Nurses' experiences and preferences around shift patterns: A scoping review

The importance of recovery and staffing on midwives' emotional wellbeing: A UK national survey

BACKGROUND

There is currently a gap in the evidence on how working practices, such as the ability to take rest breaks, finish on time or intershift recovery influence outcomes.

AIM

The aim of this study was to explore the association of individual characteristics, work-related factors and working practices on emotional wellbeing outcomes of UK midwives.

METHODS

An online cross-sectional survey collated data between September and October 2020. Outcomes explored were work-related stress, burnout, being pleased with their standard of care, job satisfaction and thoughts about leaving midwifery. Univariate analysis identified the explanatory variables to be investigated using multivariable logistic regression.

FINDINGS

A total of 2347 midwives from the four UK nations completed the survey. No standard approach in monitoring safe staffing or in-shift or intershift recovery was found. There were high levels of work-related stress, burnout and thoughts about leaving midwifery, and low levels of job satisfaction, with just half of midwives reporting they were satisfied with the standard of care they could provide. Multivariable regression revealed that working practices variables, generally related to impeded recovery or compounded by staffing issues, had a significant association with poorer emotional wellbeing outcomes.

CONCLUSION

This research has demonstrated an association between impeded recovery, including a lack of formal methods to monitor this, and poorer emotional wellbeing outcomes, and that staffing levels are highly influential in determining outcomes. There is a need to re-evaluate current approaches to job design and how midwives are expected to work.

The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses working in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation

BACKGROUND

The COVID-19 pandemic resulted in significant physical and psychological impacts for survivors, and for the healthcare professionals caring for patients. Nurses and doctors in critical care faced longer working hours, increased burden of patients, and limited resources, all in the context of personal social isolation and uncertainties regarding cross-infection. We evaluated the burden of anxiety, depression, stress, post-traumatic stress disorder (PTSD), and alcohol dependence among doctors and nurses working in intensive care units (ICUs) in Nepal and explored the individual and social drivers for these impacts.

METHODS

We conducted a mixed-methods study in Nepal, using an online survey to assess psychological well-being and semi-structured interviews to explore perceptions as to the drivers of anxiety, stress, and depression. Participants were recruited from existing national critical care professional organisations in Nepal and using a snowball technique. The online survey comprised of validated assessment tools for anxiety, depression, stress, PTSD, and alcohol dependence; all tools were analysed using published guidelines. Interviews were analysed using rapid appraisal techniques, and themes regarding the drivers for psychological distress were explored.

RESULTS

134 respondents (113 nurses, 21 doctors) completed the online survey. Twenty-eight (21%) participants experienced moderate to severe symptoms of depression; 67 (50%) experienced moderate or severe symptoms of anxiety; 114 (85%) had scores indicative of moderate to high levels of stress; 46 out of 100 reported symptoms of PTSD. Compared to doctors, nurses experienced more severe symptoms of depression, anxiety, and PTSD, whereas doctors experienced higher levels of stress than nurses. Most (95%) participants had scores indicative of low risk of alcohol dependence. Twenty participants were followed up in interviews. Social stigmatism, physical and emotional safety, enforced role change and the absence of organisational support were perceived drivers for poor psychological well-being.

CONCLUSION

Nurses and doctors working in ICU during the COVID-19 pandemic sustained psychological impacts, manifesting as stress, anxiety, and for some, symptoms of PTSD. Nurses were more vulnerable. Individual characteristics and professional inequalities in healthcare may be potential modifiable factors for policy makers seeking to mitigate risks for healthcare providers.

Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review

Background

Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves.

Aim

To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions.

Methods

Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards' reporting guidelines.

Data sources

First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied.

Results

We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work ('serve and sacrifice'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors.

Conclusions

Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being.

Future work

Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs.

Limitations

The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample.

Study registration

This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.

The relationship between quick return shift schedules and burnout among nurses: A prospective repeated measures multi-source study

BACKGROUND

In today's world, essential health care services are expected round the clock, leading to distinct shift work requirements. A notable aspect is the "quick return," where the rest interval between nursing shifts is <11 h. Preliminary research suggests a potential association between quick return schedules, diminished sleep quality, and possible nurse burnout. Yet, the motivation of nurses could potentially moderate this relationship.

