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.

Career and life planning in the context of the postgraduate medical training - current challenges and opportunities

Introduction

The possibility of balancing career and family is meanwhile a central concern for most physicians when choosing a job. The aim of this study was to identify current barriers and opportunities for physician education and career planning.

Methods

This cross-sectional study was conducted as an online survey between 11/2021 and 02/2022 and targeted physicians at all career levels in Germany who were members of a clinical professional association. Alternative and consent questions were used to assess experiences/attitudes toward various aspects of life and career planning, as well as alternative work and parental leave models, depending on gender, specialty, and hierarchical level.

Results

The majority of the 2060 participants were female (69%) and had children (66%). Many childless residents reported that they felt they had to choose between children and a career. The majority of female residents, specialists and attending physicians (Ø 55.5%) stated that they had experienced career losses as a result of taking parental leave, while most men did not share this experience (Ø 53.7%). 92% of all participants agreed with the statement that men and women have different career opportunities. Job-sharing models were considered feasible at all levels of the hierarchy by an average of 55.6% of all medical executives.

Conclusion

Parenthood and the use of parental leave and part-time work appear to have a significant impact on the career paths of those surveyed. Although the majority of directors of medical training programs are open to job-sharing models, further measures are needed in order to equalize career opportunities for men and women.

Changing Employment and Work Schedule Patterns over the 30 Working Years-A Sequential Cluster Analysis

OBJECTIVE

As labor markets have become increasingly volatile and precarious since 1980s, more workers are susceptible to working conditions such as unpredictable and unstable hours, threatening their economic security. However, our understanding of employment patterns regarding the changes in work schedules over our working lives has yet been established. This study builds our knowledge in this area by paying attention to how social positions may shape the specific work schedule patterns over our working lives.

METHODS

We used the National Longitudinal Survey of Youth-1979 (NLSY79) to examine our research questions. NLSY79 follows a nationally representative sample of United States men and women between the ages of 14 and 22 when first interviewed in 1979. The participants were then interviewed annually until 1994 and then biennially thereafter. We first conducted a sequence analysis to examine work schedule patterns between ages 22 and 53 (n = 7987). We then used a multinomial logit regression to examine the factors contributing to specific work schedule patterns, with attention to social position.

RESULTS

Our sequence analysis results suggest five work schedule patterns during 31 years of adult life: working only standard hours (25%), mainly standard hours with some portions of nonstandard hours (38%), standard hours during early working years but transitioning to either largely variable or mainly evening or night hours (14% and 13%), and mostly not working (10%). Our multinomial logit analysis indicates that being non-Hispanic Black, having a high school degree or below, or having ever experienced poverty or welfare by age 23 were more likely to have a nonstandard work schedule pattern than their counterparts.

CONCLUSIONS

Our analysis underscores the dynamic employment patterns over our working lives, with some groups more likely than others to be engaged in nonstandard or volatile work schedules. Importantly, the groups likely to be subject to nonstandard work schedules also tend to have relatively disadvantaged social positions, thus worsening their vulnerability in securing work characterized by stability and economic security.

Parenting without Predictability: Precarious Schedules, Parental Strain, and Work-Life Conflict

Against the backdrop of dramatic changes in work and family life, this paper draws on survey data from 2,971 mothers working in the service sector to examine how unpredictable schedules are associated with three dimensions of parenting: difficulty arranging childcare, work-life conflict, and parenting stress. Results demonstrate that on-call shifts, shift timing changes, work hour volatility, and short advance notice of work schedules are positively associated with difficulty arranging childcare and work-life conflict. We also find that mothers working these schedules are more likely to miss work. Finally, we consider how family structure and race moderate the relationship between schedule instability and these dimensions of parenting. Ultimately, we argue that unstable work schedules have important consequences for mothers working in the service industry.

Health behavior, sleep quality and subjective health status among Hungarian nurses working varying shifts

BACKGROUND

Distinctly, shift work is burdensome for nurses and may lead to health problems.

OBJECTIVE

The purpose of the study was to examine the nursing shift system genres and to analyze the potentially debilitating effects upon sleep quality and the subjective state of physical and mental health when considering varying shift schedules.

METHODS

The first cross-sectional study (n = 639) was performed at the Clinical Center at the University of Pécs, and throughout various hospitals in the South-Danubian Region. The Hungarian version of the Bergen Shift Work Sleep Questionnaire, the Berlin Questionnaire and the 13-item Sense of Coherence Scale were implemented. In the longitudinal survey (n = 52), the quality of sleep was determined by the ActiGraph GT1M type of activity meter supplemented with a sleep diary.

