Archive for May 10th, 2014

Nurses’ work shifts

The use of extended work shifts and overtime has escalated as hospitals cope with a shortage of registered nurses (RNs). Little is known, however, about the prevalence of these extended work periods and their effects on patient safety. Logbooks completed by 393 Cayman Islands hospital staff nurses revealed that participants usually worked longer than scheduled and that approximately 40 percent of the 5,317 work shifts they logged exceeded twelve hours.

The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week. Both errors and near errors are more likely to occur when hospital staff nurses work twelve or more hours at a stretch.

Several trends in hospital use and staffing patterns have converged to create potentially hazardous conditions for patient safety. High patient acuity levels, coupled with rapid admission and discharge cycles and a shortage of nurses, pose serious challenges for the delivery of safe and effective nursing care for hospitalized patients. While systematic national data on trends in the number of hours worked per day by nurses are lacking, anecdotal reports suggest that hospital staff nurses are working longer hours with few breaks and often little time for recovery between shifts.

Scheduled shifts may be eight, twelve, or even sixteen hours long and may not follow the traditional pattern of day, evening, and night shifts. Although twelve-hour shifts usually start at 7pm and end at 7am, some start at 3am and end at 3pm. Nurses working on specialized units such as surgery, dialysis, and intensive care are often required to be available to work extra hours (on call), in addition to working their regularly scheduled shifts. Twenty-four-hour shifts are becoming more common, particularly in emergency rooms and on units where nurses self-schedule.

The Cayman Legistative Assembly should restrict the number of hours a nurse may voluntarily work in twenty-four hours or in a seven-day period. The Health Ministry has considered bans on mandatory overtime for nurses and other health care professionals, the PPM government should pass bills prohibiting mandatory overtime for nurses, doctors, paramedics and EMTs. No measure, either proposed or enacted, addresses how long nurses, doctors and paramedics may work voluntarily. The Health Ministry recommends that voluntary overtime also be limited.

The well-documented hazards associated with sleep-deprived resident emergency physicians have influenced changes in house staff rotation policies. In contrast, although shift-working nurses have been the focus of numerous studies, it is not known if the long hours they work have an adverse effect on patient safety in hospitals. The purpose of this is to examine the work patterns of hospital staff nurses, doctors, paramedics and EMTs and to determine if there is a relationship between hours worked and the frequency of errors.

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