OBJECTIVE

To examine a moderated-mediation model, whereby sleep duration and nurse's motivation act together to mediate the link between quick return schedules and nurse's burnout.

DESIGN

A prospective repeated measures (4-5 nursing shifts per nurse) multi-source (self-report and objective measures) study.

SETTING

Internal and surgical departments across one large and one medium scale teaching hospitals in Israel.

PARTICIPANTS

Registered nurses who provide direct patient care (n = 79) across 369 shifts.

METHODS

Nurses completed a questionnaire containing personal information and information regarding their shifts during the study week. They wore an accelerometer (a wrist worn device that monitors and records an individual's activity level) during a work-week to objectively determine their sleep duration, completed a motivation questionnaire at the beginning of each shift, and completed a burnout questionnaire at the end of the week. Mixed-model regression analysis was used to test a moderated-mediation model following Hayes' recommendations, whereby the joint effect of sleep duration and motivation mediates the link between quick return schedules and burnout.

RESULTS

The moderated-mediation model was supported. Quick return schedules were negatively statistically significantly associated with sleep duration (b = -126.54, SE = 20.85, p < 0.001); so that more frequent quick return schedules were related to shorter sleep duration. However, no direct correlation was observed between sleep duration and burnout (p = 0.171). A statistically significant interaction was observed between sleep duration and motivation (b = 0.00, SE = 0.00, p < 0.001) concerning burnout. Thus, nurses with lower motivation were prone to experiencing higher levels of burnout with shorter sleep duration compared to nurses with higher motivation.

CONCLUSIONS

The mediating role of sleep duration, moderated by motivation, plays a role in the connection between quick return schedules and burnout. This indicates that nurses can sustain their work motivation even within the demands of quick return schedules, consequently mitigating burnout levels. To prioritize employees' well-being, organizations should adopt shift work structures that minimize quick return schedules and extend nurses' sleep duration. Consequently, managers must employ strategies to enhance nurses' motivation when addressing scenarios that necessitate quick return schedules.

Relationship between shift assignments, organizational justice, and turnover intention: A cross-sectional survey of Japanese shift-work nurses in hospitals

AIM

Shift management and planning processes for shift-working nurses are important for their continued work. This study aimed to determine the association between shift assignments, organizational justice, and their interaction with turnover intention among shift-work nurses.

METHODS

This cross-sectional study used an online questionnaire administered to Japanese nurses between January and February 2020. Enquiries pertaining to their daily start and end times for each shift type, the shift assignments, organizational justice, and their turnover intention were made. To examine the association with turnover intention, logistic regression analysis was performed with shift assignments, organizational justice, and their interaction terms as independent variables.

RESULTS

A total of 386 nurses participated in the final analysis. Of these, 161 nurses (41.7%) had turnover intention. Unequal work assignments and procedural justice were significantly associated with turnover intention. However, the interaction between these factors was not significant.

CONCLUSION

The results suggest that procedural justice in the workplace and turnover intention are related, but in shift planning, even procedural justice cannot buffer unequal work from leading to turnover intention. This study provides valuable insights for nursing managers who manage the schedules of shift-working nurses.

Recovery from shift work

One fifth of today's workforce is engaged in shift work and exposed to various mental and physical health risks including shift work disorder. Efficiently recovering from shift work through physical and mental interventions allows us to mitigate negative effects on health, enables a better work-life balance and enhances our overall wellbeing. The aim of this review is to provide a state-of-the-art overview of the available literature. The role of sleep timing and naps, light therapy and psychotherapy, diet and exercise in recovery from shift work is presented here. We further review the impact of shift schedules and social support on post-shift unwinding.

Effects of shift work schedules, compensatory sleep, and work-family conflict on fatigue of shift-working nurses in Chinese intensive care units

BACKGROUND

Shift work is inevitable for nurses in intensive care units. Various studies explored nurses' fatigue in multiple hospital wards. However, few studies focused on fatigue among nurses in intensive care units.

AIMS

To determine the association between shift work schedules, compensatory sleep, work-family conflict, and fatigue of shift-working nurses in critical care units.

STUDY DESIGN

A descriptive cross-sectional multi-center study was conducted in March 2022 among intensive care nurses from five hospitals.

