Category Archives: Faculty of Health Sciences

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 ‚Äď 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 ‚Äėtrade‚Äô 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

Holiday balancing acts: misogyny, work and leadership

misogyny factorCathy Pope

 

 

This month’s post is a review of Anne Summers’ TheMisogyny Factor by WFRC director Professor Catherine Pope

 

 

The directors of the Work Futures Research Centre like the idea of work-life balance¬† even if the demands of our working lives sometimes seem to get in the way.¬† One of the ways I try to inject some ‚Äėbalance‚Äô into my life is through taking holidays when I spend ¬†time reading things that are not directly related to my research work – often fiction, but not always. If I venture abroad I try to pick up a book connected to the place I am visiting and this has been a great way of discovering new things – ranging from poetry to ancient history.

This year I was lucky enough to follow an academic visit to see colleagues at University of New South Wales involved in a project about organisational performance and accreditation with a trip to Australia. I was there just ahead of the general election so the news was full of electioneering and amongst this lots of discussion about Kevin Rudd the then Labour prime minister and his predecessor Julia Gillard.

The YouTube video of Julia Gillard‚Äôs misogyny speech¬†of 2012 had already gone viral at this point, and this was followed by some UK media notably a self-penned piece after the election (in which Labor lost)¬† in the Guardian on ‚Äėpower, purpose and Labor‚Äôs future‚Äô.¬† Sydney Opera House hosted a discussion between feminist writer Anne Summers and Gillard which had picked up on some of the themes of sexism and leadership that Gillard had debated in speeches and writing – and these are revisited in Summer‚Äôs book ‚ÄėThe Misogyny Factor (2013) which I bought for my holiday reading.

If we in the UK are disheartened about lack of progress on workplace equality agendas then this book suggests that our sisters in Australia have even more to complain about. Summers describes how, despite pioneering workplace reforms (Australia was the first to introduce the 8 hour day) and human rights (one of the first places to grant women the vote was South Australia in 1894), Australia lags behind in supporting working women.¬† Australian women have lower participation in work than many other OECD countries¬† and the gap between lifetime earnings of men and women is a shocking ¬†AUS $1 million. The Misogyny Factor is not a lighthearted read – Summers documents the political and legislative history of the struggle for gender equality in and outside work, and devotes a chapter to a fairly harrowing account¬† of the way that Julia Gillard was taunted, attacked and vilified because of her gender in politics‚Äô¬† ‚Äėtop job‚Äô. Thankfully the book concludes with a chapter called ‚ÄėDestroying the Joint‚Äô. The title comes from a phrase which entered the Twitter lexicon when another feminist writer, Jane Caro, decided to take on the misogynists when radio presenter Alan Jones said ”Women are destroying the joint – Christine Nixon in Melbourne, Clover Moore here. Honestly.” Caro responded with her now famous tweet, “Got time on my hands tonight so thought I’d spend it coming up with new ways of ”destroying the joint” being a woman & all. Ideas welcome.” This ignited a social media debate about misogyny – in Australian politics, in the workplace and in the street which alongside other projects like #everydaysexism¬†has become a global conversation about gender inequality.¬† We are hoping to add to this conversation with our Policy Briefing¬†on ‚ÄėGender Equality at Work : where are we now and how far have we still to go?‚Äô which will be out soon.

WFRC welcomes Professor Peter Griffiths as co-director

Peter Griffiths

We are delighted to announce that we have recruited a new co-directorto the Work Futures Research Centre.

Peter Griffiths is currently Professor of Health Sciences Research in the Faculty of Health Sciences.

Peter studied Social Psychology at the University of Sussex in the 1980s, a decision that he says was influenced by an ‚Äėanarchist egg attack‚Äô on David Owen in 1981. Following a subsequent career in nursing, Peter undertook a PhD in nursing research at Kings‚Äô College London.

Peter’s research interests include the relationship between healthcare management structures and the outcomes for staff and patients. His early research involved nursing-led care delivered to post-acute patients, where he set up and evaluated pioneering nursing-led units.

More recently, Peter has been involved in the EU-funded RN4CAST study, which examines human resources management of nursing staff in 13 countries across Europe, Asia, Africa and the USA, and the impact of nurse deployment on patient safety. Peter also collaborates with the Health Quality Council of Saskatchewan in Canada where he is helping to evaluate the Productive Ward programme, and the Health Quality Improvement Programme in England where he assessed the feasibility of a national audit of nutritional care in hospitals and care homes.

Before arriving at Southampton, Peter was director of England’s National Nursing Research Unit from 2006 to 2010, and retains a visiting professorship there. He is also Executive Editor of the International Journal of Nursing Studies.

Peter’s strong background in multidisciplinary research means that he is an excellent addition to the WFRC, and we are looking forward to incorporating his ideas into our programme. Incidentally, this is not the first time Peter has been involved with the WFRC, he gave a seminar on his research back in 2011.

Peter will take the place of Alison Fuller at the WFRC, which was made available following her appointment as Chair in Vocational Education and Work at the Institute of Education. We wish Alison the very best in her new adventure and welcome Peter to the team.

Peter will be making his debut on the Work Thought Blog later this week, make sure you look out for it!

Inaugural Lecture of Professor Catherine Pope: Why Medical Sociology Matters

Inaugural Lecture Catherine Pope, Professor of Medical Sociology

21 June 2013 | 17:30 Р20:00

Lecture programme:  5.30pm Tea & coffee; 6.00pm Inaugural Lecture; 7.00pm Drinks reception

All welcome! RSVP at: http://catherinepopelecture.eventbrite.co.uk

For further details, please contact Tim Lees (t.lees@southampton.ac.uk)

 

Inaugural Abstract

Medical Sociology is one of the most successful branches of Sociology, applying as it does the study of society and social experience to the vital matters of what happens when we are ill or injured. Understanding ‚Äėmedicine’ by exploring the experience of health and sickness, and explaining the activity of healthcare organisations and professionals, is important not just because these things matter deeply to us and our loved ones when we are ill or injured, but also because this understanding gives us the power to intervene.

This lecture explores why Medical Sociology matters. It will draw on research and theory which has inspired me, and describe some of my own research about health care work (such as studies of secretaries managing waiting lists, and surgeons doing surgery) and organisational change in the NHS (ranging from the introduction of walk-in centres to computerised ambulance triage systems). I will argue that Medical Sociology is necessary and essential to understand and challenge health services and inform health care practice.

Catherine Pope: Bio

Catherine Pope is Professor of Medical Sociology in the Faculty of Health Sciences at University of Southampton. Her research has included ethnographic studies of waiting lists, operating theatres and ambulance journeys, and evaluations of NHS walk-in centres and NHS Treatment Centres, and Advanced Access to primary care. Most recently she has been studying a computerised decision support system in urgent and emergency care and the new health service commissioning arrangements. Thanks to a stint as deputy director of the RCUK Web Science Doctoral Training Centre, Catherine is also firmly enmeshed in research and teaching about the World Wide Web, including thinking about how the Web might be shaping health and health care. She was co-editor, with Professor Graham Crow, of Sociology and, with Professor Nicholas Mays, of the popular introductory text Qualitative Research in Health Care which has been translated into Japanese and Portuguese. She has also written (with Nicholas Mays and Professor Jennie Popay) a core text on Synthesizing Qualitative and Quantitative Health Evidence for the Open University Press.