Abstract
Aims and objectivesTo examine the association between registered nurses' (referred to as “nurses” for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers.BackgroundThe introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps.DesignCross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries.MethodsThe associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist.ResultsWhen nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant.ConclusionWorking shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care.Relevance to clinical practiceImplementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients.
Highlights
Shifts of 12 hr or more, referred to as “long shifts” for hospi‐ tal nursing have been introduced in many countries (Griffiths et al, 2014)
The potential benefits of reduced number of handovers resulting from implementing shifts of 12 hr or more have never been formally tested; in this study, we aimed to examine the association between nurses' shifts of 12 hr or more and time for active staff de‐ velopment or continuing education activities; opportunity to discuss patient care with other nurses; assignments that foster continuity of care; and important patient information being lost during handover
This study is one of the first to examine the association between long shifts and aspects of nursing work, including ability to partici‐ pate in continuing education activity and discuss patient care; and aspects of quality of care, including continuity of care and informa‐ tion loss during handover in Europe using a multi‐country multilevel design
Summary
Shifts of 12 hr or more, referred to as “long shifts” for hospi‐ tal nursing have been introduced in many countries (Griffiths et al, 2014) These long shifts offer the opportunity to remove one hando‐ ver between shifts each day and to reduce overlaps between shifts, leading to fewer staffing hours to be paid for (Ganong, Ganong, & Harrison, 1976; NHS Evidence, 2010). Handovers are high‐risk processes that can lead to inconsistency in continuity of patient care and, as a result, to patient safety incidents. This is mainly due to mis‐ communication between healthcare providers (Cohen & Hilligoss, 2010; Raduma‐Tomas, Flin, Yule, & Williams, 2011). Some early small scale reports suggested that nurses moving to shifts of 12 hr or more had fewer opportunities to participate in
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