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Crincoli S, de Cordova P, Thomas-Hawkins C, Flynn L, Zha P, Sagherian K. The Effects of Organizational Characteristics, Individual Nurse Characteristics, and Occupational Fatigue on Missed Care at Night. Nurs Res 2024; 73:101-108. [PMID: 37862123 DOI: 10.1097/nnr.0000000000000696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Missed care is defined as the omission or delay of necessary patient care and is internationally reported by nurses as a significant safety risk. Nurses working at night also report high levels of occupational fatigue that, coupled with inadequate staffing and practice environment support, may impede a nurse's ability to carry out the nursing process and lead to more missed care. OBJECTIVE The study's objective was to examine the interrelationships among organizational and nurse characteristics, occupational fatigue, and missed care among nurses working at night. METHODS A cross-sectional design was used. Participants included registered nurses (RNs) who worked at night in New Jersey acute care hospitals. Multiple linear regression and simple moderation analyses were performed to examine the associations. RESULTS Nurses reported missing necessary care at night. Unsupportive practice environments, high RN workloads, high patient-RN ratios, high chronic fatigue levels, and low intershift recovery were individually associated with missed care at night. High patient-to-RN ratios and chronic fatigue were independently associated with missed care. However, patient-to-registered-staffing levels had the most considerable effect on missed care at night. Nurses' years of experience and the number of hours of sleep between shifts were significant moderators of the relationship between occupational fatigue states and missed care. DISCUSSION This study is the first to examine the interrelationship between occupational fatigue levels, organizational and nurse characteristics, and missed care at night. There is an urgent need to implement strategies in hospital organizations that foster work schedules and adequate staffing patterns that lessen nurses' occupational fatigue levels to ensure our workforce's and patients' safety.
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Weaver SH, Hessels AJ, Paliwal M, Wurmser TA. From dusk to dawn: A healthy work environment for nurses working night shift. Nurs Manag (Harrow) 2023; 54:18-27. [PMID: 36998184 DOI: 10.1097/01.numa.0000921912.36370.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Susan H Weaver
- Susan H. Weaver is a nurse scientist at Hackensack Meridian Health Ann May Center for Nursing in Neptune, N.J., and the New Jersey Collaborating Center for Nursing in Newark, N.J. Amanda J. Hessels is an assistant professor at Columbia University School of Nursing in New York, N.Y., and a nurse scientist at Hackensack Meridian Health Ann May Center for Nursing in Neptune, N.J. Mani Paliwal is a senior biostatistician at Hackensack Meridian Health , Institute for Evidence Based Care in Edison, N.J. Theresa A. Wurmser is the vice president of nursing research, grants and academic affairs at Hackensack Meridian Health Ann May Center for Nursing in Neptune, N.J., the dean of the Georgian Court-Hackensack Meridian Health School of Nursing in Lakewood, N.J., and a member of the Nursing Management Editorial Board
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White EM, Travers JL, Gouskova N, Oh G, Syme M, Yang X, Montoya A, Feifer RA, Grabowski DC, Mor V, Berry SD. Differences In Nursing Home Staff COVID-19 Testing Rates And Odds Of Vaccination Across Work Shifts. Health Aff (Millwood) 2023; 42:217-226. [PMID: 36745839 PMCID: PMC9990769 DOI: 10.1377/hlthaff.2022.01011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
COVID-19 vaccination and regular testing of nursing home staff have been critical interventions for mitigating COVID-19 outbreaks in US nursing homes. Although implementation of testing has largely been left to nursing home organizations to coordinate, vaccination occurred through a combination of state, federal, and organization efforts. Little research has focused on structural variation in these processes. We examined whether one structural factor, the primary shift worked by staff, was associated with differences in COVID-19 testing rates and odds of vaccination, using staff-level data from a multistate sample of 294 nursing homes. In facility fixed effects analyses, we found that night-shift staff had the lowest testing rates and lowest odds of vaccination, whereas day-shift staff had the highest testing rates and odds of vaccination. These findings highlight the need to coordinate resources and communication evenly across shifts when implementing large-scale processes in nursing homes and other organizations with shift-based workforces.
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Affiliation(s)
| | | | | | | | | | | | - Ana Montoya
- Ana Montoya, University of Michigan, Ann Arbor, Michigan
| | - Richard A Feifer
- Richard A. Feifer, RAF Healthcare Solutions, Simsbury, Connecticut
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Ohnstad MO, Stensvold HJ, Pripp AH, Tvedt CR, Jelsness-Jørgensen LP, Astrup H, Eriksen BH, Lunnay ML, Mreihil K, Pedersen T, Rettedal SI, Selberg TR, Solberg R, Støen R, Rønnestad AE. Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks. Front Pediatr 2023; 11:1090701. [PMID: 37009293 PMCID: PMC10064049 DOI: 10.3389/fped.2023.1090701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Objective The objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age. Methods This was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored. Results We analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant's first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt. Conclusion Our finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.
