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Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety

Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety
Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety
Background: Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs.

Objectives: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone.

Methods: Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries.

Results: A total of 50% of nurses worked shifts of <=8 hours, but 15% worked >=12 hours. Typical shift length varied between countries and within some countries. Nurses working for >=12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13-1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10-1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09-1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51-1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23-1.42), and more care left undone (RR=1.29; 95% CI, 1.27-1.31).

Conclusions: European registered nurses working shifts of >=12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.
0025-7079
975-981
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Simon, Michael
6e9ad30e-c22f-455a-945e-98d77dcec479
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Lindqvist, Rikard
23451573-1677-473e-8f1a-326c3b72c9ef
Rafferty, Anne-Marie
ffa430c1-b88e-4028-96e2-bb458cebf5d9
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Tishelman, Carol
11d9dd11-f992-48d7-b8ef-a9f428a809d6
Aiken, Linda H.
6110096b-bab9-41a7-89f4-d7043011d6d9
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Simon, Michael
6e9ad30e-c22f-455a-945e-98d77dcec479
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Lindqvist, Rikard
23451573-1677-473e-8f1a-326c3b72c9ef
Rafferty, Anne-Marie
ffa430c1-b88e-4028-96e2-bb458cebf5d9
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Tishelman, Carol
11d9dd11-f992-48d7-b8ef-a9f428a809d6
Aiken, Linda H.
6110096b-bab9-41a7-89f4-d7043011d6d9

Griffiths, Peter, Dall'ora, Chiara, Simon, Michael, Ball, Jane, Lindqvist, Rikard, Rafferty, Anne-Marie, Schoonhoven, Lisette, Tishelman, Carol and Aiken, Linda H. (2014) Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety. Medical Care, 52 (11), 975-981. (doi:10.1097/MLR.0000000000000233). (PMID:25226543)

Record type: Article

Abstract

Background: Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs.

Objectives: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone.

Methods: Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries.

Results: A total of 50% of nurses worked shifts of <=8 hours, but 15% worked >=12 hours. Typical shift length varied between countries and within some countries. Nurses working for >=12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13-1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10-1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09-1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51-1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23-1.42), and more care left undone (RR=1.29; 95% CI, 1.27-1.31).

Conclusions: European registered nurses working shifts of >=12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.

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e-pub ahead of print date: 15 September 2014
Published date: November 2014
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 369579
URI: http://eprints.soton.ac.uk/id/eprint/369579
ISSN: 0025-7079
PURE UUID: 63850386-3ad8-45ca-8bf4-2c608c826610
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857
ORCID for Chiara Dall'ora: ORCID iD orcid.org/0000-0002-6858-3535
ORCID for Jane Ball: ORCID iD orcid.org/0000-0002-8655-2994
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 07 Oct 2014 12:22
Last modified: 26 Nov 2019 01:39

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Contributors

Author: Peter Griffiths ORCID iD
Author: Chiara Dall'ora ORCID iD
Author: Michael Simon
Author: Jane Ball ORCID iD
Author: Rikard Lindqvist
Author: Anne-Marie Rafferty
Author: Lisette Schoonhoven ORCID iD
Author: Carol Tishelman
Author: Linda H. Aiken

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