Implementing 12-hour shifts on a cardiology nursing development unit

Eight-hour versus 12-h shifts in an ICU: Comparison of nursing responses and patient outcomes

INTRODUCTION

Controversy remains about the impact of 12-h shift patterns on staff satisfaction and health and on patient outcomes. Consequently, the objective of the study was to investigate the effect on nurses and patients of 8-h rostering compared with 12-h rostering.

METHODS

We conducted a two-phase survey. Intensive care nurses completed a purposefully designed 49-item questionnaire, which included open- and closed-ended questions. Phase 1 was conducted during 2015, while the 8-h shift pattern was in place. Data for phase 2 were collected in 2017, approximately 6 months after the trial of 12-h shifts began. We extracted data from the hospital's adverse event register to compare patient outcomes between the two phases.

RESULTS

A total of 152/193 (78.8%) surveys were returned in phase 1. In phase 2, the response rate was 114/188 (60.6%). The proportion of nurses satisfied with the roster increased 3-fold after the introduction of 12-h shifts; risk ratios 3.36 (95% confidence intervals 2.62 to 4.28). Communication with all levels of senior staff improved, and the number of hours of professional development leave increased with the 12-h roster phase 1, 358 h versus 538 h in phase 2 (p = <0.0001). Most respondents believed that 12-h shifts would be beneficial for their health, and this belief was validated by official leave records; there was a reduction of 69 days for sick leave and 216 days for family leave. Adverse outcomes for patients were similar in the two periods.

CONCLUSION

Twelve-hour shifts are popular with ICU nurses, days lost to sick and family leave are reduced, and patient outcomes are not compromised.

Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions

BACKGROUND

The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account.

METHODS

Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text.

RESULTS

103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist.

CONCLUSIONS

Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further development and testing.

Critical care nurses - perceptions of 12-h shifts

BACKGROUND

Twelve-hour shifts have been illustrated in the literature as being a highly contentious shift pattern. However, it has also been highlighted that there is a distinct paucity of literature solely related to such a shift pattern in critical care areas, where there is high activity and a requirement for multiple and highly significant decision-making situations. It was therefore identified that such an area deserved further exploration.

AIM

This study aimed to elicit critical care nurses' perceptions of working 12-h shifts.

METHODS

Fifty-four nurses from three critical care areas within a large local NHS teaching hospital currently working 12-h shifts completed a self-administered questionnaire on their perceptions of 12-h shifts. Following on, a focus group interview was conducted to complement this questionnaire in an attempt to further explore these perceptions.

RESULTS

From the results of the questionnaire, patient care, job satisfaction, off duty and family life achieved the most positive responses, whereas communication, fatigue and education achieved the most negative. The focus group explored these issues with added comments on work-shy staff, suggestions on shift patterns, breaks and staffing levels.

CONCLUSIONS

Twelve-hour shifts in critical care areas are suitable shift patterns for nurses, patients and management, provided that they are fundamentally well-managed.

Twelve-hour shift on ITU: a nursing evaluation

This paper describes the introduction and subsequent evaluation of a 12-h shift system in a large ITU in the northeast of UK. To date, only a small number of studies has evaluated nurses working the 12-h shifts in critical care areas. To evaluate the level of staff satisfaction, data were collected by means of a questionnaire involving 41 nurses, at 3 months following the introduction of the 12-h shifts. The responses from the evaluation advocated the continuation of 12-h shifts with alternative shift patterns for nurses who felt dissatisfied with the current system. Twelve-hour shifts can be seen as a flexible system for nurses working in intensive care and may assist with staff satisfaction and improving nurse recruitment and retention.