to address a nursing shortage, is now the main system of shift rotation used in numerous countries. In recent years, several hospitals in Taiwan have implemented the 12-hour shift model as one initiative to improve the problems of overtime and high turnover rate among nursing staff. Under this model, nurses work only three to four days per week for 12-hour shifts per day. Despite the increase in numbers of days off, there is growing concern that long shift hours may harm both the safety of patients and the well being of the nurses. The aim of the present article is to explain the application of the 12-hour shift system and to review the potential impacts of this model. Benefits of the 12-hour shift system include improving quality of life for nursing staff, reducing the turnover rate, and increasing job satisfaction. Primary concerns regarding this system include patient safety, nurse fatigue, and the potential negative effects on the sleep quality of nurses. These findings may be referenced by policymakers considering the development / implementation of flexible work schedules in Taiwan. The government must set a ceiling on work hours allowed per week and impose limits on overtime in order to prevent burnout in nursing staff.
Job satisfaction and burnout in the nursing workforce are global concerns. Not only do job satisfaction and burnout affect the quality and safety of care, but job satisfaction is also a factor in nurses’ decisions to stay or leave their jobs. Shift patterns may be an important aspect influencing wellbeing and satisfaction among nurses. Many hospitals worldwide are moving to 12-hour shifts in an effort to improve efficiency and cope with nursing shortages. But what is the effect of these work patterns on the wellbeing of nurses working on hospital wards? This article reports on the results of a study performed in 12 European countries exploring whether 12-hour shifts are associated with burnout, job satisfaction and intention to leave the job.
On-call working time arrangements are increasingly common, involve work only in the event of an unpredictable incident and exist primarily outside of standard hours. Like other non-standard working time arrangements, on-call work disrupts sleep and can therefore have negative effects on health, safety and performance. Unlike other non-standard working time arrangements, on-call work often allows sleep opportunities between calls. Any sleep obtained during on-call periods will be beneficial for waking performance. However, there is evidence that sleep while on call may be of substantially reduced restorative value because of the expectation of receiving the call and apprehension about missing the call. In turn, waking from sleep to respond to a call may be associated with temporary increases in performance impairment. This is dependent on characteristics of both the preceding sleep, the tasks required upon waking and the availability and utility of any countermeasures to support the transition from sleep to wake. In this paper, we critically evaluate the evidence both for and against sleeping during on-call periods and conclude that some sleep, even if it is of reduced quality and broken by repeated calls, is a good strategy. We also note, however, that organisations utilising on-call working time arrangements need to systematically manage the likelihood that on-call sleep can be associated with temporary performance impairments upon waking. Given that the majority of work in this area has been laboratory-based, there is a significant need for field-based investigations of the magnitude of sleep inertia, in addition to the utility of sleep inertia countermeasures. Field studies should include working with subject matter experts to identify the real-world impacts of changes in performance associated with sleeping, or not sleeping, whilst on call.
It is estimated 1.3 million health care errors occur each year and of those errors 48,000 to 98,000 result in the deaths of patients (Barger et al., 2006). Errors occur for a variety of reasons, including the effects of extended work hours and shift work. The need for around-the-clock staff coverage has resulted in creative ways to maintain quality patient care, keep health care errors or adverse events to a minimum, and still meet the needs of the organization. One way organizations have attempted to alleviate staff shortages is to create extended work shifts. Instead of the standard 8-hour shift, workers are now working 10, 12, 16, or more hours to provide continuous patient care. Although literature does support these staffing patterns, it cannot be denied that shifts beyond the traditional 8 hours increase staff fatigue, health care errors, and adverse events and outcomes and decrease alertness and productivity. This article includes a review of current literature on shift work, the definition of shift work, error rates and adverse outcomes related to shift work, health effects on shift workers, shift work effects on older workers, recommended optimal shift length, positive and negative effects of shift work on the shift worker, hazards associated with driving after extended shifts, and implications for occupational health nurses.