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Affiliation(s)
- Mari Oma Ohnstad
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Christine Raaen Tvedt
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health and Welfare, Østfold University College, Halden, Norway
- Department of Internal Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Henriette Astrup
- Department of Pediatric and Adolescent Medicine, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Beate Horsberg Eriksen
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mai Linn Lunnay
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Khalaf Mreihil
- Department of Pediatrics and Adolescence Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Tanja Pedersen
- Neonatal Intensive Care Unit, Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Siren Irene Rettedal
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terje Reidar Selberg
- Department of Pediatrics and Adolescence Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Rønnaug Solberg
- Department of Pediatrics, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Støen
- Department of Neonatology, St Olavs - Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arild Erland Rønnestad
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Research Group for Clinical Neonatal Medicine and Epidemiology, Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Weaver SH, de Cordova PB, Vitale TR, Hargwood P, Salmond S. Experiences and perceptions of nurses working night shift: a qualitative systematic review. JBI Evid Synth 2023; 21:33-97. [PMID: 35975311 DOI: 10.11124/jbies-21-00472] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of this review was to examine the available evidence on the experiences and perceptions of nurses working the night shift within any specialty in the acute care, subacute, or long-term care setting. INTRODUCTION Nurses are required for around-the-clock patient care. Night shift nurses can experience detrimental effects because of their work hours, which disrupt their normal circadian rhythm. Understanding nurses' experiences and perceptions when working night shift will facilitate the development of strategies to minimize the potential negative effects of working at night. In examining nurses' experiences and perceptions of working night shift, there is scope to explore how to improve night shift nurses' practice environment and job satisfaction, which will then translate to improved nurse and patient outcomes. INCLUSION CRITERIA This review included qualitative studies focused on the experiences and perceptions of registered nurses and licensed practical nurses who work the night shift or rotate between day and night shift. METHODS This review followed the JBI methodology for systematic reviews of qualitative evidence. The methodology used was consistent with the a priori protocol. Studies included in this review were those published in full text, English, and between 1983 (when the seminal work on hospitals that attract and retain nurses was published) and February 2021, when the search was completed. The main databases searched for published and unpublished studies included MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science.From the search, two reviewers independently screened the studies against the inclusion criteria, and then papers selected for inclusion were assessed for methodological quality. Qualitative data were extracted from the included papers independently by the four reviewers. Results from each reviewer were discussed and clarified to reach agreement. The extracted findings were pooled and examined for shared meaning, coded, and grouped into categories. Common categories were grouped into meta-synthesis to produce a comprehensive set of synthesized findings. The final synthesized findings were graded using the ConQual approach to determine the level of confidence (trust) users may have in the value of the synthesized findings. RESULTS Thirty-four papers, representing 33 studies, met the criteria for inclusion. The studies were conducted in 11 countries across six continents, with a total of 601 participants. From these, a total of 220 findings were extracted and combined to form 11 categories based on similarity in meaning, and three syntheses were derived: i) The "Other" Shift: the distinctiveness of night nursing; ii) Juggling sleep and all aspects of life when working nights; and iii) Existing in the Twilight Zone: battling the negative impact of sleep deprivation consumes nurses who strive to keep patients, self, and others safe. CONCLUSIONS The major conclusions from this review are the uniqueness of working the night shift and the sleep deprivation of night nurses. Organizational strategies and support are needed for those working this shift, which will enhance nurse and patient safety. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019135294.
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Affiliation(s)
- Susan H Weaver
- Hackensack Meridian Health, Ann May Center for Nursing, Neptune, NJ, USA.,School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Pamela B de Cordova
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Tracy R Vitale
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Pamela Hargwood
- Robert Wood Johnson Library of the Health Sciences, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Susan Salmond
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Potrebny T, Igland J, Espehaug B, Ciliska D, Graverholt B. Individual and organizational features of a favorable work environment in nursing homes: a cross-sectional study. BMC Health Serv Res 2022; 22:1244. [PMID: 36217149 PMCID: PMC9552400 DOI: 10.1186/s12913-022-08608-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The organizational context in healthcare (i.e., the work environment) is associated with patient outcomes and job satisfaction. Long-term care is often considered to be a challenging work environment, characterized by high job demands, low job control, a fast work pace and job dissatisfaction, which may affect patient care and increase staff turnover.This study aims to investigate the organizational context in nursing homes and the features of favorable or less favorable work environments. METHODS This study is a cross-sectional study of registered nurses and licensed practical nurses in Bergen, Norway (n = 1014). The K-means clustering algorithm was used to differentiate between favorable and less favorable work environments, based on the Alberta Context Tool. Multilevel logistic regression analysis was used to investigate the associations between individual sociodemographic factors, nursing home factors and the probability of experiencing a favorable work environment. RESULTS 45% of the sample (n = 453) experienced working in a favorable work environment. Contextual features (especially a supportive work culture, more evaluation mechanisms and greater organizational slack resources) and individual features (having a native language other than Norwegian, working day shifts, working full time and belonging to a younger age group) significantly increased the likelihood of experiencing a favorable work environment. CONCLUSION The work environment in nursing homes is composed of modifiable contextual features. Action in relation to less favorable features and their associated factors should be a priority for nursing home management. This survey indicates that specific steps can be taken to reduce the reliance on part-time workers and to promote the work environment among staff working the night shift.
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Affiliation(s)
- Thomas Potrebny
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Jannicke Igland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Birgitte Espehaug
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Donna Ciliska
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Birgitte Graverholt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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The Role of the Work Environment in the Relationship Between Shiftwork and Sickness Absence. J Occup Environ Med 2022; 64:e509-e520. [DOI: 10.1097/jom.0000000000002603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hanser A, Hofbeck M, Knies R, Kumpf M, Müller N, Heimberg E. National Survey Regarding Motivation and Conditions of Physicians Working in a Pediatric Cardiac Intensive Care Unit. Thorac Cardiovasc Surg 2021; 69:e61-e67. [PMID: 34891179 PMCID: PMC8672882 DOI: 10.1055/s-0041-1736663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background The professional demands on the expertise in pediatric intensive care
have continuously increased in recent years. Due to a lack of applicants, the staffing of
a continuous shift service with qualified medical staff poses major challenges to the
hospitals. Methods A web-based questionnaire with 27 predominantly matrix questions on
working conditions and motivation for working in this area was sent to pediatric hospitals
throughout Germany. Results 165 doctors responded to the survey. The average age of the participants
was 35.2 years. The average weekend work load reported by 79% of the respondents was 2
weekends per month, 70% of the study participants performed five to seven night shifts per
month. 92% of the respondents stated that they basically enjoyed working in the intensive
care unit (ICU). When asked to prioritize the working conditions, an appreciative working
atmosphere in the team was named as priority 1 by 57%, followed by good guidance in the
independent performance of interventions (25%) and good working conditions (19%). Discussion The survey result shows that neither aspects of work–life balance nor
payments are the key issues selecting the interesting, but physically and emotionally
demanding job in pediatric ICU. Conclusion When evaluating vocational training in pediatric intensive care
medicine, the immediate working atmosphere in the team with mutual respect and
understanding and the guidance in training are more important than the general conditions.
