@article{4206, author = {Peter Griffiths and Chiara Dall'Ora and Michael Simon and Jane E. Ball and Rikard Lindqvist and Anne-Marie Rafferty and Lisette Schoonhoven and Carol Tishelman and Linda H. Aiken and RN4Cast Consortium}, title = {Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety.}, abstract = {

BACKGROUND: Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs.

OBJECTIVES: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone.

METHODS: Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries.

RESULTS: A total of 50% of nurses worked shifts of ≤ 8 hours, but 15% worked ≥ 12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥ 12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13-1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10-1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09-1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51-1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23-1.42), and more care left undone (RR=1.29; 95% CI, 1.27-1.31).

CONCLUSIONS: European registered nurses working shifts of ≥ 12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.

}, year = {2014}, journal = {Med Care}, volume = {52}, pages = {975-981}, month = {11/2014}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000233}, language = {eng}, }