Nurses work 23.4 hours of overtime on average per month (Japanese Nursing Association, 2009), which is 13.2 hours longer than the monthly average for general workers (The Ministry of Health, Labor and Welfare, 2013). The purpose of this study is to clarify the current status of the working environment and chronic fatigue for nurses in clinical care. The questionnaire was anonymous and self-administered. The contents of the question are attributes, working environment and chronic fatigue. A total of 1676 female nurses working at 117 different general hospitals located in Japan, participated in our survey. It was found that nurses are not able to fully recover from fatigue and chronic fatigue is likely to accumulate when the following conditions are relevant: they are in their 20s, they work under the working environment with overtime (the time to leave work is irregular) for 20 hours or longer on average per month, or they work on a three-shift pattern. It is necessary to adjust the environment in an organization or society including working structure by paying attention to characteristics of individual fatigue.
Medical residents have traditionally long working hours, compounded by uninterrupted shifts, and this combination leads to significant sleep deprivation. The training of new physicians has, in the past, been designed in order to provide maximum exposure to patient and surgical cases with no regard to circadian rhythms, sleep deprivation, or fatigue-related issues. Nurses, on the other hand, have been exposed to long hours and varied shifts in recent years due to excessive demand and severe shortage. Health care providers working for extended hours and variable shifts receive little or no education regarding fatigue countermeasures, sleep needs, and sleep hygiene. Sleep deprivation and variable shift work-related challenges have led to life-threatening errors, raising the concern for safety among health care providers over the past 2 decades. This chapter discusses sleep-related safety issues among resident doctors and nurses.
Objectives:
12 h shifts are becoming increasingly common for hospital nurses but there is concern that long shifts adversely affect nurses' well-being, job satisfaction and intention to leave their job. The aim of this study is to examine the association between working long shifts and burnout, job dissatisfaction, dissatisfaction with work schedule flexibility and intention to leave current job among hospital nurses.
Methods:
Cross-sectional survey of 31 627 registered nurses in 2170 general medical/surgical units within 488 hospitals across 12 European countries.
Results:
Nurses working shifts of ≥12 h were more likely than nurses working shorter hours (≤8) to experience burnout, in terms of emotional exhaustion (adjusted OR (aOR)=1.26; 95% CI 1.09 to 1.46), depersonalisation (aOR=1.21; 95% CI 1.01 to 1.47) and low personal accomplishment (aOR=1.39; 95% CI 1.20 to 1.62). Nurses working shifts of ≥12 h were more likely to experience job dissatisfaction (aOR=1.40; 95% CI 1.20 to 1.62), dissatisfaction with work schedule flexibility (aOR=1.15; 95% CI 1.00 to 1.35) and report intention to leave their job due to dissatisfaction (aOR=1.29; 95% CI 1.12 to 1.48).
Conclusions:
Longer working hours for hospital nurses are associated with adverse outcomes for nurses. Some of these adverse outcomes, such as high burnout, may pose safety risks for patients as well as nurses.
Objective: to determine the effect of working 12 hours or more on a single shift in an acute care hospital setting compared with working less than 12 hours on rates of error among nurses.
Design: Joanna Briggs Institute Systematic Review
Methods: A three-step search strategy was utilized. An initial search of MEDLINE and CINAHL was undertaken. A second search using all identified keywords and index terms was then undertaken across all included databases (Embase, Current contents, Proquest Nursing and Allied Health Source, Proquest Theses and Dissertations, Dissertation Abstracts International). Thirdly, the reference lists of identified reports and articles were searched for additional studies. Studies published before May 2014 were included. Quantitative data was pooled in statistical meta-analysis using JBI-MAStARI.
Findings: Following review of title and abstract of 5429 publications identified using the initial search strategy and removal of duplicates, 26 studies were identified as suitable for review and selected for full retrieval and assessment for methodological quality. Of these, 13 met the inclusion criteria and were included in the review. Six studies reported significant rises in error rates for nurses working greater than 12 hours on a single shift, three reported no difference, and four reported higher rates of error on shifts of up to eight hours. Meta-analysis of five of the studies where data could be extracted indicates that the risk of error is significantly higher for nurses working greater than 12 hours than for those working less than 12 hours (risk ratio = 1.51, 95% CI, 133, 172; z=6.30, p=<0.0001).
Conclusion: Hospitals and units currently operating 12 hour shift systems should review this scheduling practice due to potential negative impact on patient outcomes. Further research is required to consider factors that may mitigate the risk of error where 12 hour shifts are scheduled and this cannot be changed.