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Affiliation(s)
- Anja Hanser
- Department for Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, Universitätsklinikum Tübingen, Tübingen, Baden Württemberg, Germany
| | - Michael Hofbeck
- Department for Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, Universitätsklinikum Tübingen, Tübingen, Baden Württemberg, Germany
| | - Ralf Knies
- Department for Pediatric Cardiology, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Matthias Kumpf
- Department for Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, Universitätsklinikum Tübingen, Tübingen, Baden Württemberg, Germany
| | - Nicole Müller
- Department for Pediatric Cardiology, Universitätsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Ellen Heimberg
- Department for Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, Universitätsklinikum Tübingen, Tübingen, Baden Württemberg, Germany
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Weaver SH, de Cordova PB, Vitale TR, Salmond S. Experiences and perceptions of nurses working night shift: a qualitative systematic review protocol. JBI Evid Synth 2021; 18:1278-1284. [PMID: 32813375 DOI: 10.11124/jbisrir-d-19-00187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this qualitative systematic review is to examine the available evidence on the experiences of nurses working the night shift within any specialty in the acute care, subacute, or long-term care setting. INTRODUCTION Nurses are required for round-the-clock patient care, and night shift nurses can experience detrimental effects as a result of their work hours. Understanding nurses' experiences when working night shift will facilitate the development of strategies to minimize the potential negative effects of working at night. In examining nurses' perceptions of working night shift, there is scope to explore how to improve night shift nurses' practice environment and job satisfaction, which will then translate to improved patient outcomes. INCLUSION CRITERIA This review will consider qualitative studies that include registered nurses and licensed practical nurses who work night shift or rotate between day and night shift. Night supervisors and advanced practice nurses will be excluded due to the potential for dissimilar experiences and resources within those groups. The search will be limited to studies published in English from 1983 to the present. METHODS The search strategy is designed to locate both published and unpublished qualitative studies by searching academic databases for published studies, gray literature, and hand searching reference lists. The study selection, critical appraisal, data extraction, and synthesis for this systematic review will be conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019135294.
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Affiliation(s)
- Susan H Weaver
- Hackensack Meridian Health, Ann May Center for Nursing, Neptune, USA.,Rutgers, the State University of New Jersey, School of Nursing, Newark, USA
| | | | - Tracy R Vitale
- Rutgers, the State University of New Jersey, School of Nursing, Newark, USA
| | - Susan Salmond
- Rutgers, the State University of New Jersey, School of Nursing, Newark, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence
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Abstract
OBJECTIVE. In recent decades, teleradiology has expanded considerably, and many radiology practices now engage in intraorganizational or extraorganizational teleradiology. In this era of patient primacy, optimizing patient care and care delivery is paramount. This article provides an update on recent changes, current challenges, and future opportunities centered around the ability of teleradiology to improve temporal and geographic imaging access. We review licensing and regulations and discuss teleradiology in providing services to rural areas and assisting with disaster response, including the response to the coronavirus disease (COVID-19) pandemic. CONCLUSION. Teleradiology can help increase imaging efficiency and mitigate both geographic and temporal discrepancies in imaging care. Technologic limitations and regulatory hurdles hinder the optimal practice of teleradiology, and future attention to these issues may help ensure broader patient access to high-quality imaging across the United States.
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Rolls DA, Khanna S, Boyle J, Xie Y, Good N, Romeo M, Bell A. After-hours emergency department care: Does time or day of arrival affect survival? Emerg Med Australas 2020; 33:232-241. [PMID: 32909351 DOI: 10.1111/1742-6723.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether after-hours presentation to EDs is associated with differences in 7-day and 30-day mortality. The influence of patient case-mix and workforce staffing differences are also explored. METHODS We conducted a retrospective observational study of 3.7 million ED episodes across 30 public hospitals in Queensland, Australia during May 2013-September 2015 using routinely collected hospital data linked to hospital staffing data and the death registry. Episodes were categorised as within/after-hours using time of presentation. Staffing was derived from payroll records and explored by defining 11 staffing ratios. RESULTS Weekend presentation was slightly more associated (7-day mortality odds ratio 1.05, 95% confidence interval [CI] 1.01-1.10) or no more associated (30-day mortality odds ratio 1.01, 95% CI 0.98-1.03) with death than weekday presentation. When weeknights are included in the 'after-hours' period, odds ratios are smaller, so that after-hours presentation is no more associated (7-day mortality odds ratio 1.03, 95% CI 0.99-1.08) or less associated (30-day mortality odds ratio 0.95, 95% CI 0.93-0.97) with death. No significant after-hours patient case-mix differences were observed between weekday and weekend presentations for 7-day mortality. In other combinations of outcome and after-hours definition, some differences (especially measures relating to severity of presenting condition) were found. Staffing ratios were not strongly associated with any within/after-hours differences in ED mortality. CONCLUSIONS After-hours presentation on the weekend to an ED is associated with higher 7-day mortality even after controlling for case-mix.
