Registered Nurses Extended Work Shifts and the Association with Quality of Nursing Care and Patient Safety: A Cross Sectional Survey in Twelve European Countries

Purpose: In some countries, there is a move toward nurses working shifts of longer duration to reduce time and cost of  shift handovers and staff overlap, and to potentially improve work life balance; ‘12 hour’ shifts have become  the norm in some countries and hospitals. However, concerns have been raised as to whether nurses can perform reliably and effectively when working longer shifts.  This presentation gives the results of a study that aims to describe shift patterns of European nurses and to investigate whether shift length  is associated with nurse-reported quality and safety of care and with aspects of needed nursing care left undone.

Methods: Cross-sectional survey of 31,627 registered nurses (RN) in 2170 general medical/surgical units within 487 acute general hospitals across 12 European countries. Multi-level regression modelling to explore associations between shift work and nurse reported measures of quality and safety of care.

Results: Most nurses (50.5%) reported working shifts  <8 hours, whilst 15% of nurses worked shifts  >12. There was considerable variation in typical shift length between countries and within some countries. For example in Spain 90% of day shifts were ≤8 hours compared to 45% in England  and 9% in Ireland with 73% of nurses working 12 hour day shifts. Working a shift of >12 hours was associated with nurses being more likely to report poor or failing patient safety (OR 1.46 95% CI 1.16 - 1.83), and poor or fair quality of care (OR 1.39, 95% CI 1.00-1.85). Nurses reported a significantly increased number of care activities needed, but left undone on their last shift when working any shift >8 hours (OR 1.04 to1.13). Working beyond contracted hours was also associated with reports of poor or fair quality of care (OR = 1.35), poor or failing patient safety (OR = 1.67) and missed care (OR = 1.29).

 

Conclusion: European nurses working 12 hours or longer and those working overtime were more likely to report low quality and safety ratings. Policies to adopt a 12 hour nursing shift length should proceed with caution. Use of overtime (i.e. working a longer shift than contracted) to mitigate staffing shortages or increase flexibility may also incur additional risk to quality. Further research is required using objective measures of quality and safety and patient experience.