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

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

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.

12‐hr shifts, health resources, nurses, personnel staffing and scheduling, quality of healthcare, shift work schedule
0020-7489
Saville, Christina
2c726abd-1604-458c-bc0b-daeef1b084bd
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Saville, Christina
2c726abd-1604-458c-bc0b-daeef1b084bd
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b

Saville, Christina, Dall'ora, Chiara and Griffiths, Peter (2020) The association between 12-hour shifts and nurses-in-charge's perceptions of missed care and staffing adequacy: a retrospective cross-sectional observational study. International Journal of Nursing Studies, 112, [103721]. (doi:10.1016/j.ijnurstu.2020.103721).

Record type: Article

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.

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Accepted/In Press date: 8 May 2020
e-pub ahead of print date: 20 July 2020
Published date: 1 December 2020
Additional Information: Funding Information: This report presents independent research funded by the United Kingdom's National Institute for Health Research (NIHR) Health Services and Delivery Research programme award number 14/194/21. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This paper draws on research and data reported in the NIHR Journals Library Health Services and Delivery Journal ( Griffiths et al., 2020 ). Data are available from the corresponding author on reasonable request. Publisher Copyright: © 2020 Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
Keywords: 12‐hr shifts, health resources, nurses, personnel staffing and scheduling, quality of healthcare, shift work schedule

Identifiers

Local EPrints ID: 441381
URI: http://eprints.soton.ac.uk/id/eprint/441381
ISSN: 0020-7489
PURE UUID: 7a1417ef-d0e9-4169-b67d-dee7b083147f
ORCID for Christina Saville: ORCID iD orcid.org/0000-0001-7718-5689
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

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Date deposited: 11 Jun 2020 16:30
Last modified: 06 Jun 2024 02:00

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