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Affiliation(s)
- David A Rolls
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - Sankalp Khanna
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Justin Boyle
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Yang Xie
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Sydney, New South Wales, Australia
| | - Norm Good
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Michelle Romeo
- Queensland Department of Health, Brisbane, Queensland, Australia
| | - Anthony Bell
- The Wesley Hospital, Auchenflower, Queensland, Australia
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Bernstrøm VH, Houkes I. Shift work and sickness absence at a Norwegian hospital: a longitudinal multilevel study. Occup Environ Med 2020; 77:555-563. [PMID: 32327467 DOI: 10.1136/oemed-2019-106240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Shift work is known to be related to several negative health consequences and sickness absence. Research results regarding the relationship between types of shift schedules and sickness absence and whether and how individual factors moderate this relationship, are mixed though. The present paper aims to provide more insight in these relationships. METHODS We used registry data from a large Norwegian hospital gathered for the years 2012-2016, for >14 000 employees. With random effects at the individual and unit levels, we analysed the relationship between shift schedule worked and sickness absence in the same year. RESULTS The results showed increased risk of short-term sickness absence for two-shift and three-shift rotations, as well as fixed night shifts compared with fixed-day shifts. We also found an increased number of absence periods for two-shift rotations without nights and three-shift rotations. Results for long-term sickness absence were mixed, with increased odds for two-shift rotations without nights, but reduced odds for three-shift rotations. We found partial support for a moderating influence of age, gender and parental status. CONCLUSIONS There is a clear relationship between working shifts and increased risk of short-term sickness absence. The relationship persists across gender, age group and parental status. The relationship between shift work and long-term sickness absence appears to be schedule and population specific. These findings may have implications for HR policies and the organisation of shift work in healthcare organisations.
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Affiliation(s)
| | - Inge Houkes
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Working-hour phenomenon in obstetrics is an attainable target to improve neonatal outcomes. Am J Obstet Gynecol 2019; 221:257.e1-257.e9. [PMID: 31055029 DOI: 10.1016/j.ajog.2019.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Giving birth in a health care facility does not guarantee high-quality care or favorable outcomes. The working-hour phenomenon describes adverse outcomes of institutional births outside regular working hours. OBJECTIVES The objectives of the study were to evaluate whether the time of birth is associated with adverse neonatal outcomes and to identify the riskiest time periods for obstetrical care. STUDY DESIGN This nationwide retrospective cohort study analyzed data from 2008 to 2016 from all 82 obstetric departments in Austria. Births at ≥ 23+0 gestational weeks with ≥500 g birthweight were included. Independent variables were categorized by the time of day vs night as core time (morning, day) and off hours (evening, nighttime periods 1-4). The composite primary outcome was adverse neonatal outcome, defined as arterial umbilical cord blood pH <7.2, 5 minute Apgar score <7, and/or admission to the neonatal intensive care unit. Multivariate logistic regression was used to develop a model to predict these adverse neonatal outcomes. RESULTS Of 462,947 births, 227,672 (49.2%) occurred during off hours and had a comparable distribution in all maternity units, regardless of volume (<500 births per year: 50.3% during core time vs 49.7% during off hours; ≥500 births per year: 50.7% core time vs 49.3% off hours; perinatal tertiary center: 51.2% core time vs 48.8% off hours). Furthermore, most women (35.8-35.9%) gave birth between 2:00 and 5:59 am (night periods 3 and 4). After adjustment for covariates, we found that adverse neonatal outcomes also occurred more frequently during these night periods 3 and 4, in addition to the early morning period (night 3: odds ratio, 1.05; 95% confidence interval, 1.03-1.08; P < .001; night 4: odds ratio, 1.08; 95% confidence interval, 1.05-1.10; P < .001; early morning period: odds ratio, 1.05; 95% confidence interval, 1.02-1.08; P < .001). The adjusted odds for adverse outcomes were lowest for births between 6:00 and 7:59 pm (odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .006). CONCLUSION There is an increased risk of adverse neonatal outcomes when giving birth between 2:00 and 7:59 am. The so-called working-hour phenomenon is an attainable target to improve neonatal outcomes. Health care providers should ensure an optimal organizational framework during this time period.
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Bernstrøm VH, Alves DE, Ellingsen D, Ingelsrud MH. Healthy working time arrangements for healthcare personnel and patients: a systematic literature review. BMC Health Serv Res 2019; 19:193. [PMID: 30917819 PMCID: PMC6437911 DOI: 10.1186/s12913-019-3993-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/06/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND A number of working time arrangements have been linked to negative consequences for both health personnel and their patients. A common hypothesis put forth to explain these findings suggests that certain working time arrangements lead to negative patient consequences due to the adverse impact they have on employee health. The purpose of this study is to use systematic reviews to investigate whether employee health explains the relationship between working time arrangements and patient safety. METHODS A systematic literature review was performed including published reviews and original studies from MEDLINE, PsycINFO, Cinahl and Web of Science investigating working time arrangements for healthcare personnel, employee health and patient safety. In addition, we screened reference lists of identified reviews. Two reviewers independently identified relevant publications according to inclusion criteria, extracted findings and assessed quality. RESULTS Six thousand nine hundred thirty papers were identified, of which 52 studies met our criteria. Articles were categorized into five groups according to how they approached the research question: 1) independent analyses of relationship between working time arrangements and employee health, and of working time arrangements and patient safety (5 studies); 2) relationship between working time arrangements on both employee health and patient safety (21 studies); 3) working time arrangements and employee health as two explanatory variables for patient safety (8 studies); 4) combinations of the above analyses (7 studies); 5) other relevant studies (5 studies). Studies that find that working time is detrimental to employee health, generally also find detrimental results for patient safety. This is particularly shown through increases in errors by health personnel. When controlling for employee health, the relationship between working time arrangements and patient safety is reduced, but still significant. CONCLUSIONS Results suggest that employee health partially (but not completely) mediates the relationship between working time arrangements and patient safety. However, there is a lack of studies directly investigating employee health as a mediator between working time arrangements and patient safety. Future studies should address this research gap.
