Nurse survey shows longer working hours impact on quality of care

Results of a survey of more than 30,000 nurses across Europe show that nurses who work longer shifts and more overtime are more likely to rate the standard of care delivered on their ward as poor, give a negative rating of their hospitals safety and omit necessary patient care.

Led by researchers at the University of Southampton and the National Nursing Research Unit (NNRU) at King's College London, the RN4CAST survey of nurses in over 450 hospitals across 12 European countries, was part of an international research programme looking at links between nursing workforce issues and patient outcomes.

Results showed that nearly a third of nurses in England are working shifts of more than 12 hours, something which is becoming more common in English hospitals. Hospitals are adopting long shifts to reduce the number of handovers between nurses and to save costs. Some nurses seem to prefer them because they work fewer days in a week.

Nurses working these long shifts were 30 per cent more likely to report poor quality of care compared to nurses working traditional eight hour shifts. They were also 41 per cent more likely to report failing or poor standards of safety and reported leaving more necessary nursing care undone than nurses working shifts lasting eight hours. Nurses working overtime in their last shift were also likely to report lower standards of care, safety and care left undone.

Professor Peter Griffiths, Chair of Health Services Research at the University of Southampton who led the study, comments: "These findings raise questions for healthcare organisations, especially in the current economic climate, where employers in many countries including England are aiming to use the existing workforce more efficiently, either to reduce expenditure or because of nursing shortages. Moving from three shorter shifts per day to two longer ones has been claimed to save up to 14 percent of salary costs. But at what cost to the patient? This strategy needs to be looked at in much more detail. If nurses perform less effectively and less safely, what's the point?"

"This is compelling evidence that policy makers in England need to take note of," Professor Griffiths adds. "Although eight hour shifts are still common, a lot of nurses are working these longer shifts, but this study shows that this could be counterproductive. Additionally, the increased flexibility associated with working overtime may not deliver the desired goals for employers."

The paper was published in Medical Care.