Relationships between comprehensive characteristics of nurse work schedules and adverse patient outcomes: A systematic literature review

Assessing the impacts of nurse staffing and work schedules on nurse turnover: A systematic review

AIM

This study aimed to investigate and synthesize the impacts of nurse staffing and work schedules on nurse turnover in acute hospitals.

BACKGROUND

The retention of nurses during the COVID-19 pandemic was critical due to the increased demand for nurses. Among the multifaceted factors contributing to nurse turnover, it is worth examining nurse staffing and work schedules while considering policy intervention.

METHODS

The findings of this systematic literature review were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Using eight databases, including CINAHL and PubMed, research articles published from January 2000 until June 2021 were reviewed. The inclusion criteria were original peer-reviewed research, nonexperimental studies published in English or Korean languages, and studies examining the impacts of nurse staffing and work schedules on nurses' actual turnover.

RESULTS

Fourteen articles were reviewed. Among them, 12 studies investigated the relationship between nurse staffing and turnover, and four examined the impact of work schedules on nurse turnover. Nurse staffing levels are strongly related to nurse turnover in the expected direction. However, few studies have found that work schedules are significantly related to nurse turnover.

CONCLUSION

Inadequate and unsafe nurse staffing leads to increased nurse turnover rates. More studies are needed to investigate the impacts of work schedules on nurse turnover.

IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY

Several states in the United States have adopted the nurse staffing policy during the COVID-19 pandemic. More hospitals and the government should adopt and implement policies to regulate nurse staffing, reduce nurse turnover, and increase retention. Policy intervention in nurse work schedules should also be considered to prevent nurse turnover.

Synergistic interaction between long shifts and short rest periods on depression in shift workers: A cross-sectional study from Korea

BACKGROUND

Long shifts and short rest periods (SRP) between shifts are important factors that greatly affect shift workers' health. However, reports on the psychological effects of shift work, such as depression, have been inconsistent. Therefore, this study aimed to investigate the combined effect of long shifts and SRP on depression in shift workers.

METHODS

This cross-sectional study included 3295 shift workers in the sixth Korean Working Conditions Survey. The relative excess risk due to interaction (RERI) was computed to estimate the combined effect of long shifts and SRP on depression.

RESULTS

Depression in shift workers was not significantly associated with long shifts or SRP after adjustment, but the risk was significantly increased when exposed to both factors simultaneously (odds ratio 1.36, 95% confidence interval 1.03-1.79). The RERI between the two factors was statistically significant (p = 0.020), indicating a synergistic interaction with depression. Sensitivity analysis by occupation showed a significant interaction in the combined group of office and service workers (p = 0.034).

CONCLUSIONS

Simultaneous exposure to SRP and long shifts should be avoided when planning shift work schedules or devising health policies for shift workers. Special consideration is needed for healthcare and service workers, who may be particularly vulnerable to negative health impacts due to shift work.

Health-promoting work schedules among nurses and nurse assistants in France: results from nationwide AMADEUS survey

BACKGROUND

The study aimed to investigate the relationship between different work schedules and self-reported working conditions and health risk behaviours among nurses and nurse assistants (NNA) in France. It hypothesized that work schedules, particularly long shifts, could impact work-life balance, workload, stress levels, burnout, and smoking habits. NNA had the option to work either with a 7-hour schedule, 5 days per week, or with long work schedules consisting of ten to twelve-hour shifts, three days per week. These schedules could potentially influence various aspects of their professional lives.

METHODS

The survey followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and was administered to NNA working in public and private national healthcare facilities in France. The researchers used the Job Content Questionnaire to assess the work environment and the French version of the 22-item Maslach Burnout Inventory (MBI) scale to measure burnout.

