Overtime and alertness of rotating‐shift nurses: An observational study using ecological momentary assessment

Abstract

Aims and objectives This study aimed to determine the effect of overtime on alertness at work among rotating‐shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts. Background Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work. Design A prospective observational study was employed. The study followed STROBE checklist for observational studies. Methods Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real‐time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed‐effect models were employed to investigate the association between overtime and alertness. Results A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous‐day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous‐day overtime hours and consecutive overtime days in all shifts. Conclusions The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty. Relevance to clinical practice Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

Overtime on a rotating-shift pattern impacts nurses’ alertness increasing risks for patients

“…Except for the association between evenings and overtime, all components of the hypothesised model were shown to be statistically significant. According to the findings, while there was no significant relationship between previous-day overtime hours and alertness ratings of 80, there was a significant correlation between sequential overtime days 1…”

“…The overtime hours were calculated using the participants’ clock-in and clock-out times. The mean difference in overtime hours per shift among shift types was investigated using a linear mixed model1; model also used to examine the correlations between previous-day overtime hours and following overtime days with the nurses’ alertness 1. Mixed-effects binomial logistic regression was used to assess the influence of previous-day overtime hours and consecutive overtime days when alertness scores were ≤80 1…”

“…Nurses are typically scheduled to work long rotating shifts and routinely incorporate overtime to allow hospitals to provide round-the-clock care to patients. This can exacerbate fatigue diminishing productivity and making nurses more prone to errors 1. Recent studies highlighted the association between nurses’ overtime and poor patient outcomes with a call for further research required 2.…”

“…Recent studies highlighted the association between nurses’ overtime and poor patient outcomes with a call for further research required 2. When studying the impact of overtime on alertness in rotating shifts, Min et al employed an ecological momentary assessment (EMA) to allow participants to recount their own real-time experiences at specific time points to reduce recollection bias 1…”

“…This represents a typical strategy used to address chronic understaffing and to deal with natural fluctuations in patient flow. The underpinning mechanism of the link between nurse overtime, nursing injuries and adverse patient events is that working overtime or long hours increases weariness, impairing alertness and attention on both normal and extra shifts 1 4 5. Even though fatigue has been linked to poor patient, staff and organisational outcomes, healthcare organisations continue to schedule nurses for long rotating shifts in order to satisfy round-the-clock care and nurses’ preferences.…”