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)

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.

Ruth’s week

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

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)

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): 975-81

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)

… 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

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

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?

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.

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

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

Thanks for your attention Any thoughts, comments or questions?