RESULTS

A total of 3,133 NNA participated in the study, including 2,369 nurses (75.6%) and 764 nurse assistants (24.4%). Among them, 1,811 individuals (57.8%) followed a 7-hour work schedule, while 1,322 individuals (42.2%) had a long work schedule. Multivariate analyses revealed that NNA working with long schedules reported higher psychological demands, more frequent burnout, a higher number of daily smoked cigarettes, and greater coffee consumption. These findings were independent of other factors such as sector of employment, type of healthcare facility, job status, work schedules, night shifts, department specialty, age, and family responsibilities.

CONCLUSIONS

While some NNA may choose long schedules to have more days off, those working with these schedules experience greater work-related burdens and engage in worse health risk behaviours as a coping mechanism. It emphasizes the importance of considering health-promoting work schedules to address the high psychological demands and burnout experienced by NNA with long schedules. Implementing changes in work schedules could potentially improve the overall well-being and job satisfaction of these healthcare professionals.

The effect of full-time culture on quality and safety of care – a literature review

Purpose

The purpose of this study is to increase knowledge and understanding of the relationship between full-time-culture and the outcome for quality and safety of care.

Design/methodology/approach

The paper is a literature review with a qualitatively oriented thematic analysis concerning quality or safety outcomes for patients, or patients and staff when introducing a full-time culture.

Findings

Identified factors that could have a positive or negative impact on quality and patient safety when introducing full-time culture were length of shift, fatigue/burnout, autonomy/empowerment and system/structure. Working shifts over 12 h or more than 40 h a week is associated with increased adverse events and errors, lower quality patient care, less attention to safety concerns and more care left undone. Long shifts give healthcare personnel more flexibility and better quality-time off, but there is also an association between long shifts and fatigue or burnout. Having a choice and flexibility around shift patterns is a predictor of increased wellbeing and health.

Originality/value

A major challenge across healthcare services is having enough qualified personnel to handle the increasing number of patients. One of the measures to get enough qualified personnel for the expected tasks is to increase the number of full-time employees and move towards a full-time culture. It is argued that full-time culture will have a positive effect on work environment, efficiency and quality due to a better allocation of work tasks, predictable work schedule, reduced sick leave, and continuity in treatment and care. There is limited research on how the introduction of full-time culture will affect the quality and safety for patients and staff, and few studies have been focusing on the relationship between longer shift, work schedule, and quality and safety of care.

Association of Work Schedules With Nurse Turnover: A Cross-Sectional National Study

Objective: To examine the relationship of work schedules with nurse turnover across various work settings. Methods: A cross-sectional study design was used with data collected from 17,046 nurses who participated in the 2018 National Sample Survey of Registered Nurses in the U.S. Multivariate logistic regression was used to examine the effects of work hours and overtime on nurse turnover. Results: Longer weekly work hours increased nurse turnover (OR = 1.104, 95% confidence interval [CI] = 1.006-1.023). A non-linear relationship was observed between overtime and turnover. Compared with nurses with no overtime, the turnover for nurses working 1-11 h overtime per week decreased (OR = 0.893, 95% CI = 0.798-0.999). When nurses worked ≥12 h, turnover increased (OR = 1.260, 95% CI = 1.028-1.545). Earning from the primary nursing position decreased turnover among nurses working in hospitals, other inpatient settings, and clinics. Job satisfaction decreased turnover. Conclusion: To prevent nurse turnover, it is important to monitor and regulate nurses' working hours at institutional and government levels. Government support and policy implementations can help prevent turnover.

The newly-licensed registered nurse workforce: Looking back to move forward

BACKGROUND

Newly licensed registered nurses (NLRNs) are a vital health human resource necessary for the sustainability of the nursing workforce. There are challenges associated with the transition of NLRNs into practice; yet, new nurses continue to leave their positions within the first year. To compound the situation, a global pandemic hit in 2020. To leverage a sustainable future for our nursing workforce we must examine workforce data of NLRNs.

PURPOSE

The purpose of this descriptive study was to review the most recent national source of workforce data to determine if the data reveals insight to help renew the focus on the NLRN workforce.

