The impact of moving to a 12h shift pattern on employee wellbeing: A qualitative study in an acute mental health setting

Understanding burnout in nurses: identification and coping strategies

Burnout, a psychological syndrome caused by prolonged exposure to chronic workplace stressors, is a prevalent issue in nursing, characterised by emotional exhaustion, depersonalisation and a diminished sense of accomplishment. This article explores the widespread impact of burnout in nursing, identifying its key indicators and consequences for both nurses and patient care. Furthermore, it evaluates evidence-based management strategies, including organisational interventions, resilience training, and peer support programmes, aimed at mitigating burnout and improving outcomes.

Psychosocial Care Delivery in Intensive Home Treatment During a Mental Health Crisis: A Qualitative Thematic Analysis

Community-based intensive home treatment (IHT) is delivered as an alternative to psychiatric hospital admission as part of crisis resolution services. People receiving IHT present with complex mental health issues and are acutely distressed. Home treatment options are often preferred and there is evidence of service fidelity, although less is known about psychosocial care in this setting. Underpinned by a critical realist epistemology, this study aimed to explore psychosocial care in the context of home treatment from the perspectives of staff, service users and family carers. Data were collected using individual interviews and focus groups in two NHS organisations in England. An inductive qualitative thematic analysis resulted in five themes focused on (1) the staffing model and effective care provision, (2) the organisation of work and effective care provision, (3) skills and training and service user need, (4) opportunities for involvement and personal choice, and (5) effective communication. Findings suggest that co-production may improve congruence between IHT service design, what service users and carers want and staff ideals about optimal care. Service designs that optimise continuity of care and effective communication were advocated. Staff training in therapeutic interventions was limited by not being tailored to the home treatment context. Evidence gaps remain regarding the most effective psychosocial care and related training and supervision required. There is also a lack of clarity about how carers and family members ought to be supported given their often-crucial role in supporting the person between staff visits.

Working Hours Associated with the Quality of Nursing Care, Missed Nursing Care, and Nursing Practice Environment in China: A Multicenter Cross-Sectional Study

Aim

The aim of the study was to examine the effect of the length of working hours on missed nursing care, quality of nursing care, and perceptions of the nursing practice environment.

Methods

A multicenter cross-sectional investigation using online questionnaires was conducted from April 2 to May 10, 2022, in twenty nine hospitals (13 Level-III hospitals and 16 Level-II hospitals). We collected data on the working hours of nurses and nurse-reported outcomes, including missed nursing care, quality of nursing care, and nursing practice environment. Restricted cubic spline (RCS) regression models were used to examine relationships between the hours per shift and nurse-reported outcomes.

Results

We investigated 12,703 nurses with a response rate of 97.33%. Nurses worked on average 7.72 (SD = 1.16) hours on the day shift and 8.92 (SD = 2.20) hours on the night shift, respectively. On the day shift, working 7.5 hours shift showed minimal missed nursing care; meanwhile, working 7-7.5 hours were correlated with the highest satisfaction of the nursing practice environment and better quality of nursing care. On the night shift, the highest missed nursing care was found for a working duration of 12 hours to the working 7 hours, with the lowest satisfaction while better quality was observed. The percentage of nurses who reported working overtime was 30.33%. Nurses who worked overtime reported lower satisfaction and poorer quality of nursing care on all shifts; moreover, working overtime showed the positive correlation to missed nursing care on the day shift, while on night shift was not statistically significant.

Conclusion

Positive outcomes were observed for nurses who reported working 7-7.75 hours on the day shift and 12 hours (no more than 15 hours) on the night shift. Implications of Nursing Management. The results reemphasized the need for managers to reduce the working hours, overtime work, and the frequency of the night shift.