RESULTS

Interestingly, most respondents weight gained among the irregular schedule group (p = 0.004). The nurses working a flexible schedule reportedly slept better (p = 0.003), had a higher sense of coherence (p = 0.013) and exhibited better subjective health status (p = 0.017) than when compared with nurses working irregular shifts. The frequency of psychosomatic complaints aligned with the length of rest periods proved influential (p = 0.013).

CONCLUSION

Admittedly, the irregularity of work schedules is stressful for nurses. Due to the health status of nurses, it is a worthy consideration to establish the least exhausting work schedules.

Congruence is not everything: a response surface analysis on the role of fit between actual and preferred working time arrangements for work-life balance

Working time arrangements that match employees' preferences have been proposed as determinants of employees' well-being, an assumption rooted in person-environment fit theory. The aim of this study was to investigate the role of fit and misfit between actual and preferred working time arrangements (length of working hours, control over the beginning and end of workdays, and workplace segmentation) for employees' satisfaction with work-life balance. We analyzed data from 8,580 employees from the BAuA-working time survey - a representative study among the working population in Germany - by means of polynomial regression and response surface analyses. Analyses did not point toward congruence effects but revealed significant main effects: Satisfaction with work-life balance was higher in case of shorter actual and longer preferred weekly working hours, and it was decreased if employees worked longer than they preferred. Moreover, more supplies and lower preferences in terms of control over the beginning and end of workdays, more workplace segmentation supplies, and lower workplace segmentation preferences were related to higher satisfaction with work-life balance. Overall, this study sheds light on the roles of fit and misfit between actual and preferred working time arrangements for employees' work-home interface. Findings suggest that while employees' preferences should find entrance into the design of work schedules, congruence is not a precondition for achieving a good work-life balance. Most importantly, for a good work-life balance, working hours should not be longer than preferred, and employees should have some control over their scheduling and possibilities to segment work and private life.

23rd International Symposium on Shiftwork and Working Time: Towards a Global Consensus

The Working Time Society (WTS), and the International Commission on Occupational Health (ICOH) Scientific Committee on Shiftwork and Working Time, are twin organisations focused on conducting research, and informing practice, regarding the impact of work hours in general, and shiftwork in particular, on the efficiency, productivity, safety, well-being, health, and biological rhythms, of employees. Every 2-3 years since 1969, the WTS and ICOH have conducted a series of international symposia in Europe, Asia, Australia, North America, and South America. The purpose of these symposia is to provide a forum for the exchange of knowledge, and the discussion of contested issues, with researchers, employee representatives, regulators, and employers. The most recent symposium in this series - the 23rd International Symposium on Shiftwork and Working Time, entitled "Toward a Global Consensus" - was held on 19-23 June 2017, at Yulara, Australia, near Uluru. Since 2004, Chronobiology International has released a special issue after each symposium, and that tradition continues with a special issue that includes 17 contributions based on a selection of the 128 papers that were presented at the most recent symposium. Here, we provide an overview of the papers that comprise the special issue, and we briefly comment on the implications of the findings for shiftworkers and their employers.

Sociomedical problems of overwork-related deaths and disorders in Japan

Objectives

Cerebrovascular and cardiovascular diseases (CCVDs) and mental disorders, including suicide, are prevalent among overworked individuals in Japan. The 2014 legislation regarding the prevention of overwork‐related deaths and disorders has accelerated the research in this field and ultimately the implementation of preventive actions.

Methods

To understand the current problematic situations, the Research Center for Overwork‐Related Disorders of the National Institute of Occupational Safety and Health, Japan, conducted analyses of compensated claims for overwork‐related CCVDs and mental disorders that were recognized from January 2010 to March 2015.

Results

The majority of CCVD cases were the men in their 50s. Transport and postal activities was the highest risk industry. Cerebrovascular cases were higher than cardiovascular ones. Long working hours was the principal factor for CCVDs. The mental disorder cases comprised approximately 70% men and affected younger age groups (peak in the third decade) with various industries at risk. In men, there was an almost equal number of F3 (Mood [affective] disorders) and F4 (Neurotic, stress‐related, and somatoform disorders) diagnoses according to the 10th revision of the International Classification of Diseases and Related Health Problems. A larger number of women were diagnosed to have F4. The mental disorder cases were associated not only with long working hours, but also with injuries and disasters as well as interpersonal conflict at work.

Conclusions

Multiple, simultaneous actions need to be made by employees, employers, researchers, and the authorities to achieve the goal of reducing the number of workers suffering from the overwork‐related CCVDs and mental disorders.

Different work schedules of nurses in Hungary and their effects on health

Background and purpose

The shift work is burdensome for nurses and may lead to health problems. Aims - The purpose of the study was to examine the nursing shift system types and to analyse the effects on nutritional status, subjective state of physical and mental health in case of different shift schedules.

