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Nurses’ 12-hour shifts and missed or delayed vital signs observations on hospital wards: retrospective observational study

Nurses’ 12-hour shifts and missed or delayed vital signs observations on hospital wards: retrospective observational study
Nurses’ 12-hour shifts and missed or delayed vital signs observations on hospital wards: retrospective observational study
Objectives: 12-hour shifts worked by nurses on acute hospital wards have been associated with increased rates of missed care reported by nurses. This study aimed to measure the association between nurses working shifts of at least 12 hours and an objective measure of missed care – vital signs observations taken on time according to an acuity-based surveillance protocol.

Design: A retrospective observational study using routinely collected data from March 2012 to March 2015.

Setting: 32 general inpatient wards at a large acute hospital in England.

Participants: 658,628 nursing shifts nested in 24,069 ward-days.

Outcome measures: The rate of daily delayed and missed vital signs observations. We focussed on situations where vital signs observations were required at least every 4 hours and measured the number of instances where observations were delayed or missed, per 24-hour period. For each ward and each day, shift patterns were characterised in terms of proportion of care hours per patient day deriving from “long” shifts (≥12-hour) for both registered nurses and healthcare assistants.

Results: On 99,043 occasions (53%) observations were significantly delayed, and on 81,568 occasions (44%) observations were missed. Observations were more likely to be delayed when a higher proportion of the hours worked by healthcare assistants were part of long shifts (IRR = 1.05; 95% CI: 1.00-1.10). No significant association was found in relation to the proportion of hours registered nurses worked as long shifts.

Conclusion: On days when a higher proportion of hours worked by health care assistants are from long shifts, the risk of delaying vital signs observations is higher, suggesting lower job performance. While longer shifts are thought to require fewer staff resources to maintain nurse to patient ratios, any benefits may be lost if staff become less productive
2044-6055
1-6
Dall'Ora, Chiara
8e26f9ed-5ea5-46b0-91fc-4c7a8aa26f7a
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Redfern, Oliver
6a813657-1f29-4085-8807-e24e32723e15
Recio Saucedo, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Meredith, Paul
d0a0e287-ad7f-41cb-9347-94d7a0e957c1
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Missed Care Study Group
Dall'Ora, Chiara
8e26f9ed-5ea5-46b0-91fc-4c7a8aa26f7a
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Redfern, Oliver
6a813657-1f29-4085-8807-e24e32723e15
Recio Saucedo, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Meredith, Paul
d0a0e287-ad7f-41cb-9347-94d7a0e957c1
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1

Dall'Ora, Chiara, Griffiths, Peter, Redfern, Oliver, Recio Saucedo, Alejandra, Meredith, Paul and Ball, Jane , Missed Care Study Group (2019) Nurses’ 12-hour shifts and missed or delayed vital signs observations on hospital wards: retrospective observational study. BMJ Open, 9 (1), 1-6. (doi:10.1136/bmjopen-2018-024778).

Record type: Article

Abstract

Objectives: 12-hour shifts worked by nurses on acute hospital wards have been associated with increased rates of missed care reported by nurses. This study aimed to measure the association between nurses working shifts of at least 12 hours and an objective measure of missed care – vital signs observations taken on time according to an acuity-based surveillance protocol.

Design: A retrospective observational study using routinely collected data from March 2012 to March 2015.

Setting: 32 general inpatient wards at a large acute hospital in England.

Participants: 658,628 nursing shifts nested in 24,069 ward-days.

Outcome measures: The rate of daily delayed and missed vital signs observations. We focussed on situations where vital signs observations were required at least every 4 hours and measured the number of instances where observations were delayed or missed, per 24-hour period. For each ward and each day, shift patterns were characterised in terms of proportion of care hours per patient day deriving from “long” shifts (≥12-hour) for both registered nurses and healthcare assistants.

Results: On 99,043 occasions (53%) observations were significantly delayed, and on 81,568 occasions (44%) observations were missed. Observations were more likely to be delayed when a higher proportion of the hours worked by healthcare assistants were part of long shifts (IRR = 1.05; 95% CI: 1.00-1.10). No significant association was found in relation to the proportion of hours registered nurses worked as long shifts.

Conclusion: On days when a higher proportion of hours worked by health care assistants are from long shifts, the risk of delaying vital signs observations is higher, suggesting lower job performance. While longer shifts are thought to require fewer staff resources to maintain nurse to patient ratios, any benefits may be lost if staff become less productive

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More information

Accepted/In Press date: 5 November 2018
e-pub ahead of print date: 1 February 2019

Identifiers

Local EPrints ID: 425942
URI: https://eprints.soton.ac.uk/id/eprint/425942
ISSN: 2044-6055
PURE UUID: 18c14fcd-670b-4d0b-8aba-35e2bc1a6d85
ORCID for Chiara Dall'Ora: ORCID iD orcid.org/0000-0002-6858-3535
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857
ORCID for Alejandra Recio Saucedo: ORCID iD orcid.org/0000-0003-2823-4573
ORCID for Jane Ball: ORCID iD orcid.org/0000-0002-8655-2994

Catalogue record

Date deposited: 07 Nov 2018 17:30
Last modified: 30 Apr 2019 04:01

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