Nursing 12-Hour Shifts and Patient Incidents in Mental Health and Community Hospitals: A Longitudinal Study Using Routinely Collected Data

Shifts of 12 hours or longer are common in nursing services within general hospital wards. Concerns have been raised about their safety, but previous research has mostly used staff-reported measures of quality and safety and has occurred in general hospital settings only. This study aims to measure the association between the use of 12+ hour shifts in nursing staff (including registered nurses, healthcare support workers or nursing assistants, and nursing associates) and the rate of patient incidents in mental health and community hospitals. This is a longitudinal study using routinely collected data from two mental health and community NHS trusts in the South of England. We accessed rosters of nursing staff and patient incident data from April 2018 to March 2021. We extracted 1,018,971 shifts and excluded those not worked by nursing staff, with a final sample of 898,143 shifts. We extracted 53,078 incidents. We only included incidents that involved patients and that occurred in wards. Our final sample consisted of 38,373 patient incidents. We linked all patient incidents and nurses' worked shifts at the ward-day level. Depending on the distribution of incident rates, we used either negative binomial mixed-effects models or Poisson mixed-effect models to investigate the association between the proportion of 12+ hour shifts and all patient incidents, violence against staff, falls, self-injury, disruptive behaviour, and medication management incidents at the ward-day level. We found a relationship between 12+ hour shifts and the incident rate. Compared to days in wards with no long shifts, increasing the proportion of long shifts was initially associated with a small increase in the overall rate of incidents, but the rate increased sharply as the proportion of long shifts was above 70%. Rates of self-injury increased more steadily as the proportion of long shifts increased. The mandatory implementation of long shifts should be discouraged.

Development of a new personalized staff-scheduling method with a work-life balance perspective: case of a hospital

Burnout rates and dissatisfaction among healthcare workers remain high due to long working hours. One possible solution to this problem is to let them choose their weekly working hours and starting times in order to achieve a work-life balance. Moreover, a scheduling process that responds to changing healthcare demands at different times of the day should increase work efficiency in hospitals. In this study, a methodology and software were developed to schedule hospital personnel, taking into account their preferences regarding working hours and starting time. The software also allows the hospital management to determine the number of staff needed at different times of the day. Three methods and five working-time scenarios characterized by different divisions of working time are proposed to solve the scheduling problem. The Seniority score Priority assignment Method appoints personnel prioritizing seniority, whereas the newly developed Balanced and Fair assignment Method and Genetic Algorithm Method aim for a more nuanced distribution. The methods proposed were applied to physicians in the internal diseases department in a specific hospital. Weekly/monthly scheduling of all employees was carried out with the software. The results of scheduling factoring in work-life balance, and the performances of algorithms are shown for the hospital where the application was trialled.

A Comparison of Shift Length and Nursing and Quality Outcomes in Acute Inpatient Mental Health Units

OBJECTIVE

This study compared outcomes between units that used either 8-hour or 12-hour shifts in acute inpatient mental health units.

BACKGROUND

Most hospitals continue to use 12-hour shifts despite research suggesting safety concerns with longer shifts. There is a gap in the literature on effects of shift lengths on nursing and patient outcomes in acute mental health units.

METHODS

This study is a retrospective comparative analysis of cross-sectional data between 32 inpatient mental health units that used 8-hour versus 12-hour shifts. Independent samples t test was used to examine differences on several staffing, quality, and safety measures.

RESULTS

A moderate effect size was found between the groups in quality and safety measures involving patient disruptive behaviors, with the 8-hour group having more desirable outcomes.

CONCLUSIONS

Nurse leaders in acute mental health units should consider the impacts of shift length on quality and safety when determining staffing patterns. More research is needed to evaluate correlations or causality.

Nurses' perceptions of night shifts: A qualitative study

AIM

To describe the experiences and perceptions of emergency nurses regarding the shortening of night shifts and identify aspects of nurses' preferences for night shifts.

BACKGROUND

Shift work can be associated with distinct physical and psychological disadvantages for nurses, especially night nurses. Knowledge regarding the factors influencing their perceptions of night shifts is limited.

METHODS

A qualitative description design. Fifteen nurses from the emergency setting with 6 to 14 years of work experience participated in interviews. Semistructured interviews were conducted between November 2018 and March 2019. A thematic analysis was performed for the data analysis.