Extended work shifts of 12 hours or more have become a common scheduling strategy for nurses in several countries, though this is not the case in Norway. There, many managers, nurses, and union representatives have expressed concerns about whether nurses can function effectively while working long shifts. This study thus aimed to examine how long shifts influence nursing outcomes such as stress, continuity, and responsibility in Norwegian nursing homes. Data were collected during in-depth interviews with 16 nurses employed at four different nursing homes who have worked 12–14-hour shifts. Results suggest that long shifts actually reduce stress and increase both work continuity and accountability, though these positive impacts of long shifts occur primarily when all departmental staff work long shifts. Furthermore, fewer shift changes mean more time spent with patients and better communication.
The aim of this study was to compare job satisfaction, quality of life (QOL), incident report rate and overtime hours for 12-hour shifts and for 8-hour shifts in a pediatric intensive care unit (PICU).
This article gives an account of research carried out on working hours in a French hospital and specifically the impact on two ways of organizing working hours (12 hour shifts vs 8 hour shifts) on workers health and job strain as perceived by the health care providers. Based on 255 questionnaires, this research indicates that the health care providers who work in 12 hour shifts and 8 hour shifts have the same perception of their health and job strain. However, there are some differences: the health care providers working in 12 hour shifts feel less fatigue and emotional exhaustion than the health care providers working in 8 hour shifts. We discuss these results taking into account that: i) breaks in 12 hour shifts are longer than in 8 hour shifts; ii) workers have better relationships with their colleagues in 12 hour shifts, based on consultation and a vote held when a hospital department thought about changing to 12 hour shifts and iii) the workers volunteer to work in a 12 hour shifts.
Despite the increasing use of and discussion about 12-hour shifts, little work has been carried out in the United Kingdom to assess its impact. A study was carried out to compare two medical wards which had been operating a 12-hour shift for more than one year with two medical wards which had carried on with a conventional shift system over the same period of time. Staff questionnaires, interviews, patient interviews, documentation review, and analysis of a number of organizational issues were undertaken to evaluate the effect of the shift pattern worked. Viewing this shift pattern from a variety of perspectives indicates that there were no significant differences between the shift patterns with regard to staff perception, patient perception, documentation and organisational issues. However, some aspects of the 12-hour shift produced more favourable responses from the staff: less fatigue was reported by those working the 12-hour shift and documentation was more complete on these wards. However, the length of time available for the handover was identified as a problematic area. Staff surveyed had chosen to work these hours which may positively have influenced the impact of this shift pattern on both staff and patients. This work demonstrates the complexities in evaluating patterns of work in providing patient care over 24 hours.
The requirement to ensure that practice is evidence-based, means that all aspects of the structure, process and outcome of nursing care need to be subjected to critical review. This report attempts to do this in regard to the 12-hour shift pattern. Twelve-hour shifts are being introduced by an increasing number of managements, a practice which has raised concerns since there is some evidence indicating that 12-hour shifts affect the amount of care patients receive, and that there are possible links between length of shift worked, nurses' stress and fatigue levels and the impact these might have on the quality of care. This review discusses the main effects of the change in shifts on nurses and patients alike. The review focuses on studies since 1980 and on studies carried out in the United Kingdom. The search produced a considerable number of references; however, only those which met the inclusion criteria are included in this paper; a complete list is available on request. Much of the published work currently available lacks rigour. Yet, this is an important topic on which sound information is needed to inform decision-making.
Interest in 12-hour nursing shifts has been renewed in response to demands for improved cost-effectiveness in the NHS, but the effects of this shift on the delivery of patient care have been unclear. This paper describes the results of a repeated-measures study of 10 wards, using activity analysis to describe patterns of care under an 8-hour compared to a 12-hour shift system. Significant reductions in the amount of direct patient care were found under the 12-hour shift, with corresponding increases in unofficial work-breaks. It is suggested that these findings, which were consistent over all study wards and throughout the whole 12-hour day, demonstrate a "pacing" effect by nurses who face 12 hours on duty. Such a detrimental effect should be a major consideration when coming to any decision to implement a 12-hour shift.