METHODS

Data were collected by online survey, including self-designed demographic questions, the Fatigue Scale-14, the Chinese adult daytime sleepiness scale, and the work-family scale. Pearson correlation was conducted for bivariate analysis. Independent-sample t-test, one-way ANOVA, and multiple linear regression analysis were performed to examine fatigue-related variables.

RESULTS

A total of 326 nurses responded to the survey with an effective response rate of 74.9%. The mean scores of physical fatigue and mental fatigue were 6.80 and 3.72, respectively. The bivariate analyses showed that work-family conflict was positively correlated with physical (r = 0.483, p < .001) and mental fatigue (r = 0.406, p < .001). Multiple linear regression results showed that work-family conflict, daytime sleepiness, and shift system were statistically significant factors influencing physical fatigue (F = 41.793, p < .001). Work-family conflict, sleep duration after the night shift, and daytime sleepiness were the main influencing factors of mental fatigue (F = 25.105, p < .001).

CONCLUSIONS

Nurses with higher work-family conflict, daytime sleepiness, and working 12-h shifts have higher levels of physical fatigue. Higher work-family conflict, shorter sleep duration after night shifts, and daytime sleepiness are associated with higher mental fatigue among intensive care nurses.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers and nurses should consider work-family factors and compensatory sleep in their efforts to reduce fatigue. It is necessary to strengthen work-supporting strategies and compensatory sleep guidance for nurses to promote fatigue recovery.

Exploring nurses' well-being and strategies to support self-care

Nurses experience a range of challenges in their practice that can adversely affect their well-being, for example work-related stress and workforce issues. These challenges may have been intensified by various factors, such as the coronavirus disease 2019 (COVID-19) pandemic and shift working. This article considers the concept of well-being and explores nurses' well-being in the context of ongoing stressors and workforce issues. It also examines some of the effects of shift work on nurses' well-being and how these could be mitigated. The authors outline a range of self-care practices that nurses could engage in and consider how they may be supported in this by their line managers and healthcare organisations.

Work-schedule management in psychiatric hospitals and its associations with nurses' emotional exhaustion and intention to leave: A cross-sectional multicenter study

BACKGROUND

Managing nurses' work schedules in hospitals is challenging because employer needs, like shift changes at short notice and overtime, may conflict with nurses' desires for a predictable and stable schedule. Nurses should have a certain degree of control over their work schedules, and their supervisors should support their needs in scheduling. How perceived control over work schedules, perceived support from supervisors in scheduling, shift changes at short notice, and overtime affect nurses' emotional exhaustion and intentions to leave has not been studied.

OBJECTIVES

The aims are (1) to describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses in psychiatric hospitals; (2) to assess the variation of these four factors between units at psychiatric hospitals; and (3) to investigate the association between these factors with nurses' emotional exhaustion and intentions to leave.

DESIGN

Cross-sectional survey study.

SETTING(S)

Swiss psychiatric hospitals with 24-hour services.

PARTICIPANTS

Registered nurses (N = 994) from 114 adult-inpatient units.

METHODS

To describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses, we calculated frequencies, percentages, means, and standard deviations of their responses to the survey. To assess the variation between units, we computed intraclass correlations for the four factors. We constructed random-effects models accounting for the clustering of nurses in units for emotional exhaustion and intentions to leave separately.

RESULTS

Perception of work-schedule control was 3.32 (SD 1.39, range 0-5); perception of supervisor work-schedule support was 3.28 (SD 1.14, range 0-4). On average, 9 % of the nurses had to take over a shift at short notice at least three times per month, and 40 % worked at least 15 minute overtime on their most recent shift. Intraclass correlation for all four factors was higher than 0.05. Emotional exhaustion was significantly associated with supervisor support and overtime, and leaving intentions were significantly associated with perceived control, supervisor support and overtime.

CONCLUSION

Perceived control, perceived supervisor support, shift changes at short notice, and overtime are promising factors for interventions to prevent nurses' emotional exhaustion and allay their intentions to leave. Unit managers should provide nurses with increased predictability and influence on their work schedules. This could reduce early career endings and early retirement and counteract nurse shortages.

Pregnant nurses' experiences of working shifts: a qualitative systematic review

OBJECTIVE

The objective of this systematic review was to synthesize the experiences of nurses who work shifts during pregnancy.

