Tag 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 ‚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

Five years into Work Futures

We established the Work Futures Research Centre in December 2008 with four co-directors: Professor Susan Halford, Professor Pauline Leonard, Professor Alison Fuller, and Professor Catherine Pope.  Originally supported by the Research Strategy sub-committee of the School of Social Sciences, a year later WFRC became a University Strategic Research Group.

Our objectives are :

–¬†¬†¬†¬†¬†¬†¬† To build a collaborative, interdisciplinary network for academic research on changing forms of work organisation, workforce change, development and learning, and employment

–¬†¬†¬†¬†¬†¬†¬† To improve links with employers, policy makers, and other stakeholders outside ¬†the University¬† to strengthen Work Futures research

–¬†¬†¬†¬†¬†¬†¬† To inform and influence the agenda for research on Work Futures and position the University of Southampton as a leading centre for this research

Since 2008 members of our WFRC network have raised in excess of £4.5m in funding across 21 research  projects linked to our priorities. Our research has led to over 30 research papers and contributed to different Units of Assessment in the University’s REF2014 submission.

Recent successes include a commissioned scoping study for ESRC, on the ‚ÄėNew Dynamics of Working‚Äô which will inform research strategy for this major funder. Pauline Leonard and Susan Halford were also ¬†recipients of funding from the inaugural PublicPolicy@Southampton project which led to a symposium at the House of Commons on ‚ÄėGender Equality at Work: How far have we come and how far have we got to go?‚Äô in 2013.

WFRC members developed an innovative undergraduate curriculum module ‚ÄėWork and Employment Theory in Practice‚Äô and delivered a multidisciplinary seminar series with the Digital Economy USRG focussed on the role of technology in school-to-work transition.

In September 2013, Alison Fuller left the University of Southampton to take up a new post at the Institute of Education at the University of London ESRC Centre for Learning and Life Chances in Knowledge Economies. Alison remains a key collaborator in WFRC and Professor Peter Griffiths has joined us as a co-director. Peter is based in Faculty of Health Sciences and brings further expertise on workforce configuration and organisational policy in health sector to the Centre. Peter is currently working on a major review for NICE about staff-patient ratios in the NHS.

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!