Longer Nursing Shifts Tied to More Burnout

(MedScape) For hospital nurses, working 12 hours or longer is associated with adverse outcomes, including nurse burnout, that may endanger patients and nurses, a new study has shown.

Chiara Dall’Ora, MSc, from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, United Kingdom, and colleagues present their findings in an article published online August 23 in BMJ Open.

“Shifts of 12 [hours] or longer have become increasingly common for nurses in hospitals in some countries in Europe. This change is mainly driven by managers’ perceptions of improved efficiency from reducing the number of nurse shifts a day, therefore resulting in fewer handovers between shifts, less interruptions to clinical care provision and increased productivity due to a reduction in the overlap between two shifts,” the authors explain. “From the nurse perspective, longer shifts offer a potential to benefit from a compressed working week, with fewer work days and more days off-work, lower commuting costs and increased flexibility.”

However, some experts are concerned that long shifts negatively affect nurses’ well-being, job satisfaction, and plans to leave their job. To find out, Dall’Ora and colleagues conducted a cross-sectional survey of 31,627 registered nurses in 2170 general medical or surgical units from 488 hospitals across 12 European countries.

The investigators controlled for a range of potential confounders, including shift type (day/night), overtime (yes/no), nurse staffing levels, hospital size, whether or not a hospital was a teaching hospital, nurses’ age, and nurses’ sex. Some of those variables have been associated with adverse outcomes in the past.

Nurses who worked shifts of at least 12 hours in length were more likely than those who worked shorter shifts (≤8 hours) to report burnout in terms of emotional exhaustion (adjusted OR [aOR], 1.26; 95% confidence interval [CI], 1.09 – 1.46), depersonalization (aOR, 1.21; 95% CI, 1.01 – 1.47), and low personal accomplishment (aOR, 1.39; 95% CI, 1.20 – 1.62).

Those who worked shifts of at least 12 hours in length were more likely to report job dissatisfaction (aOR, 1.40; 95% CI, 1.20 – 1.62) and dissatisfaction with their work schedule flexibility (aOR, 1.15; 95% CI, 1.00 – 1.35), and to report plans to leave their job because of dissatisfaction (aOR, 1.29; 95% CI, 1.12 – 1.48).

“Our results provide the basis for managers and nurses alike to question routine implementation of shifts longer than 8 [hours], and the use of overtime that is associated with poor nurse outcomes under any shift length, suggesting that overtime may not be a useful strategy to cope with nursing shortages,” the authors conclude. “In the context of austerity measures leading to cuts in spending on public services in Europe, it is particularly important for policymakers and managers to have good evidence on which to base decisions on hospital nurse work hours to ensure that the well-being of workers and the quality of care is maintained and nurses are retained in practice.”

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