METHODS

This descriptive study was a secondary analysis of demographic, education, employment, and work environment variables from the 2018 National Sample Survey of Registered Nurses.

FINDINGS

The NLRN workforce is slightly more diverse, seeking a BSN as the first degree, and funding their initial education with federal loans. NLRNs cite inadequate staffing, stressful work environments, burnout, and salary as the reasons for leaving the first job. NLRNs cite a balanced schedule, experience in the job, and a sense of community with peers as reasons why they stay.

DISCUSSION

This study joins the decades of literature that points to a small group of problems that account for the overwhelming majority or nursing turnover and attrition. After analyzing the data, the authors pose several questions to readers for consideration about the NLRN workforce. The authors' hope is to garner renewed attention to the issues facing NLRNs.

A Comparison of Shift Length and Nursing and Quality Outcomes in Acute Inpatient Mental Health Units

OBJECTIVE

This study compared outcomes between units that used either 8-hour or 12-hour shifts in acute inpatient mental health units.

BACKGROUND

Most hospitals continue to use 12-hour shifts despite research suggesting safety concerns with longer shifts. There is a gap in the literature on effects of shift lengths on nursing and patient outcomes in acute mental health units.

METHODS

This study is a retrospective comparative analysis of cross-sectional data between 32 inpatient mental health units that used 8-hour versus 12-hour shifts. Independent samples t test was used to examine differences on several staffing, quality, and safety measures.

RESULTS

A moderate effect size was found between the groups in quality and safety measures involving patient disruptive behaviors, with the 8-hour group having more desirable outcomes.

CONCLUSIONS

Nurse leaders in acute mental health units should consider the impacts of shift length on quality and safety when determining staffing patterns. More research is needed to evaluate correlations or causality.

The mediating role of psychological needs on the relationship between perceived organizational support and work engagement

AIM

To examine the mediating effect of basic psychological needs on the relationship between perceived organizational support and work engagement among nurses.

BACKGROUND

The satisfaction of basic psychological needs is crucial for breeding and sustaining individuals' intrinsic motivation. Little is known about the underlying motivational mechanisms that explain the relationship among perceived organizational support, basic psychological needs, and work engagement in a nursing context.

METHODS

This was a cross-sectional online survey. A sample of 858 nurses from 12 hospitals was surveyed on their perceived organizational support, basic psychological needs, and work engagement. Structural equation models and bootstrapping methods were used to examine the hypotheses. STROBE reporting guidelines were utilized.

RESULTS

Perceived organizational support was positively associated with basic psychological needs and work engagement. Basic psychological needs were positively associated with work engagement. Basic psychological needs mediated the relationship between perceived organizational and work engagement.

CONCLUSION

Perceived organizational support may enhance work engagement by fulfilling the basic psychological needs of nurses.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Basic psychological needs deserve more attention in nursing organizations. Managers should seek optimal strategies to fulfill nurses' needs for autonomy, competence, and relatedness to stimulate their intrinsic motivation to enhance work engagement.

Nurses' perceptions of career growth: A qualitative descriptive study

AIMS

To explore nurses' experiences and perceptions of career growth and its influencing factors, as career growth is more closely associated with individual attitudes and behaviours in the new career era.

DESIGN

A qualitative descriptive design was used.

METHODS

Thirty-one nurses from 10 secondary and 8 tertiary hospitals in Sichuan Province of China were purposively selected to participate in this study. The data were collected using individual semi-structured face-to-face interviews. Two researchers independently reviewed the transcripts and emergent coding. The data were analysed using qualitative content analysis.

FINDINGS

The nurses' perceptions of career growth fully described the nurses' experience and occurred in five dimensions: career promotion, career goal progress, professional ability and quality improvement, professional identity development and increase in personal prestige. The factors influencing career growth were identified at the organizational, individual and social levels. Career growth in nursing was complex, changed over time and showed several specific characteristics compared with other careers. The nurse-specific symbol of career growth was professional identity development, which reflected career progression characteristics.