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Affiliation(s)
- Vilde H. Bernstrøm
- OsloMet – Oslo Metropolitan University, Work Research Institute, P.O.Box 4 St. Olavs Plass, N-0130 OSLO, Oslo, Norway
| | - Daniele Evelin Alves
- OsloMet – Oslo Metropolitan University, Work Research Institute, P.O.Box 4 St. Olavs Plass, N-0130 OSLO, Oslo, Norway
| | - Dag Ellingsen
- OsloMet – Oslo Metropolitan University, Work Research Institute, P.O.Box 4 St. Olavs Plass, N-0130 OSLO, Oslo, Norway
| | - Mari Holm Ingelsrud
- OsloMet – Oslo Metropolitan University, Work Research Institute, P.O.Box 4 St. Olavs Plass, N-0130 OSLO, Oslo, Norway
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Duvald I, Moellekaer A, Boysen MA, Vest-Hansen B. Linking the severity of illness and the weekend effect: a cohort study examining emergency department visits. Scand J Trauma Resusc Emerg Med 2018; 26:72. [PMID: 30185223 PMCID: PMC6125948 DOI: 10.1186/s13049-018-0542-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite extensive research on the "weekend effect" i.e., the increased mortality associated with hospital admission during weekend, knowledge about disease severity in previous studies is limited. The aim of this study is to examine patient characteristics, including disease severity, 30-day mortality, and length of stay (LOS), according to time of admission to an emergency department. METHODS Our study encompassed all patients admitted to a Danish emergency department in 2014-2015. Using data from electronic patient records, this study examines patient characteristics including age, gender, Charlson Comorbidity Index score, triage score, and primary diagnosis. Triage score and transfer to intensive care unit (ICU) were used as indicators of disease severity. LOS within the department and within the hospital was examined. Age- and sex-standardized 30-day mortality rates comparing patients with the same triage score admitted at daytime, evening, and nighttime on weekdays and on weekends were computed. To test differences, a Cox regression analysis was added. RESULTS We included 35,459 patient visits, of which 10,435 (32%) started on a weekend. There were no large differences in baseline characteristics between patients admitted on weekdays and those admitted on weekends. The relative risk (RR) for being triaged orange or red was 1.16 (95% confidence interval (CI) 1.06-1.28, P = 0.0017) for weekend admissions as compared with weekday admissions. Weekend admissions were twice as likely as weekday admissions to be transferred to the ICU (RR, 1.96; 95% CI 1.53-2.52, P = 0.0000). No significant changes were found in LOS. The 30-day mortality rate increased with disease severity regardless of time of admission. When comparing the 30-day mortality rate for patients with the same triage score, the trend was toward a higher mortality when admission occurred during the weekend. Increasing mortality rate was significant for patients admitted at evening on weekends with a hazard ratio of 1.32 (95% CI 1.03-1.70, P = 0.027) when compared with patients admitted on daytime on weekdays. CONCLUSIONS When comparing weekday and weekend admissions, the 30-day mortality rate increased for patients admitted at evening on weekends after adjusting for comorbidity and triage score, indicating that the weekend effect was independent of changes in illness severity.
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Affiliation(s)
- Iben Duvald
- Interdisciplinary Centre for Organizational Architecture, Department of Management, Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, build. 2610-336, 8210 Aarhus V, Denmark
- DESIGN EM – Research Network for Organizational Design and Emergency Medicine, Fuglesangs Allé 4, build. 2610, 8210 Aarhus V, Denmark
- Department of Business Development and Technology, Business and Social Sciences, Aarhus University, Birk Centerpark 15, 7400 Herning, Denmark
| | - Anders Moellekaer
- DESIGN EM – Research Network for Organizational Design and Emergency Medicine, Fuglesangs Allé 4, build. 2610, 8210 Aarhus V, Denmark
- Research Center for Emergency Medicine, Department of Clininal Medicine, Aarhus University and Department of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Betina Vest-Hansen
- Research Center for Emergency Medicine, Department of Clininal Medicine, Aarhus University and Department of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
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Patterson PD, Runyon MS, Higgins JS, Weaver MD, Teasley EM, Kroemer AJ, Matthews ME, Curtis BR, Flickinger KL, Xun X, Bizhanova Z, Weiss PM, Condle JP, Renn ML, Sequeira DJ, Coppler PJ, Lang ES, Martin-Gill C. Shorter Versus Longer Shift Durations to Mitigate Fatigue and Fatigue-Related Risks in Emergency Medical Services Personnel and Related Shift Workers: A Systematic Review. PREHOSP EMERG CARE 2018; 22:28-36. [PMID: 29324079 DOI: 10.1080/10903127.2017.1376135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study comprehensively reviewed the literature on the impact of shorter versus longer shifts on critical and important outcomes for Emergency Medical Services (EMS) personnel and related shift worker groups. METHODS Six databases (e.g., PubMed/MEDLINE) were searched, including one website. This search was guided by a research question developed by an expert panel a priori and registered with the PROSPERO database of systematic reviews (2016:CRD42016040099). The critical outcomes of interest were patient safety and personnel safety. The important outcomes of interest were personnel performance, acute fatigue, sleep and sleep quality, retention/turnover, long-term health, burnout/stress, and cost to system. Screeners worked independently and full-text articles were assessed for relevance. Data abstracted from the retained literature were categorized as favorable, unfavorable, mixed/inconclusive, or no impact toward the shorter shift duration. This research characterized the evidence as very low, low, moderate, or high quality according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. RESULTS The searched yielded n = 21,674 records. Of the 480 full-text articles reviewed, 100 reported comparisons of outcomes of interest by shift duration. We identified 24 different shift duration comparisons, most commonly 8 hours versus 12 hours. No one study reported findings for all 9 outcomes. Two studies reported findings linked to both critical outcomes of patient and personnel safety, 34 reported findings for one of two critical outcomes, and 64 did not report findings for critical outcomes. Fifteen studies were grouped to compare shifts <24 hours versus shifts ≥24 hours. None of the findings for the critical outcomes of patient and personnel safety were categorized as unfavorable toward shorter duration shifts (<24 hours). Nine studies were favorable toward shifts <24 hours for at least one of the 7 important outcomes, while findings from one study were categorized as unfavorable. Evidence quality was low or very low. CONCLUSIONS The quality of existing evidence on the impact of shift duration on fatigue and fatigue-related risks is low or very low. Despite these limitations, this systematic review suggests that for outcomes considered critical or important to EMS personnel, shifts <24 hours in duration are more favorable than shifts ≥24 hours.