INCLUSION CRITERIA

This review included studies that focused on the experiences of pregnant registered nurses, regardless of their level of qualification, working shifts in any workplace, including hospitals, nursing home facilities, or clinics, in any country. Nurses not involved in direct care (eg, advanced practice nurses, administrators, educators) were excluded.

METHODS

The review followed the JBI methodology for qualitative systematic reviews. Published and gray literature were searched for via CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycINFO (EBSCOhost), Igaku Chuo Zasshi (Japan Medical Abstracts Society). No language restrictions were imposed, and the date limit was set for 2013 to 2021. Two independent reviewers performed data collection, extraction, critical appraisal, and analysis. Unequivocal and credible findings were used to develop categories, which were then synthesized to provide a set of comprehensive findings, which were graded according to ConQual.

RESULTS

Five qualitative studies were included (2 from the USA, 2 from Japan, and 1 from Korea), from which 23 findings with narrative illustrations were extracted. Of these findings, 22 were assessed as unequivocal and 1 as credible. The studies were low-to-moderate quality based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies, including phenomenology, qualitative description, and the grounded theory approach. Results were integrated into 8 categories and 3 synthesized findings. The first synthesized finding was that nurses struggle with the physical burden of pregnancy and work environments that threaten continued pregnancy. The second was that nurses achieve work-pregnancy compatibility by disclosing their pregnancy and obtaining support. The third was that development as a nurse results from continuing to work during pregnancy.

CONCLUSIONS

Pregnant nurses face a harsh work environment; the support they receive after disclosing their pregnancy allows them to balance work and pregnancy; and they feel that they grow as professionals by continuing to work even if they are pregnant. More research is needed to inform support systems for them.

REVIEW REGISTRATION

PROSPERO CRD42022309674.

SUPPLEMENTAL DIGITAL CONTENT

A Japanese-language version of the abstract of this review is available as Supplemental Digital Content: http://links.lww.com/SRX/A31.

Chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda

AIM

This study aimed to assess chronic stress and coping mechanisms among nurses in Lango sub-region, northern Uganda, conducted between May and June 2022.

DESIGN

Institutional-based cross-sectional design conducted between May and June 2022.

METHODS

The study included 498 participants recruited from six health facilities. A 12-Item Short Form Survey tool was used to collect data on chronic stress, while a researcher-developed questionnaire was used to collect data on coping strategies. Descriptive statistics, binary logistic regression and multiple regression were conducted for data analysis. A p-value of 0.05 was considered statistically significant.

RESULTS

Out of 498 participants, 153 (30.7%) were aged between 31 and 40 years, 341 (68.5%) were female, 288 (57.8%) were married, and 266 (53.4%) had less than Diploma. Of the 498 participants, 351 (70.5%) experienced chronic stress. The protective factors against chronic stress were being married (AOR: 0.132; 95% CI: 0.043-0.408; p < 0.001), optimizing shift length (AOR: 0.056; 95% CI: 0.027-0.115; p < 0.001), religiosity/Spirituality (AOR: 2.750; 95% CI: 1.376-5.497; p = 0.004), and regular exercise and breaks (AOR: 0.405; 95% CI: 0.223-0.737; p = 0.003).

The Road to Developing Standard Time for Efficient Nursing Care: A Time and Motion Analysis

(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities--which are often not taken into account while estimating nurse-to-patient care time allocation--that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses' overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time-motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.

Consecutive Shifts: A Repeated Measure Study to Evaluate Stress, Biomarkers, Social Support, and Fatigue in Medical/Surgical Nurses

Nurses report that they are required to work during their scheduled breaks and generally experience extended work times and heavy workloads due to staffing shortages. This study aimed to examine changes in personal, work-related, and overall stress, as well as biological responses and fatigue experienced by nurses during three consecutive 12 h workdays (i.e., the typical "three-twelves" schedule). We also considered the moderating effects of social resources. This prospective study of 81 medical/surgical nurses who completed questionnaires and provided saliva samples at four designated intervals (i.e., pre-shift and post-shift on workdays 1 and 3). Fatigue reported by night shift nurses increased significantly over three consecutive workdays (p = 0.001). Day shift nurses said they encountered more social support than those on the night shift (p = 0.05). Social support moderated the relationship between work-related stress at baseline and reported fatigue on day 3.

Concurrent trajectories of self-rated health and working hour patterns in health care shift workers: A longitudinal analysis with 8-year follow-up

Background

The association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (working <35 h/week and working night shifts) and the extent to which these trajectories were predicted by employees' lifestyle and mental health.