CONCLUSIONS

Career growth is a multi-dimensional concept with varying influencing factors. The meaning of career growth for nurses is distinct from that for employees in other careers.

IMPACT

Nursing managers should guide nurses to comprehensively assess their career growth from multiple perspectives, and professional identity development deserves more attention. Both organizations and individuals should take responsibility for career management to pursue career growth.

Infections, accidents and nursing overtime in a neonatal intensive care unit

The paper investigates the effects of nursing overtime on nosocomial infections and medical accidents in a neonatal intensive care unit (NICU). The literature lacks clear evidence on this issue and we conjecture that this may be due to empirical and methodological factors. We model the occurrences of both events using a sample of 3979 neonates who represents over 84,846 observations (infant/days). We exploit an important change in workforce arrangement that was implemented in June 2012, and which aimed at reducing overtime hours to identify a causal impact between the latter and the two outcomes of interest. We contrast the results using a standard mixed-effects logit model with those of a semiparametric mixed-effects logit model. Contrary to the mixed-effects logit model, the semiparametric model unequivocally shows that both adverse events are impacted by nursing overtime as well as being highly sensitive to infant and NICU-related characteristics. Furthermore, the mixed-effects logit model is rejected in favour of the semiparametric one.

The Impact of Working Environment on Nurses' Caring Behavior in Sabah, Malaysia

Aims

This study aims to investigate 5 types of work environment influencing nurses' caring behavior, namely (i) participation in hospital affairs, (ii) foundations for quality of care, (iii) manager ability, leadership, and support of nurses, (iv) staffing and resource adequacy, and (v) nurse-physician relations.

Design

This research is a cross-sectional study using the survey method.

Methods

Data were collected from 3,532 nurses working in public hospitals and health clinics within Sabah, Malaysia in 2015. The hypothesized model was evaluated using partial least squares method.

Results

The findings reveal that all forms of work environment have a positive effect on nurses' caring behavior except for staffing and resource adequacy which shows a negative effect on caring behavior.

Conclusion

Overall, this study has added to theoretical contributions in the academic and research fields as well as in practical implications in the field of nursing practice by addressing the influence of work environments on caring behavior.

Implications for Nursing Management

The present research has provided convergent evidence on the role of the working environment in influencing the behavior of nurses working in hospitals and health clinics in Sabah, Malaysia.

Work hours and overtime of nurses working in Cambodian hospitals

Aim

To examine the nature and prevalence of Cambodian nurses’ work hours and overtime and related factors

Background

The chronic shortage of nursing workforce is a major cause of overtime among nurses.

Introduction

Nursing shortage and working overtime among nurses negatively affect nurse and patient outcomes, but nurses’ work hours and overtime in Cambodia have not been comprehensively examined.

Methods

A multicenter cross‐sectional study was conducted in four Cambodian hospitals. Data were collected from 253 nurses providing direct nursing care using a questionnaire. The STROBE checklist was used for reporting this study.

Results

More than a fifth of staff nurses worked more than 48 h, which is the legal work hour limit in Cambodia. Two major reasons for working mandatory or voluntary overtime, on‐call or 24‐h on‐call were (a) not wanting to let down colleagues and (b) able to get all work done. The number of patients cared for was related to whether or not nurses worked 48 h or more.

Conclusion

Overtime work and adverse nurse scheduling are common in Cambodia.

Implications for nursing and health policy

Nurse managers and healthcare institutes in Cambodia need to monitor Cambodian nurses’ work hours, which are often beyond the legal work hour limit. Moreover, it is important to understand why nurses work overtime and develop health policies, strategies, and programs that can help promote patient and nurse safety and retain qualified nursing staff. The 24‐h on‐call practice needs to be regulated according to the labor policy in healthcare institutes to prevent adverse nurse and patient outcomes.