Methods

In the first phase of the research 326 nurses working in changing shifts filled out the Bergen Shift Work Questionnaire after adaptation into Hungarian. 518 nurses participated in our second study in hospitals of the South-Danubian Region, in clinics of University of Pécs and at trainings organized by the Faculty of Health Sciences of the University of Pécs.

Results

Based on the psychometric characteristics of Bergen Shift Work Questionnaire technically it is suitable for the examination of sleeping disorders associated with shift work. Sleeping quality is worse in those working in irregular work shifts compared to those working in regular and flexible work schedules (p<0.001). The irregular work schedule is worse than the regular work schedule according to 76.6% of the nurses. According to 63.8% of the respondents the following regular work schedule is the best: after one 12-hour day shift one 12-hour night shift, followed by two days of rest. The average Body Mass Index (BMI) is 26.16 kg/m2. Since the nurses work in shift work 47.7% of them reported weight gain. Among the psychosomatic symptoms the most frequent is back pain (78.4%) related elevated BMI (p=0.013). The nurses' sense of coherence on average is 61.76 points. In case of full-time employees the sense of coherence is better than those who work in shifts (t=2.933, p=0.004). The nurses working irregular shift work asses their health worst (mean rank: 166.61; p=0.019), and their sense of coherence is lower (p=0.04).

Conclusion

The irregularity of work schedules is stressful for nurses. Due to the health of nurses it would be useful to establish the least exhausting work schedules.

Effects of Accumulating Work Shifts on Performance-Based Fatigue Using Multiple Strength Measurements in Day and Night Shift Nurses and Aides

Objective This study aimed to examine the effects of accumulating nursing work on maximal and rapid strength characteristics in female nurses and compare these effects in day versus night shift workers. Background Nurses exhibit among the highest nonfatal injury rates of all occupations, which may be a consequence of long, cumulative work shift schedules. Fatigue may accumulate across multiple shifts and lead to performance impairments, which in turn may be linked to injury risks. Method Thirty-seven nurses and aides performed isometric strength-based performance testing of three muscle groups, including the knee extensors, knee flexors, and wrist flexors (hand grip), as well as countermovement jumps, at baseline and following exposure to three 12-hour work shifts in a four-day period. Variables included peak torque (PT) and rate of torque development (RTD) from isometric strength testing and jump height and power output. Results The rigorous work period resulted in significant decreases (-7.2% to -19.2%) in a large majority (8/9) of the isometric strength-based measurements. No differences were noted for the day versus night shift workers except for the RTD at 200 millisecond variable, for which the night shift had greater work-induced decreases than the day shift workers. No changes were observed for jump height or power output. Conclusions A compressed nursing work schedule resulted in decreases in strength-based performance abilities, being indicative of performance fatigue. Application Compressed work schedules involving long shifts lead to functional declines in nurse performance capacities that may pose risks for both the nurse and patient quality of care. Fatigue management plans are needed to monitor and regulate increased levels of fatigue.

Parents' Work Schedules and Time Spent with Children

This paper adds to the growing body of research on the overlap between work and family by investigating the relationship between attributes of work schedules for parents and the amount of time they spend with their children. Nationally representative time diary data from the ATUS is used to calculate the amount of time parents spend with children on a random day, and this data is merged with the CPS Work Schedules Supplement which provides information on the respondent's usual work schedule, such as having a flexible schedule, variable start and stop times, working from home or a day schedule. The results show that though some work schedule attributes have little influence on the amount of time parents spend with children, certain aspects of the timing of work are related to the total time parents spend with their children. The attributes of work schedules are also found to be associated with the amount of time spent in specific activities with children.

Separate and Joint Associations of Shift Work and Sleep Quality with Lipids

Background

Shift work and/or sleep quality may affect health. We investigated whether shift work and sleep quality, separately and jointly, were associated with abnormal levels of triglycerides, total cholesterol (TC), and low-and high-density lipoprotein cholesterol in 360 police officers (27.5% women).

Methods

Triglycerides, TC, and high-density lipoprotein were analyzed on the Abbott Architect; low-density lipoprotein was calculated. Shift work was assessed using City of Buffalo payroll work history records. Sleep quality (good, ≤ 5; intermediate, 6–8; poor, ≥ 9) was assessed using the Pittsburgh Sleep Quality Index questionnaire. A shift work + sleep quality variable was created: day plus good sleep; day plus poor sleep; afternoon/night plus good; and poor sleep quality. Mean values of lipid biomarkers were compared across categories of the exposures using analysis of variance/analysis of covariance.