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Angerer P, Schmook R, Elfantel I, Li J. Night Work and the Risk of Depression. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:404-411. [PMID: 28669378 DOI: 10.3238/arztebl.2017.0404] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 09/10/2016] [Accepted: 03/15/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Working the night shift interferes with the circadian chronobiological rhythm, causing sleep disturbances, fatigue, and diminished wellbeing, and increases the risk of serious disease. The question whether night work increases the risk of depression has not been adequately studied to date. METHODS We carried out a systematic, broadly conceived literature search in the PubMed, Scopus, PsycINFO, and PSYNDEX databases and the Medpilot search portal on the topic of nighttime shift work and mental illness. RESULTS The search yielded 5682 hits, which were narrowed down by predefined selection criteria to 11 high-quality longitudinal studies on the relationship between nighttime shift work and depressive illness. Only these 11 studies were subjected to further analysis. 3 of 4 studies on nighttime shift work in the health professions (almost exclusively nursing) revealed no association with depression over an observation period of two years. On the other hand, 5 studies on nighttime shift work in occupations outside the health sector, with observation periods of two or more years, yielded evidence of an elevated risk of depression after several years of nighttime shift work, but not in any uniform pattern. A supplementary meta-analysis of 5 of the studies revealed a 42% increase of the risk of depression among persons working the night shift (95% confidence interval [0.92; 2.19]). Psychosocial working conditions that have a negative influence on health partially account for these associations. CONCLUSION Although there is evidence that nighttime shift work (at least, in occupations outside the health sector) does increase the risk of depression, this evidence is not strong enough to sustain a general medical recommendation against shift work for employees with depressive conditions. It would seem appropriate to address this question on an individual basis, with strong support from physicians and close attention to the deleterious psychosocial factors associated with shift work.
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Affiliation(s)
- Peter Angerer
- Institute of Occupational and Social Medicine, Centre for Health and Society, Medical Faculty Heinrich Heine University Düsseldorf
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18
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Robinson S, Harris A, Atkinson S, Atterbury C, Bolton-Maggs P, Elliott C, Hawkins T, Hazra E, Howell C, New H, Shackleton T, Shreeve K, Taylor C. The administration of blood components: a British Society for Haematology Guideline. Transfus Med 2017; 28:3-21. [PMID: 29110357 DOI: 10.1111/tme.12481] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/04/2017] [Accepted: 09/16/2017] [Indexed: 01/02/2023]
Affiliation(s)
- S Robinson
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Harris
- Diagnostic and Therapeutic Services, NHS Blood and Transplant (NHSBT), Birmingham, UK
| | - S Atkinson
- Department Anaesthesia, Belfast Health and Social Care Trust, Chair of Northern Ireland Transfusion Committee, Northern, Ireland
| | - C Atterbury
- Department of Haematology, The Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust, King's Lyn, UK
| | - P Bolton-Maggs
- Serious Hazards of Transfusion (SHOT) Office, NHSBT, Manchester, UK
| | - C Elliott
- Transfusion, South Tees Hospitals NHS Trust, Middlesbrough, UK
| | - T Hawkins
- Department of Haematology, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, UK
| | - E Hazra
- NHS National Services Scotland, Scottish National Blood Transfusion Service - Better Blood Transfusion, United Kingdom of Great Britain & Northern Ireland
| | - C Howell
- Diagnostic and Therapeutic Services, NHSBT, Bristol, UK
| | - H New
- Products, NHSBT, London, UK
| | - T Shackleton
- Department of Haematology, Alder Hey Hospital Children's NHS Foundation Trust, Liverpool, UK
| | - K Shreeve
- Better Blood Transfusion Team, Welsh Blood Service, Pencoed, UK
| | - C Taylor
- Haematology, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK
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Pauls LA, Johnson-Paben R, McGready J, Murphy JD, Pronovost PJ, Wu CL. The Weekend Effect in Hospitalized Patients: A Meta-Analysis. J Hosp Med 2017; 12:760-766. [PMID: 28914284 DOI: 10.12788/jhm.2815] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The presence of a "weekend effect" (increased mortality rate during Saturday and/or Sunday admissions) for hospitalized inpatients is uncertain. PURPOSE We performed a systematic review to examine the presence of a weekend effect on hospital inpatient mortality. DATA SOURCES PubMed, EMBASE, SCOPUS, and Cochrane databases (January 1966-April 2013) were utilized for our search. STUDY SELECTION We examined the mortality rate for hospital inpatients admitted during the weekend compared with those admitted during the workweek. To be included, the study had to provide discrete mortality data around the weekends (including holidays) versus weekdays, include patients who were admitted as inpatients over the weekend, and be published in English. DATA EXTRACTION The primary outcome was all-cause weekend versus weekday mortality with subgroup analysis by personnel staffing levels, rates and times to procedures rates and delays, or illness severity. DATA SYNTHESIS A total of 97 studies (N = 51,114,109 patients) were examined. Patients admitted on the weekends had a significantly higher overall mortality (relative risk, 1.19; 95% confidence interval, 1.14-1.23). With regard to the subgroup analyses, patients admitted on the weekends consistently had higher mortality than those admitted during the week, regardless of the levels of weekend/weekday differences in staffing, procedure rates and delays, and illness severity. CONCLUSIONS Hospital inpatients admitted during weekends may have a higher mortality rate compared with inpatients admitted during the weekdays.
