Download Read publication - NIHR CLAHRC Wessex

Nurses’ shift patterns and the
association with patient safety
and nurse absenteeism
Chiara Dall’Ora
Doctoral student, University of Southampton
Collaboration for Leadership in Applied
Health Research and Care (Wessex)
Ruth’s case
Ruth is a registered nurse at Southampton General Hospital. She
currently lives in Brighton (and she loves it) and can do so thanks to the
shift patterns in her ward.
Her ward deployed a 12.5-h shift system, meaning that she can work 3
consecutive 12.5-h shifts and then benefit from 4 days off in Brighton.
Let us have a look at her typical week.
Collaboration for Leadership in Applied Health Research and Care (Wessex)
Ruth’s week
DAY 1, DAY 2, DAY 3
4 am
5 am
7 am
8.30 pm
11 pm
DAY 4, DAY 5, DAY 6, DAY 7
Collaboration for Leadership in Applied Health Research and Care (Wessex)
Benefits
• 4 consecutive days off
• More free time from work
• Fewer long commutes (v 10 long commutes with a 8-h shift pattern)
• Commute costs reduced
Better work-life balance
Collaboration for Leadership in Applied Health Research and Care (Wessex)
Downsides
• Fatigue at the end of the long shift
• Cumulative fatigue at the end of the 3rd long shift
• Sleep deprivation
• Decreased alertness
• Weariness after long commutes
Potential threat to patient safety
Potential threat to personal safety and
community safety
(Risk of drowsy driving/accidents)
Collaboration for Leadership in Applied Health Research and Care (Wessex)
The evidence so far…
Studies conducted by the CLAHRC showed that shifts of 12-h or longer
are associated with:
• decreases in patient safety and
• poor quality of care
• more missed care (care left undone)
when compared to their peers working 8 hours or less.
Griffiths P, Dall'ora C, Simon M, et al(2014) Nurses' shift length and overtime working in 12 European countries: The association
with perceived quality of care and patient safety. Medical Care 52(11): 975-81
Collaboration for Leadership in Applied Health Research and Care (Wessex)
More evidence…
A further CLAHRC study showed that 12-h or longer shifts are
associated with higher levels of
• burnout
• job dissatisfaction
• intention to leave the job
Dall’Ora C, Griffiths P, Ball J, Simon M and Aiken LH (2015) Association of 12 h shifts and nurses’ job satisfaction, burnout and
intention to leave: findings from a cross-sectional study of 12 European countries. BMJ Open 5 (9)
Collaboration for Leadership in Applied Health Research and Care (Wessex)
… Why if 12-h shifts improve work life balance?
• Job satisfaction ≠ life satisfaction
• Cumulative long shifts may have a negative effect on wellbeing
• Days off may be spent recovering from consecutive long shifts
Collaboration for Leadership in Applied Health Research and Care (Wessex)
However
Shift length is not the only shift characteristic that can impact on patient
and nurse outcomes… Shift work involves numerous characteristics:
•
•
•
•
•
weekly work hours
compressed working week
overtime
night work/rotating or fixed shifts
rest opportunities
Dall’Ora C, Ball J, Recio-Saucedo A and Griffiths P (2016) Characteristics of shift work and their impact on employee performance
and wellbeing: A literature review. International Journal of Nursing Studies 57: 12-27
Collaboration for Leadership in Applied Health Research and Care (Wessex)
New CLAHRC study
Research Questions:
1. What is the association between patterns of nurses shift work in
acute hospital wards and patient safety?
2. What is the association of patterns of nurses shift work in acute
hospital wards and nurses’ wellbeing at work?
3. What is the optimal combination of nurses’ shift characteristics
to ensure adequate patient surveillance?
Collaboration for Leadership in Applied Health Research and Care (Wessex)
Methods
I have access to routinely collected data of a CLAHRC Wessex Trust.
Data will cover ward nurses’ shifts patterns, missed vital signs
observations and nurses’ absenteeism.
Length of working hours
1. Shift length
2. Weekly hours
3. Compressed working
week
4. Overtime
Time of day / rotation
1. Day shift
2. Night shift
3. Early start (≤ 6 am)
4. Fixed/ rotating shifts
Shift intensity
1. Consecutive shifts
1a. Consecutive day shifts
1b. Consecutive night shifts
1. Time between shifts
2a. Quick returns
2b. Days off
1. Breaks during shifts
2. Fixed/ rotating shifts
Work environment
Missed care
Absenteeism
Collaboration for Leadership in Applied Health Research and Care (Wessex)
What will my study add?
• One of the first shift work studies based on objective measurements
• One of the first shift work studies using longitudinal data
• One of the first shift work studies to examine together the impact of
a set of shift characteristics
• Extended knowledge and criteria to inform shift planning
Collaboration for Leadership in Applied Health Research and Care (Wessex)
Something for Ruth (and not only)…
• Ruth may become aware of potential downsides of working her
actual shift pattern
• Her manager may have access to robust data to plan safe shifts
• The patients Ruth cares for may benefit from the care of a less
fatigued and worn out nurse, with lower risks of errors and adverse
events
Collaboration for Leadership in Applied Health Research and Care (Wessex)
Thanks for your attention
Any thoughts, comments or questions?
Collaboration for Leadership in Applied Health Research and Care (Wessex)