The association between 12-hour shifts and nurses-in-charge's perceptions of missed care and staffing adequacy: a retrospective cross-sectional observational study

Abstract

Background Due to worldwide nursing shortages and difficulty retaining staff, long shifts for nursing staff (both registered nurses and nursing assistants) working in hospitals have been adopted widely. Because long shifts reduce the daily number of shifts from three to two, many assume that long shifts improve productivity by removing one handover and staff overlap. However, it is unclear whether staffing levels are more likely to be perceived as adequate when more long shifts are used. Objectives To investigate the association between the proportion of long (≥12‐hour) shifts worked on a ward and nurses-in-charge's perceptions that the staffing level was sufficient to meet patient need. Methods A retrospective cross-sectional study using routinely collected data (patient administrative data and rosters) linked to nurses-in-charge's reports from 81 wards within four English hospitals across 1 year (2017). Hierarchical logistic regression models were used to determine associations between the proportion of long shifts and nurses-in-charge's reports of having enough staff for quality or leaving necessary nursing care undone, after controlling for the staffing level relative to demand (shortfall). We tested for interactions between staffing shortfall and the proportion of long shifts. Results The sample comprised 19648 ward days. On average across wards, 72% of shifts were long. With mixed short and long shifts, the odds of nurses-in-charge reporting that there were enough staff for quality were 14-17% lower than when all shifts were long. For example, the odds of reporting enough staff for quality with between 60-80% long shifts was 15% lower (95% confidence interval 2% to 27%) than with all long shifts. Associations with nursing care left undone were consistent with this pattern. Although including interactions between staffing shortfalls and the proportion of long shifts did not improve model fit, the effect of long shifts did appear to differ according to shortfall, with lower proportions of long shifts associated with benefits when staffing levels were high relative to current norms. Conclusions Rather than a clear distinction between wards using short and long shifts, we found that a mixed pattern operated on most days and wards, with no wards using all short shifts. We found that when wards use exclusively long shifts rather than a mixture, nurses-in-charge are more likely to judge that they have enough staff. However, the adverse effects of mixed shifts on perceptions of staffing adequacy may be reduced or eliminated by higher staffing levels. ISRCTN 12307968. Tweetable abstract 12-hour shifts in nursing: a mix of short and long shifts may be worse than all long shifts.

The Factor Associated with Missed Nursing Care in Hospital: A Systematic Review

“…tasks, and insufficient quality improvement (Albsoul et al, 2019. Similarly inadequate staffing was linked to an increase in the number of missed activities as well as heavy workloads [2], [16].…”

“…Cho et al, (2017), explained lower patient-perceived staffing adequacy is linked to more missed care and adverse events. Furthermore, poorer staffing is associated with increased missed activities and heavy workloads such as a lack of management support, ineffective handover, a breakdown in communication between the nursing team and the medical staff, a lack of time to complete tasks, and a lack of quality improvement [16]. Appropriate workforce policies and practices are required to reduce the risk of missed care and patients dying as a result of factors under the control of the health system, such as safe nurse staffing.…”

The Effect of Staggered Shift Scheduling Mode on Nurses in the COVID-19 Isolation Ward- A Cross Sectional Study

“…Therefore, we thought that the 6-h (overlapping by 1 h) scheduling mode is more reasonable, which can not only reasonably save the consumption of protective clothing, but also reduce the discomfort of nurses. 27…”

“…Therefore, we thought that the 6-h (overlapping by 1 h) scheduling mode is more reasonable, which can not only reasonably save the consumption of protective clothing, but also reduce the discomfort of nurses. 27 To sum up, in a special period and under specific conditions, providing nurses with flexible 1-h buffer time, not only can staggered shifts reduce their work intensity and physical exertion per unit time, but also save materials reasonably and improve nurses' work satisfaction, so that the human resources and protective materials in the isolation ward can be used more reasonably and effectively. 28,29…”

Shift work in nursing: closing the knowledge gaps and advancing innovation in practice

“…Given the essential role correct hand hygiene plays in preventing transmission of COVID-19 ( World Health Organization, 2020a ), any changes to shift patterns which imply nurses’ lower compliance with hand antisepsis may have unintended consequences and should therefore be discouraged. A further innovation in this special issue has been analysing the effects of 12-hour shifts by exploration of ward managers’ views of staffing adequacy: by looking at objective shift data, authors found that mixed shift patterns are detrimental to perceptions of staffing adequacy, indicating that 12-hour shifts are not a solution to improving availability of nursing staff ( Saville et al., 2020 ). The consequences of moving to long shifts appear to go beyond decreased job performance, but also include poor nurse wellbeing and reduced opportunities for social support, as investigated by the first study in nursing to follow-up nurses and outcomes over a post implementation period of 12 months ( Suter et al., 2020 ).…”