Author Archives: Peter Griffiths

Longer nursing shifts might ‘hit patient care’

Portrait Peter Griffiths

Peter Griffiths

Our recent paper about the length of nursing shifts in hospitals has attracted quite a lot of attention including, I am reliably informed, a piece in the daily Sun. In simple terms, the issue is this: Traditionally, shift work was organised by dividing the day into three eight-hour shifts. Workers would generally work 5 such shifts per week. This pattern was the norm in nursing for many years. In common with other industries there is now a trend for some hospitals to adopt longer shifts, typically two shifts per day each lasting 12-13 hours. Employees work fewer shifts each week (generally three instead of five). Changes are driven by perceived efficiencies for the employer (fewer handovers and reduced overlap between shifts), and improved work life balance for employees because they work fewer days per week. However, persistent concerns have been raised about negative impacts on the quality of care associated with working longer hours.

Our study, based on a cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries, found that 15% worked these long shifts. But in some countries, most notably England, Ireland and Poland, the practice was far more common. Nurses working longer shifts were more likely to report poor patient safety, quality of care and more care activities left undone. This effect was independent of any effect of working overtime.

Nurse and clock

(c) iStockphoto.com

Now, there are lots of issues here – in the end this is only self-report. However, these results are consistent with a number of studies from other countries showing higher rates of nurse burnout and even increased patient deaths in hospitals where nurses work 12 hour shifts.

So what are we to make of these findings? Our results suggest that a policy of moving to longer shifts to reduce overall workforce requirements may have unintended consequences and reduce the efficiency and effectiveness of the workforce in delivering high quality, safe care. But the response to our paper in the social media makes it clear that the issue is not simple. While many nurses responding to reports of the study in the ‘trade’ magazine Nursing Times agreed that working long shifts compromised quality, others (and sometimes the same nurses) expressed a strong preference for them. The emphasis seemed to be on the benefits of the extra days off. Most of these benefits were for the nurses themselves, not for the quality of care they could provide.

This presents a dilemma. Personally, the idea of working 12-13 hours in a busy hospital ward is a daunting one. On the other hand the idea that I might only have to work on 3 days per week is appealing. I might be tempted by such a compromise. But what should be done if what is at stake is not simply an equation to be balanced between my preferences and my employer’s desire for efficiency. What is at stake here is the quality and safety of hospital care.

I suspect that there is no going back. Hospitals with 12 hour shift patterns are likely to find it very difficult to move back because their employees, often female and with children, have organised their lives around this pattern. But research such as ours does point to the vital importance of considering some of the staples of research on shift work over the years. It becomes increasingly important to ensure that nurses get adequate opportunity for rest between shifts and are not required to work too many long shifts in a row. And perhaps, if more research like this accumulates, some consideration does need to be given to restricting choice. The EU working time directive governs many aspects of working hours but, as far as I can see, these shift patterns seem largely outside its scope. But in the end, should employees in safety critical work be permitted to choose to work in ways that are known to increase risk and should employers be allowed to ask them to?

Tired nurse yawn at work

(c)evolution-diet.com

Griffiths , P., D’all Ora, C., Simon, M., Ball, J., Lindqvist, R., Rafferty, A.M., Schoonhoven, L., Tishelman, C., Aiken, J.L., in press. Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety. Medical Care (online early DOI doi: 10.1097/MLR.0000000000000233

Sex Work Futures?

Sex work futures?

It’s the start of the new term for Universities and Colleges throughout the world. Choices and compromises have led new students to embark on courses that are likely to profoundly influence their future careers – because of the knowledge and skills they acquire, because of the networks of contacts they build and because of the previously unthought-of of possibilities that they are awakened to.  Of course, universities can also influence future career choices in other ways and student clubs and societies can also play a role in developing people’s future career choices and opportunities.

So far this sounds like a dull homage to the benefits of a university education and the role of extracurricular activities in preparing for the future. Not really the stuff of a blog on work futures and, let’s be frank, potentially disappointing given the title of the blog. Not so.

Here is the thing. Last week, the annual University of Southampton Fresher’s week ‘RAG’ showcased the work of many student societies, including the University Pole Dancing Club. Now I must confess that encountering a pole dancing demonstration outside a University Students Union was, for me, rather unexpected. I was equally surprised that the display was not the subject of any protest by members of the student body, but perhaps my view on these things has been skewed by being a the University of Sussex in the 1980’s where (I am fairly certain) such things would not have been  tolerated.

I know that pole dancing is now being pushed as ‘exercise’, but let’s be very clear about this. It is a form of exercise that is based on a form of sex work. This got me thinking. Am I simply a dinosaur stuck in the past? Perhaps sex work is just one more career opportunity and if some members of the University Pole Dancing club find their way into the sex industry because their horizons are broadened while at university, so be it. Certainly evidence from recent surveys suggests that sex work does have a role, potential of actual as a means of supplementing students’ income while at University in the UK. The ‘mainstreaming’ of sex work seems widespread in other developed economies.

Is sex work just another job?

Is sex work just another job?

So can we regard sex work as ‘just another job’? Is it simply a choice that some (mostly women, although by no means exclusively) choose to make, as free and legitimate as any other? Perhaps for some it is, I really don’t know. But what I do know is that sex work operates in a context that is associated with human trafficking and forms of slavery. Sex work operates in a context that relies on the objectification of other human beings in a way that is often predicated on treating them as less than fully human.

You might protest not in this country (are you sure?), not our University Club (of course not!), not pole dancing (…maybe?). Perhaps, but in my view, until the sex industry operates in a world where women are universally given equal opportunities the association between sex work and exploitation is too close for me to ever feel comfortable with pole dancing being treated as just another recreational activity or a fully informed career choice. Of course, exploitation is not confined to the sex industry and when we  consider the future of work we should consider the many forms of exploitation that remain hidden to a greater or lesser extent – cheap labour in sweat shops comes to mind. Perhaps next year the Fresher’s fair could include a sponsored sweatshop in which students have to produce garments at high speed in order to get enough money for tomorrow’s food? Or would that be seen as distasteful? It certainly would not be seen as opening up a career opportunity

Some might find it reassuring, others depressing (perhaps it is both) that the club raised a grand total of £2.10 for charity at the Fresher’s fair – the lowest of any of the clubs or societies listed on the University web site.