Improving the Experiences of Night Shift Nurses in Australian Regional Public Hospitals: An Action Research Project

Purpose:  To develop a participatory plan to improve the working experience of night shift nurses and enhance delivery of patient care in Australian regional acute inpatient facilities.

Methods:  A participatory action research approach was utilised to take up the findings of an initiating qualitative research study which explored the expressed needs and experiences of regional Australian night shift nurses. The original research study was conducted by the presenting author in 2011.  A study reference group consisting of night shift clinical nurses and nurse managers took a problem solving approach to working with the data from the initial study. Key areas for potential action/change were identified.  In 2012, the reference group invited nurses from four regional hospitals to contribute their ideas via focus groups (primary data source), email or anonymous open-ended questionnaire.  Separate focus groups were held for managers and nurses. Focus group facilitators were not in organisational or managerial relationships with focus group participants. Focus group discussions and open-ended questionnaires were organised around the key potential action/change domains derived from the initiating study.  These domains were: professional development; leadership and support; interdepartmental cooperation; communication and valuing the night shift role.  Specific action steps were developed within each domain.

Results:  Sixty-nine nurses and nurse managers attended focus groups across the four hospital sites, 54 questionnaires were returned and four emails were received. Opportunistic conversations were held between reference group members and nurses during this phase of the study period.  A constructivist paradigm was employed in the interpretation of all study data in order to develop solutions to problems of both a practical and professional-cultural nature.  Nurse empowerment was a key interpretive lens used to derive potential changes and solutions from the data.  A spectrum of findings evolved that grouped naturally into two categories based on a locus of approval for change.  Five potential actions required changes to nursing related legislation (Category 1).  Sixty-four primary action steps and 36 secondary action steps that were within the scope of control of local health district managers or their staff were identified (Category 2).

Conclusion:  Some of the changes sought by the night shift nurses could only be achieved through extensive lobbying and legislation. Many more identified positive change areas were actionable locally.  A number of these changes were potentially cost neutral. The views of the nurses and nurse managers relating to identified changes were not always in agreement.  Nonetheless, through mutual consideration, major improvements for the night shift are being planned and actioned.  This workplace improvement project is ongoing and the action research reference group continues to meet and inform/guide cycles of localised change as they develop.