FINDINGS

The following three themes emerged: (1) maintaining quality within quantity, (2) maintaining comfort within busyness, and (3) buffering the gap between ideal and reality.

CONCLUSIONS

Considering work intensity and patient safety, nurses believe that an 8 h night shift is the most suitable length for the emergency department. Long shifts are probably more suitable for other departments with lower night workloads.

Because they're worth it? A discussion paper on the value of 12-h shifts for hospital nursing

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.

Nurse workforce scheduling: A qualitative study of Indonesian nurse managers' experiences during the COVID-19 pandemic

Background

The increase in COVID-19 cases in Indonesia has resulted in changes in the hospital workflow, including the staffing process and scheduling, especially in the isolation units. Nurse managers are working hard in the scheduling system to ensure high-quality care is provided with the best human resources.

Objective

This study aimed to explore the experiences of nurse managers in managing staff nurses' work schedules during the COVID-19 pandemic.

Methods

A qualitative descriptive design was used in this study. Eleven nurse managers from three COVID-19 referral hospitals were selected using purposive sampling. Data were collected using online semi-structured interviews. Thematic analysis was used for data analysis, and data were presented using a thematic tree. Consolidated criteria for reporting qualitative research (COREQ) checklist was used as a reporting guideline of the study.

Results

Four themes were developed: (i) Nurse shortage, (ii) Strategically looking for ways to fulfill the workforce, (iii) Change of shift schedule, and (iv) Expecting guidance from superiors and compliance from staff.

Conclusion

The lack of nurse staff is a problem during a pandemic. Thus, managing personnel effectively, mobilizing and rotating, and recruiting volunteers are strategies to fulfill the workforce during the pandemic. Using a sedentary shift pattern and sufficient holidays could prevent nurses from falling ill and increase compliance with scheduling. In addition, a staffing calculation formula is needed, and top nursing managers are suggested to provide guidance or direction to the head nurses to reduce confusion in managing the work schedule during the pandemic.

The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study

BACKGROUND

Healthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied.

OBJECTIVE

To determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures.

DESIGN

A quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested).

SETTING

Participants were tested in a northwestern US university's nursing simulation laboratory.

PARTICIPANTS

A volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals.

METHODS

Simulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness.

RESULTS

In our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors.

CONCLUSIONS AND RELEVANCE

Nurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts-if any-on patient care. Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

Nurses' experiences and preferences around shift patterns: A scoping review

OBJECTIVE

To explore the evidence on nurses' experiences and preferences around shift patterns in the international literature.

DATA SOURCES

Electronic databases (CINHAL, MEDLINE and Scopus) were searched to identify primary studies up to April 2021.

METHODS

Papers reporting qualitative or quantitative studies exploring the subjective experience and/or preferences of nurses around shift patterns were considered, with no restrictions on methods, date or setting. Key study features were extracted including setting, design and results. Findings were organised thematically by key features of shift work.

RESULTS

30 relevant papers were published between 1993 and 2021. They contained mostly qualitative studies where nurses reflected on their experience and preferences around shift patterns. The studies reported on three major aspects of shift work: shift work per se (i.e. the mere fact of working shift), shift length, and time of shift. Across all three aspects of shift work, nurses strive to deliver high quality of care despite facing intense working conditions, experiencing physical and mental fatigue or exhaustion. Preference for or adaptation to a specific shift pattern is facilitated when nurses are consulted before its implementation or have a certain autonomy to self-roster. Days off work tend to mitigate the adverse effects of working (short, long, early or night) shifts. How shift work and patterns impact on experiences and preferences seems to also vary according to nurses' personal characteristics and circumstances (e.g. age, caring responsibilities, years of experience).

CONCLUSIONS

Shift patterns are often organised in ways that are detrimental to nurses' health and wellbeing, their job performance, and the patient care they provide. Further research should explore the extent to which nurses' preferences are considered when choosing or being imposed shift work patterns. Research should also strive to better describe and address the constraints nurses face when it comes to choice around shift patterns.