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Affiliation(s)
- Lynn A Pauls
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rebecca Johnson-Paben
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John McGready
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jamie D Murphy
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Peter J Pronovost
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA
| | - Christopher L Wu
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
- Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA
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20
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Gifkins J, Loudoun R, Johnston A. Coping strategies and social support needs of experienced and inexperienced nurses performing shiftwork. J Adv Nurs 2017; 73:3079-3089. [PMID: 28677140 DOI: 10.1111/jan.13374] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 01/21/2023]
Abstract
AIM The aim of this investigation was to compare perceptions of nurses exposed to short or longer term shift work and their experiences working under this type of scheduling. BACKGROUND Shift work is a crucial component of nurses' working lives, ensuring continuous care for patients. This study fills a research gap around the personal experiences of shift working nurses and the strategies used to manage the impacts of shift work. DESIGN Qualitative case study design. METHODS Constructivist methodology, including in-depth semi-structured interviews conducted in 2015, was used for the study. Iterative review and inductive analysis of transcripts from nine recently graduated nurses and twelve experienced nurses enabled identification and verification of key themes. FINDINGS Three main areas of difference between new and experienced nurses relating to shift work challenges in a nursing environment emerged: perceptions about the utility of working in shifts, coping strategies and social support at home and work. Most experienced nurses found shift work advantageous, especially those with dependents. Coping strategies included flexible shift arrangements in both groups. Experienced nurses detailed the importance of support from family and friends while inexperienced nurses described feeling disconnected from social supports. Experienced nurses cited a lack of support from nursing managers as problematic. CONCLUSIONS Findings suggest shift selection mitigated challenges of shift work for both inexperienced and experienced nurses, indicating autonomous roster selection is critical. Similarly, social support at work from senior nurses and management and at home played an important role in nurses' coping.
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Affiliation(s)
- Jane Gifkins
- Griffith University, Brisbane, Qld, Australia.,School of Natural Sciences, Griffith University, Nathan, Qld, Australia
| | - Rebecca Loudoun
- Centre for Research on Work, Organisation and Wellbeing, Griffith University, Nathan, Qld, Australia
| | - Amy Johnston
- Department of Emergency Medicine, Gold Coast Hospital and Health Service and Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
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21
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Ohnstad MO, Solberg MT. Patient acuity and nurse staffing challenges in Norwegian neonatal intensive care units. J Nurs Manag 2017; 25:569-576. [DOI: 10.1111/jonm.12495] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mari O. Ohnstad
- Oslo University Hospital & Lovisenberg Diaconal University College; Oslo Norway
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22
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Copanitsanou P, Fotos N, Brokalaki H. Effects of work environment on patient and nurse outcomes. ACTA ACUST UNITED AC 2017; 26:172-176. [PMID: 28185485 DOI: 10.12968/bjon.2017.26.3.172] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Several parameters of the nurse's work environment lead to fewer patient complications and lower nurse burnout. The aim of this systematic review was the analysis of research data related to the effect of nurses' work environments on outcomes for both patients and nurses. METHODS Medline was searched by using keywords: 'working conditions', 'work environment', 'nurses', 'nursing staff', 'patients', 'outcomes'. RESULTS In total, 10 studies were included, of which 4 were cross-sectional and the remaining were descriptive correlational studies. Patients who were hospitalised in units with good work environments for the nurses were more satisfied with the nursing care than the patients in units with poor work environments. Nurses who perceived their work environment to be good experienced higher job satisfaction and lower rates of burnout syndrome. CONCLUSIONS A good work environment constitutes a determinant factor for high care quality and, at the same time, relates to improved outcomes for the nurses.
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Affiliation(s)
| | - Nikolaos Fotos
- Assistant Professor, Faculty of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Hero Brokalaki
- Professor, Faculty of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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23
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Weaver SH, Lindgren TG. Getting safely through the shift: a qualitative exploration of the administrative supervisor role. J Nurs Manag 2017; 25:430-437. [DOI: 10.1111/jonm.12481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Susan H. Weaver
- Ann May Center for Nursing; Hackensack Meridian Health; Neptune USA
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24
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Hanna TN, Shekhani H, Lamoureux C, Mar H, Nicola R, Sliker C, Johnson JO. Emergency Radiology Practice Patterns: Shifts, Schedules, and Job Satisfaction. J Am Coll Radiol 2017; 14:345-352. [DOI: 10.1016/j.jacr.2016.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/11/2016] [Accepted: 09/19/2016] [Indexed: 01/27/2023]
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Abstract
The administrative supervisor, who is the nurse manager present on the night and weekend shifts, can be found in hospitals throughout the United States. Yet, very little research has been published about this role on weekend and night shifts in acute care hospitals. The objective of this qualitative research study was to gain a better understanding of the administrative supervisor role. In-depth interviews with administrative supervisors were conducted at acute care hospitals in the mid-Atlantic region of the United States. Thematic analysis was used to reduce the data and identify codes and themes. Administrative supervisors experience and described their role within a "different" hospital world on weekends and at night. The administrative supervisors consistently stated that they oversee and are responsible for staffing and patient flow, crisis management, and management support for the staff. That administrative supervision is a challenging position for nurses is particularly evident as researchers seek to obtain a better understanding of how nurse leaders make a difference. This research delineates these different supervisor role responsibilities to provide a better understanding of management during the "off-shift." Nurse leaders can utilize this information to assist in justifying the need for this shift management role at their institutions.
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26
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Emergency Department Weekend Presentation and Mortality in Patients With Acute Myocardial Infarction. Nurs Res 2017; 66:20-27. [DOI: 10.1097/nnr.0000000000000196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Henderson J, Willis E, Toffoli L, Hamilton P, Blackman I. The impact of rationing of health resources on capacity of Australian public sector nurses to deliver nursing care after-hours: a qualitative study. Nurs Inq 2016; 23:368-376. [PMID: 27548331 DOI: 10.1111/nin.12151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 11/26/2022]
Abstract
Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after-hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care.