Methods

Participants of this cohort study with a 8-year follow-up were 5,947 health care shift workers. We linked self-reports of health from three repeated surveys with objective pay-roll based data on working hours. Using group-based multi-trajectory analysis we identified concurrent trajectories for self-rated health and working hour patterns. We examined their associations with baseline lifestyle-related factors (smoking, at-risk alcohol use, obesity, and physical inactivity) and mental health (sleep problems and psychological distress) using multinomial regression analysis.

Results

Three combined trajectories of self-rated health and working <35 h/week and four combined trajectories of self-rated health and night work were identified. Unhealthy lifestyle and poor mental health were associated with trajectories of moderate and declining health. Sleep problems were linked with working <35 h/week. Younger age and good mental health were associated with a combined trajectory of good health and continued night shift work.

Conclusion

Trajectories of suboptimal and declining health are associated with trajectories of reducing working hours and leaving night work, and are more common in employees with unhealthy lifestyle, sleep problems, and psychological distress.

The Moderating Effect of Community Environment on the Association Between Social Support and Chinese Older Adults' Health: An Empirical Analysis Study

Background

The aging population conundrum and the gradual weakening of older adults' health and ability to obtain resources as they age have drawn attention to this population's health. Older adults' health relates not only to their own quality of life, but also to the development of families/society.

Methods

We analyzed micro data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study Follow-up Questionnaire, using the probit model, ordinary least squares model, and other methods.

Results and Conclusions

Both formal and informal social support significantly impacted the physical and mental health of Chinese older adults, and the community environment moderated this relationship. To build a reasonable and effective social support system for older adults and improve their health, we suggest that stakeholders should continue to strengthen the formal and informal social support provided to older adults; they should also build a community-based care system, which will allow for the moderating role of community environment on the relationship between social support and older adults' health. Family and social support factors are important for older adults' health. We should enable the moderating role of community environment on the relationship between social support and health to be fully exerted, as well as build a community-based pension system.

Because they're worth it? A discussion paper on the value of 12-h shifts for hospital nursing

The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses' wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses.

The Daily Basic Psychological Need Satisfaction and Work Engagement of Nurses: A ‘Shortitudinal’ Diary Study

Nurses’ satisfaction and work engagement have been linked to patient outcomes. Nightshift nurses provide healthcare to the population and experience unique challenges in performing their healthcare tasks. Therefore, the current study aimed to investigate the daily basic needs satisfaction and work engagement of nightshift nurses in accordance with the satisfaction of three basic psychological needs as indicated by the Self-Determination Theory. A quantitative, ‘shortitudinal’ design (diary study; over a few days) with a multi-level research approach using a daily diary survey method was completed by a convenience sample of nurses working the nightshift in a public hospital (n = 33). The results revealed that the daily need for autonomy and need for relatedness did not significantly predict variance in daily work engagement. However, need for competence did significantly predict variance in daily work engagement, and general emotional load explained significant variability in daily need satisfaction of competence. Lastly, general role clarity had a negative impact on the daily variability in work engagement. This study provides healthcare organisations with explanations for variance in nursing performance and suggests possible interventions to address nursing outcomes in accordance with the three basic needs of nightshift nurses in daily activity.

Student nurses' views on shift patterns: What do they prefer and why? Results from a Tweetchat

Aim

The main aim of the study was to understand student nurses’ views around shift patterns.

Design

Qualitative study.

Method

We held a Tweetchat in May 2019, where we asked questions around the frequency of 12‐hr shifts working on placement; schedule flexibility while on placement; which shift patterns they preferred and why. Data from the Tweetchat were analysed using reflexive thematic analysis to generate themes from initial codes.

Results

Seventy‐three nursing students participated in the Tweetchat. The majority reported that they work 12‐hr shifts on placements, particularly when based in a hospital. We identified three themes: ‘Achieving a personal equilibrium’; ‘Meeting the needs of the care environment’; ‘Factors affecting negotiation capacity’. Data highlighted a conflict for most students, where they preferred 12‐hr shifts because of more time off for study, paid work and leisure, while acknowledging 12‐hr shifts negatively affected their fatigue, exhaustion and led them to follow a poor diet and neglect exercise and sleep.