A before and after study was carried out amongst staff of 10 wards of a county hospital before and after the introduction of a 12-hour shift system for nurses. The purpose was to investigate the impact of the shift system on job satisfaction. Some 320 nurses covering all qualified and unqualified grades were surveyed using a standard job satisfaction attitude scale. It was found that under the 12-hour shift both intrinsic and extrinsic factors of job satisfaction had been detrimentally affected. Considerable dissatisfaction was expressed about hours of work, conditions of work and the impact of the shift on domestic and social arrangements. The vast majority (83%) reported that they did not want to go on working the shift and there was support for the view that recruitment to nursing would be adversely affected by the shift.
Despite the increasing use of, and discussion about, 12-hour shifts there has been little assessment of its impact in the UK. A study was carried out to compare two medical wards that had been operating a 12-hour shift for more than one year with two medical wards that had continued with a conventional shift system over the same period. Staff questionnaires and interviews, patient interviews, documentation review and analysis of a number of organisational issues were undertaken to evaluate the effect of the shift pattern worked. There were no significant differences between the shift patterns. However, some aspects of the 12-hour shift produced more favourable responses from the staff: less fatigue was reported by those working the 12-hour shift and documentation was more complete on these wards. However, the length of time available for the handover was identified as a problematic area. This work demonstrates the complexities in evaluating patterns of work.
The aim of this pilot evaluation was to assess whether changing a nursing shift pattern to incorporate 12-hour shifts would have positive effects for patients and staff in a ward environment.
All nurses, night sisters and therapists in contact with the ward during the trial were asked to complete a questionnaire. Data on sickness, agency use, 'untoward incidents' and spread of unsocial hours were also analysed to see what effects a change in shift pattern had.
The new shift pattern offered benefits for patients through improved communication, increased continuity of care and more content staff. In addition, staff complied to the Working Time Regulations (DTI 1998) with no change to their unsocial hour pay. There was also a reduced need for agency nurses.
This study illustrated the potential a new nursing shift pattern involving 12-hour shifts has for patient care, as well as for staff job satisfaction and efficient management of the ward. Twelve-hour shifts are infamous in nursing and many studies cite exhausted and dissatisfied staff as a reason for the negative press (Fitzpatrick et al 1999, Todd et al 1993). In particular, Todd et al (1989) claimed that the quality of patient care was negatively affected on wards that used a 12-hour shift pattern. The study reported here challenges Todd et al's work (1989, 1993) by demonstrating the benefits a change in shift pattern to 12-hour shifts can have for patients and staff in a ward environment.
The first part of this two-part article discussed the implementation of 12-hours shifts using a locally devised nursing development unit (NDU) framework (Vol 9(19): 2095-9). This article, the second part, discusses the results of a survey to evaluate the 12-hour shifts, the problems encountered during the implementation of 12-hours shifts, the solutions and the NDU framework as described in the first part of the article. A qualitative design to the postal survey was chosen with the resulting data being subjected to a content analysis. Data triangulation compared survey results with incident reports and sickness records. The limitations of the survey included having the change agent analysing the data, the sampling method and being unable to pilot the questionnaire. The results indicated an improvement in the quality of patient care, although this is difficult to measure, a pacing of workload throughout the day, and tiredness during, after and at the end of a stretch of shifts. Other results centred on staff morale, social life, student nurses' experience and night shifts. The solutions to identified problems included the employment of two twilight nurses to help the night staff during the busy early evening period. As a requirement of the NDU framework, standards were produced from the survey results, as this would allow subsequent audit of the 12-hour shift system. The recommendations from this survey included the dissemination of results both locally and nationally to expand the body of nursing knowledge and to promote practice based on the best available evidence.
This paper describes the introduction and subsequent evaluation of a 12‐h shift system in a large ITU in the northeast of UK
To date, only a small number of studies has evaluated nurses working the 12‐h shifts in critical care areas
To evaluate the level of staff satisfaction, data were collected by means of a questionnaire involving 41 nurses, at 3 months following the introduction of the 12‐h shifts
The responses from the evaluation advocated the continuation of 12‐h shifts with alternative shift patterns for nurses who felt dissatisfied with the current system
Twelve‐hour shifts can be seen as a flexible system for nurses working in intensive care and may assist with staff satisfaction and improving nurse recruitment and retention
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