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Affiliation(s)
- Julie Henderson
- School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Eileen Willis
- School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Luisa Toffoli
- School of Nursing & Midwifery, University of South Australia, Adelaide, SA, Australia
| | - Patricia Hamilton
- College of Nursing, Texas Women's University, Denton, Dallas, TX, USA
| | - Ian Blackman
- School of Nursing & Midwifery, Flinders University, Adelaide, SA, Australia
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Bell A, McDonald F, Hobson T. The Ethical Imperative to Move to a Seven-Day Care Model. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:251-260. [PMID: 26883659 DOI: 10.1007/s11673-016-9708-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 06/02/2015] [Indexed: 06/05/2023]
Abstract
Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.
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Affiliation(s)
- Anthony Bell
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, MetroNorth Hospital and Health Service, Butterfield St, Herston, 4029, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - Fiona McDonald
- Australian Centre for Health Law Research, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
- Department of Bioethics, Dalhousie University, Halifax, NS, Canada.
| | - Tania Hobson
- QEII Jubilee Hospital and Community Based Services, Metro South Health Level 5, QEII Jubilee Hospital, 360 Troughton Road Coopers Plains, Brisbane, Queensland, Australia, 4108
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de Cordova PB, Bradford MA, Stone PW. Increased errors and decreased performance at night: A systematic review of the evidence concerning shift work and quality. Work 2016; 53:825-34. [DOI: 10.3233/wor-162250] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
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30
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Ha EH. Attitudes towards rotating shift work in clinical nurses: a Q-methodology study. J Clin Nurs 2015; 24:2488-97. [DOI: 10.1111/jocn.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Eun-Ho Ha
- Red Cross College of Nursing; Chung-Ang University; Seoul Korea
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Miller H, Goetzl L, Wing DA, Powers B, Rugarn O. Optimising daytime deliveries when inducing labour using prostaglandin vaginal inserts. J Matern Fetal Neonatal Med 2015; 29:517-22. [PMID: 25758619 PMCID: PMC4776722 DOI: 10.3109/14767058.2015.1011117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine induction start time(s) that would maximise daytime deliveries when using prostaglandin vaginal inserts. METHODS Women enrolled into the Phase III trial, EXPEDITE (clinical trial registration: NCT01127581), had labour induced with either a misoprostol or dinoprostone vaginal insert (MVI or DVI). A secondary analysis was conducted to determine the optimal start times for induction by identifying the 12-h period with the highest proportion of deliveries by parity and treatment. RESULTS Optimal start times for achieving daytime deliveries when using MVI appear to be 19:00 in nulliparae and 23:00 in multiparae. Applying these start times, the median time of onset of active labour would be approximately 08:30 for both parities and the median time of delivery would be the following day at approximately 16:30 for nulliparae and 12:00 (midday) for multiparae. Optimal start times when using DVI appear to be 07:00 for nulliparae and 23:00 for multiparae. Using these start times, the median time of onset of active labour would be the following day at approximately 04:00 and 11:50, and the median time of delivery would be approximately 13:40 and 16:10, respectively. CONCLUSIONS When optimising daytime deliveries, different times to initiate induction of labour may be appropriate depending on parity and the type of retrievable prostaglandin vaginal insert used.
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Affiliation(s)
- Hugh Miller
- a Watching Over Mothers & Babies Foundation , Tucson , AZ , USA
| | - Laura Goetzl
- b Department of Obstetrics, Gynecology and Reproductive Sciences , Temple University , Philadelphia , PA , USA
| | - Deborah A Wing
- c Department of Obstetrics and Gynecology , University of California , Irvine, Orange , CA , USA .,d Miller Children's and Women's Hospital , Long Beach , CA , USA
| | - Barbara Powers
- e Independent Consultant , Phoenixville , PA , USA , and
| | - Olof Rugarn
- f Ferring Pharmaceuticals , Copenhagen , Denmark
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Leroyer E, Romieu V, Mediouni Z, Bécour B, Descatha A. Extended-duration hospital shifts, medical errors and patient mortality. Br J Hosp Med (Lond) 2014; 75:96-101. [PMID: 24521805 DOI: 10.12968/hmed.2014.75.2.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Zakia Mediouni
- Consultant in the AP-HP, Occupational Health Unit/EMS (Samu92), University Hospital of Paris West Suburb, Garches, France
| | - Bertrand Bécour
- Consultant in the AP-HP, Hôtel-Dieu Hospital, Forensic Unit, Paris, France
| | - Alexis Descatha
- Head of Occupational Health Unit and Consultant in EMS (Samu92), University Hospital of Paris West Suburb, Poincaré Site, 92380 Garches, France
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de Cordova PB, Phibbs CS, Schmitt SK, Stone PW. Night and day in the VA: associations between night shift staffing, nurse workforce characteristics, and length of stay. Res Nurs Health 2014; 37:90-7. [PMID: 24403000 DOI: 10.1002/nur.21582] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 11/09/2022]
Abstract
In hospitals, nurses provide patient care around the clock, but the impact of night staff characteristics on patient outcomes is not well understood. The aim of this study was to examine the association between night nurse staffing and workforce characteristics and the length of stay (LOS) in 138 veterans affairs (VA) hospitals using panel data from 2002 through 2006. Staffing in hours per patient day was higher during the day than at night. The day nurse workforce had more educational preparation than the night workforce. Nurses' years of experience at the unit, facility, and VA level were greater at night. In multivariable analyses controlling for confounding variables, higher night staffing and a higher skill mix were associated with reduced LOS.
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Affiliation(s)
- Pamela B de Cordova
- College of Nursing, Rutgers, The State University of New Jersey, 110 Paterson Street, New Brunswick, NJ, 08901
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Kalisch BJ, Lee S, Dabney BW. Outcomes of inpatient mobilization: a literature review. J Clin Nurs 2013; 23:1486-501. [DOI: 10.1111/jocn.12315] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 02/04/2023]
Affiliation(s)
| | - Soohee Lee
- School of Nursing; University of Michigan; Ann Arbor MI USA
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