Results

Shift work was not significantly associated with lipids. However, as sleep quality worsened, mean levels of triglycerides and TC gradually increased but only among female officers (age- and race-adjusted p = 0.013 and 0.030, respectively). Age significantly modified the association between sleep quality and TC. Among officers ≥ 40 years old, those reporting poor sleep quality had a significantly higher mean level of TC (202.9 ± 3.7 mg/dL) compared with those reporting good sleep quality (190.6 ± 4.0 mg/dL) (gender- and race-adjusted p = 0.010). Female officers who worked the day shift and also reported good sleep quality had the lowest mean level of TC compared with women in the other three categories (p = 0.014).

Conclusion

Sleep quality and its combined influence with shift work may play a role in the alteration of some lipid measures.

Achieving work-life balance in the National Collegiate Athletic Association Division I setting, part I: the role of the head athletic trainer

CONTEXT

Supervisor support has been identified as key to the fulfillment of work-life balance for the athletic trainer (AT), yet limited literature exists on the perspectives of supervisors.

OBJECTIVE

To investigate how the head AT facilitates work-life balance among staff members within the National Collegiate Athletic Association Division I setting.

DESIGN

Qualitative study.

SETTING

Web-based management system.

PATIENTS OR OTHER PARTICIPANTS

A total of 18 head ATs (13 men, 5 women; age = 44 ± 8 years, athletic training experience = 22 ± 7 years) volunteered for an asynchronous, Web-based interview.

DATA COLLECTION AND ANALYSIS

Participants responded to a series of questions by journaling their thoughts and experiences. We included multiple-analyst triangulation, stakeholder checks, and peer review to establish data credibility. We analyzed the data via a general inductive approach.

RESULTS

Four prevailing themes emerged from the data: modeling work-life balance, encouraging disengagement from the AT role, cooperation and community workplace, and administrative support and understanding.

CONCLUSIONS

Head ATs at the Division I level recognized the need to promote work-life balance among their staffs. They not only were supportive of policies that promote work-life balance, including spending time away from the role of the AT and teamwork among staff members, but also modeled and practiced the strategies that they promoted.

Shift work and diabetes--a systematic review

Diabetes mellitus is a chronic disease, which has an increasing trend all over the world. Type 2 diabetes constitutes 90% of all diabetes. It is associated with weight gain and insulin resistance. Research during recent years has suggested that shift work could be a risk factor of type 2 diabetes. Since shift work is becoming more common, it could contribute to the increasing trend of diabetes. In this systematic review, we have studied the potential association between shift work and type 2 diabetes. We have also reviewed studies on control of diabetes in relation to shift work.

Work Hours, Schedules, and Insufficient Sleep Among Mothers and Their Young Children

Studies have linked parents' employment, work hours, and work schedules to their own sleep quality and quantity, but it is unclear whether these associations extend to children. The authors used data from the 5-year in-home survey of the Fragile Families and Child Wellbeing Study (N = 1,818) to examine the associations between maternal work hours and schedule and insufficient sleep among disadvantaged mothers and their young children. They found that mothers who worked more than 35 hours per week were more likely to experience insufficient sleep compared to mothers who worked fewer hours, whereas children were more likely to experience insufficient sleep when their mothers worked between 20 and 40 hours. Nonstandard work schedules were associated with an increased likelihood of insufficient sleep for mothers but not their children. The results highlight a potentially difficult balance between work and family for many disadvantaged working mothers in the United States.

Strategies for managing work/life interaction among women and men with variable and unpredictable work hours in retail sales in Québec, Canada

Increasingly, work schedules in retail sales are generated by software that takes into account variations in predicted sales. The resulting variable and unpredictable schedules require employees to be available, unpaid, over extended periods. At the request of a union, we studied schedule preferences in a retail chain in Québec using observations, interviews, and questionnaires. Shift start times had varied on average by four hours over the previous week; 83 percent had worked at least one day the previous weekend. Difficulties with work/life balance were associated with schedules and, among women, with family responsibilities. Most workers wanted: more advance notice; early shifts; regular schedules; two days off in sequence; and weekends off. Choices varied, so software could be adapted to take preferences into account. Also, employers could give better advance notice and establish systems for shift exchanges. Governments could limit store hours and schedule variability while prolonging the minimum sequential duration of leave per week.

Nonstandard Work Schedules, Perceived Family Well-Being, and Daily Stressors

Data from two studies assessed the effects of nonstandard work schedules on perceived family well-being and daily stressors. Study 1, using a sample of employed, married adults aged 25 - 74 (n = 1,166) from the National Survey of Midlife in the United States, showed that night work was associated with perceptions of greater marital instability, negative family-work, and work-family spillover than weekend or daytime work. In Study 2, with a subsample of adults (n = 458) who participated in the National Study of Daily Experiences, weekend workers reported more daily work stressors than weekday workers. Several sociodemographic variables were tested as moderators. Both studies demonstrated that nonstandard work schedules place a strain on working, married adults at the global and daily level.