1. Doctoral student, University of Southampton
Nurses’ shift patterns and the association with patient safety and nurse absenteeism
Chiara Dall’Ora
Doctoral student, University of Southampton
Collaboration for Leadership in Applied Health Research and Care (Wessex)

2. Ruth’s case
Ruth is a registered nurse at Southampton General Hospital. She currently lives in Brighton (and she loves it) and can do so thanks to the shift patterns in her ward. Her ward deployed a 12.5-h shift system, meaning that she can work 3 consecutive 12.5-h shifts and then benefit from 4 days off in Brighton. Let us have a look at her typical week.

3. Ruth’s week

4. Benefits 4 consecutive days off More free time from work
Fewer long commutes (v 10 long commutes with a 8-h shift pattern)
Commute costs reduced
Better work-life balance

5. Downsides Fatigue at the end of the long shift
Cumulative fatigue at the end of the 3rd long shift
Sleep deprivation
Decreased alertness
Weariness after long commutes
Potential threat to patient safety
Potential threat to personal safety and
community safety
(Risk of drowsy driving/accidents)

6. The evidence so far…
Studies conducted by the CLAHRC showed that shifts of 12-h or longer are associated with:
decreases in patient safety and
poor quality of care
more missed care (care left undone)
when compared to their peers working 8 hours or less.
Griffiths P, Dall'ora C, Simon M, et al(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):

7. More evidence…
A further CLAHRC study showed that 12-h or longer shifts are associated with higher levels of
burnout
job dissatisfaction
intention to leave the job
Dall’Ora C, Griffiths P, Ball J, Simon M and Aiken LH (2015) Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from a cross-sectional study of 12 European countries. BMJ Open 5 (9)

8. … Why if 12-h shifts improve work life balance?
Job satisfaction ≠ life satisfaction
Cumulative long shifts may have a negative effect on wellbeing
Days off may be spent recovering from consecutive long shifts

9. However
Shift length is not the only shift characteristic that can impact on patient and nurse outcomes… Shift work involves numerous characteristics:
weekly work hours
compressed working week
overtime
night work/rotating or fixed shifts
rest opportunities
Dall’Ora C, Ball J, Recio-Saucedo A and Griffiths P (2016) Characteristics of shift work and their impact on employee performance and wellbeing: A literature review. International Journal of Nursing Studies 57: 12-27

10. New CLAHRC study Research Questions:
What is the association between patterns of nurses shift work in acute hospital wards and patient safety?
What is the association of patterns of nurses shift work in acute hospital wards and nurses’ wellbeing at work?
What is the optimal combination of nurses’ shift characteristics to ensure adequate patient surveillance?

11. Methods
I have access to routinely collected data of a CLAHRC Wessex Trust. Data will cover ward nurses’ shifts patterns, missed vital signs observations and nurses’ absenteeism.

12. What will my study add?
One of the first shift work studies based on objective measurements
One of the first shift work studies using longitudinal data
One of the first shift work studies to examine together the impact of a set of shift characteristics
Extended knowledge and criteria to inform shift planning

13. Something for Ruth (and not only)…
Ruth may become aware of potential downsides of working her actual shift pattern
Her manager may have access to robust data to plan safe shifts
The patients Ruth cares for may benefit from the care of a less fatigued and worn out nurse, with lower risks of errors and adverse events

14. Thanks for your attention
Any thoughts, comments or questions?