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Fujimoto M. Issues and Perspectives for the Study of Disruptive Clinician Behavior. Cureus 2024; 16:e63314. [PMID: 38938907 PMCID: PMC11210996 DOI: 10.7759/cureus.63314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 06/29/2024] Open
Abstract
This article discusses issues and perspectives related to the study of disruptive clinician behavior (DCB) to improve patient safety and healthcare professionals' work environments. Multiple terminologies and ambiguous definitions have resulted in conceptual confusion in studies on DCB. In addition, subjective classifications have led the attributes of DCB to overlap and fluctuate. Therefore, we share Rosenberg's definition of DCB as "any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse to physical and sexual harassment." It is recommended that DCB be understood as a hierarchical structure identified through statistical analysis of field survey data. Furthermore, a recurring list of items is duplicated across existing studies on DCB triggers, contributing factors, and influences. These items can be organized into separate path models based on their mutual relationships. Given these assumed models, we believe that further studies on DCB can shift toward elucidating the mechanisms of occurrence and impact. Finally, based on the path models, we recommend improving healthcare professionals' psychological and social states through a policy shift from "zero-tolerance" to "to err is human" as a priority issue for DCB prevention and countermeasures.
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Affiliation(s)
- Manabu Fujimoto
- Institute for Teaching and Learning, Ritsumeikan University, Kyoto, JPN
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Konkol M, George EL, Scott PW, Imes CC. Examining Nurses' Perception of Shift Work and Evaluating Supportive Interventions. J Nurs Care Qual 2024; 39:10-17. [PMID: 36917831 DOI: 10.1097/ncq.0000000000000704] [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: 03/16/2023]
Abstract
BACKGROUND Health care requires a delicate equilibrium of nurse health safety and patient safety outcomes. Shift work can disrupt this balance, resulting in poor outcomes for staff and patients. PROBLEM Limited evidence exists on nurses' perceptions of shift work, fatigue countermeasures use, and interest in risk-mitigating interventions. METHODS An online survey of nurses was conducted. Survey questions assessed perceptions of shift work, use of fatigue countermeasures, and potential interventions. RESULTS The participants perceived multiple differences between day and night shifts when asked about their ability to complete both work- and life-oriented tasks. Use of fatigue countermeasures was more common while working night shift. Potential interventions included the use of blackout curtains, an on-site exercise facility, consulting a nutritionist, and block scheduling. CONCLUSIONS Health care leaders should consider nurses' perceptions and interests when incorporating initiatives to mitigate the negative effects of shift work.
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Affiliation(s)
- Megan Konkol
- University of Pittsburgh Medical Center Presbyterian Shadyside, Pittsburgh, Pennsylvania (Ms Konkol and Dr George) and University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Drs Scott and Imes)
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Grøtting G, Øvergård KI. The relation between routines for shiftwork scheduling and sickness absence at a Norwegian hospital: A cross-sectional study. Int J Nurs Stud 2023; 141:104477. [PMID: 36940648 DOI: 10.1016/j.ijnurstu.2023.104477] [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: 11/02/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Shift work is associated with negative health outcomes. Routines for scheduling of shift work can help reduce negative health outcomes of shift work and improve work-life balance and social well-being for nurses working shift work. OBJECTIVE To investigate the association between organizational units' routines for shift work scheduling and nurses' sickness absence at the unit level. DESIGN Cross-sectional study design combining quantitative questionnaire data on shift work scheduling routines with data of mean percentage of sickness absence at the unit, mean level of exhaustion at the unit, mean age and percentage of women working at the unit. PARTICIPANTS A total of 126 leaders at organizational units with nurses working shift work schedule at Oslo University Hospital answered a questionnaire about shift work scheduling. MEASURES Three aspects of health-promoting shift work scheduling (fatigue-reducing scheduling, organizational health measures, and individual adaptation) and the extent to which operational considerations were made during shift work scheduling were used as independent variables. Covariates were mean age of nurses at each unit, mean percent female nurses, and mean exhaustion at unit level. Percent sickness absence was used as a dependent variable. METHODS Questionnaire data on shift work scheduling routines was merged with information on average age of employees in the unit, ratio female nurses, and units' average score on exhaustion. Multivariable linear regression analyses were used to assess the contribution of routines for shift work scheduling after controlling for mean level of exhaustion, average age, and proportion of women at each unit. RESULTS The factors "fatigue reducing scheduling", "organizational health measures" and "operational considerations" had no observed total effect on mean sickness absence. Individual adjustment in shift work scheduling had a direct negative association with sickness absence after controlling for other shift work scheduling routines, exhaustion, age, and gender. CONCLUSIONS There is a relationship between the units' routines for shift work scheduling and mean sickness absence at the unit, and the possibility of individual adjustment was the only aspect of shift work scheduling that had an above-zero association with sickness absence.
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Affiliation(s)
- Gina Grøtting
- Department of Occupational and Environmental Health, Oslo University Hospital, Norway; Research Group for Health Promotion in Settings, Department of Health-, Social-, and Welfare Studies, University of South-Eastern Norway, Postboks 4, 3199 Borre, Norway
| | - Kjell Ivar Øvergård
- Research Group for Health Promotion in Settings, Department of Health-, Social-, and Welfare Studies, University of South-Eastern Norway, Postboks 4, 3199 Borre, Norway.
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Magerøy MR, Wiig S. The effect of full-time culture on quality and safety of care – a literature review. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2023. [DOI: 10.1108/ijhg-11-2022-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PurposeThe 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/approachThe 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.FindingsIdentified 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/valueA 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.
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Krutova O, Peutere L, Ervasti J, Härmä M, Virtanen M, Ropponen A. Sequence analysis of the combinations of work shifts and absences in health care - comparison of two years of administrative data. BMC Nurs 2022; 21:376. [PMID: 36585739 PMCID: PMC9801614 DOI: 10.1186/s12912-022-01160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In health care, the shift work is arranged as irregular work shifts to provide operational hours for 24/7 care. We aimed to investigate working hour trends and turnover in health care via identification of time-related sequences of work shifts and absences among health care employees. The transitions between the work shifts (i.e., morning, day, evening, and night shifts), and absences (days off and other leaves) over time were analyzed and the predictors of change in irregular shift work were quantified. METHODS A longitudinal cohort study was conducted using employer-owned payroll-based register data of objective and day-to-day working hours and absences of one hospital district in Finland from 2014 to 2019 (n = 4931 employees). The working hour data included start and end of work shifts, any kind of absence from work (days off, sickness absence, parental leave), and employee's age, and sex. Daily work shifts and absences in 2014 and 2019 were used in sequence analysis. Generalized linear model was used to estimate how each identified sequence cluster was associated with sex and age. RESULTS We identified four sequence clusters: "Morning" (60% in 2014 and 56% in 2019), "Varying shift types" (22% both in 2014 and 2019), "Employee turnover" (13% in 2014 and 3% in 2019), and "Unstable employment (5% in 2014 and 19% in 2019). The analysis of transitions from one cluster to another between 2014 and 2019 indicated that most employees stayed in the same clusters, and most often in the "Varying shift types" (60%) and "Morning" (72%) clusters. The majority of those who moved, moved to the cluster "Morning" in 2019 from "Employee turnover" (43%), "Unstable employment" (46%) or "Varying shift types" (21%). Women were more often than men in the clusters "Employee turnover" and "Unstable employment", whereas older employees were more often in "Morning" and less often in the other cluster groups. CONCLUSION Four clusters with different combinations of work shifts and absences were identified. The transition rates between work shifts and absences with five years in between indicated that most employees stayed in the same clusters. The likelihood of a working hour pattern characterized by "Morning" seems to increase with age.
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Affiliation(s)
- Oxana Krutova
- Finnish Institute of Occupational Health, P.O.Box 18, Helsinki, 00032, Finland
| | - Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, P.O.Box 18, Helsinki, 00032, Finland
| | - Mikko Härmä
- Finnish Institute of Occupational Health, P.O.Box 18, Helsinki, 00032, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.,CNS, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annina Ropponen
- Finnish Institute of Occupational Health, P.O.Box 18, Helsinki, 00032, Finland. .,CNS, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
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The implementation of the European Working Time Directive in Europe and its impact on training in obstetrics and gynaecology: A ten year follow-up. Eur J Obstet Gynecol Reprod Biol 2022; 278:1-5. [PMID: 36108448 DOI: 10.1016/j.ejogrb.2022.08.022] [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: 06/03/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To reassess the compliance with the European Working Time Directive (EWTD) in the member countries of the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) and to investigate the impact of the EWTD on training. STUDY DESIGN In this observational, cross-sectional study, an online questionnaire, containing multiple-choice questions and open questions, was distributed among Obstetrics and Gynaecology trainees in 33 ENTOG member countries. The questionnaire was designed as a follow-up of a similar survey conducted by ENTOG in 2009 and assessed the overall compliance with the EWTD, the adaptations needed to achieve this compliance, the impact of the EWTD on the quality of training and the well-being of trainees. The answers were analysed using descriptive statistics in Microsoft Excel. RESULTS 59 responses from 28/33 (84.8%) ENTOG member countries were collected. Only 5 out of 28 (17.9%) countries were found to be nationally compliant with EWTD. There were no clear differences in the compliance between different types of the hospitals (university/teaching/district), but a trend was observed towards higher rate of implementation in smaller hospitals (<1500 deliveries per year). Regarding the changes needed to become EWTD-compliant and yet maintain high-quality training, the most common suggestions were: hiring extra junior doctors, restructuring training, having less doctors on duty simultaneously, consultants performing more hands on work, dedicated training sessions, reduction of administrative tasks and simulation training for surgical skills. The majority of trainees, 7 out of 12, (58.3%) in the EWTD-compliant hospitals experienced a positive effect on their training, whereas the majority of trainees in non-compliant hospitals, 31 out of 47, (66%) were uncertain about the impact of the EWTD on the quality of training. Among the positive changes, better work-life balance and more consultants available out of the daily working hours were listed. CONCLUSIONS Despite the introduction and implementation of the EWTD over two decades ago, the compliance rates across Europe remain low and seem not to have altered in the last ten years. In order to ensure the quality of training and, most importantly patient safety, we suggest that European nations keep striving to implement the EWTD for doctors in training. We also suggest for nations that have yet to implement this directive to use the strategies as an exemplar in countries that follow EWTD.
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Westley JA, Peterson J, Fort D, Burton J, List R. Impact of nurse's worked hours on medication administration near-miss error alerts. Chronobiol Int 2020; 37:1373-1376. [PMID: 32835534 DOI: 10.1080/07420528.2020.1811295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Long working hours have been shown to negatively impact adverse events in health care. In this study, a retrospective correlational design was used to evaluate the relationship between working hours and near-miss medication error alerts. During a two-year period, 5372 nurses triggered 420,706 near-miss alerts on 9, 285, 786 medication administrations. Nurses who worked 60 h or more in a week yielded an average near-miss rate of 4.0% compared to 3.0% (p <.001) for nurses who did not. Nurses working extended hours had a significantly increased risk of triggering a near-miss alert compared to those not working extended hours.
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Affiliation(s)
| | - Jessica Peterson
- Nursing Education & Research, Ochsner Health, New Orleans, LA, USA
| | - Daniel Fort
- Center for Outcomes & Health Services Research, Ochsner Health, New Orleans, LA, USA
| | - Jeffrey Burton
- Center for Outcomes & Health Services Research, Ochsner Health, New Orleans, LA, USA
| | - Robert List
- Staffing Resource Center, Ochsner Health, New Orleans, LA, USA
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Cortegiani A, Ippolito M, Misseri G, Helviz Y, Ingoglia G, Bonanno G, Giarratano A, Rochwerg B, Einav S. Association between night/after-hours surgery and mortality: a systematic review and meta-analysis. Br J Anaesth 2020; 124:623-637. [DOI: 10.1016/j.bja.2020.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 01/11/2023] Open
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McClelland L, Plunkett E, McCrossan R, Ferguson K, Fraser J, Gildersleve C, Holland J, Lomas JP, Redfern N, Pandit JJ. A national survey of out-of-hours working and fatigue in consultants in anaesthesia and paediatric intensive care in the UK and Ireland. Anaesthesia 2019; 74:1509-1523. [PMID: 31478198 DOI: 10.1111/anae.14819] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
The tragic death of an anaesthetic trainee driving home after a series of night shifts prompted a national survey of fatigue in trainee anaesthetists. This indicated that fatigue was widespread, with significant impact on trainees' health and well-being. Consultants deliver an increasing proportion of patient care resulting in long periods of continuous daytime duty and overnight on-call work, so we wished to investigate their experience of out-of-hours working and the causes and impact of work-related fatigue. We conducted a national survey of consultant anaesthetists and paediatric intensivists in the UK and Ireland between 25 June and 6 August 2018. The response rate was 46% (94% of hospitals were represented): 84% of respondents (95%CI 83.1-84.9%) contribute to a night on-call rota with 32% (30.9-33.1%) working 1:8 or more frequently. Sleep disturbance on-call is common: 47% (45.6-48.4%) typically receive two to three phone calls overnight, and 48% (46.6-49.4%) take 30 min or more to fall back to sleep. Only 15% (14.0-16.0%) reported always achieving 11 h of rest between their on-call and their next clinical duty, as stipulated by the European Working Time Directive. Moreover, 24% (22.8-25.2%) stated that there is no departmental arrangement for covering scheduled clinical duties following a night on-call if they have been in the hospital overnight. Overall, 91% (90.3-91.7%) reported work-related fatigue with over half reporting a moderate or significantly negative impact on health, well-being and home life. We discuss potential explanations for these results and ways to mitigate the effects of fatigue among consultants.
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Affiliation(s)
- L McClelland
- Department of Intensive Care Medicine and Anaesthesia, Royal Gwent Hospital, Newport, UK
| | - E Plunkett
- Department of Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - R McCrossan
- Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - K Ferguson
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - J Fraser
- Department of Paediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
| | - C Gildersleve
- Department of Paediatric Anaesthesia, Children's Hospital for Wales, Cardiff, UK
| | - J Holland
- Department of Anaesthesia, Princess of Wales Hospital, Bridgend, UK
| | - J P Lomas
- Department of Anaesthesia and Intensive Care, Bolton Foundation Trust, Bolton, UK
| | - N Redfern
- Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - J J Pandit
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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