"To understand God's thoughts we must study statistics,
for these are the measure of His purpose."
- Florence Nightingale
for these are the measure of His purpose."
- Florence Nightingale
This is my first edition of Nursing Idea's Research Challenge (I'm a little behind in the challenge). I was a consumer of nursing research in junior and senior year nursing classes, but only as a confused outsider. I'm about halfway through the senior nursing research class, and it has been fun to actually begin to understand terminology and the research process when critiquing studies. I'm in the beginning stages of developing my research skills, but it's never too early to start participating in this important part of nursing.
Published Study of Interest:
"Nurses' Work Schedule Characteristics, Nurse Staffing, and Patient Mortality"
My interest stems from my experience with both day and night 12-hour shifts for home health care and clinical. I have felt the toll of exhaustion working multiple twelves in a row. Last semester, a lunch break discussion with my clinical instructor and a staff nurse on the unit gave me some insight into nurse's experiences with 12-hour and 8-hour shifts. One of my professors mentioned this study, and my search led me to this summary.
Recently, nursing research literature has described the effects of nurse staffing ratios and education on patient outcomes. The authors of this study found that one individual aspect of nursing care has been left out of the literature--work schedules. Their lit review notes that studies have shown that 12-hr shifts cause fatigue and sleep deprivation, but "their impact on patient outcomes is largely unknown" (1).
Work schedule variables included: time on call, working while sick, mandatory overtime, time between shifts, days in a row worked, hours worked per week (and more).
Mortality was measured with the following Agency for Healthcare and Quality (AHRQ) In-patient Quality Indicators (IQIs): "pneumonia, congestive heart failure (CHF), acute myocardial infarction (AMI) and stroke, and postsurgical procedures related to abdominal aortic aneurysm (AAA) repair and craniotomy" (1).
Significant associations occurred between the following:
Pneumonia deaths with long work hours and lack of time away from work.
AAA deaths with lack of time away.
CHF mortality with working while sick.
AMI mortality with nurses' weekly burden (hours worked per week).
The authors intertwine fatigue and sleep deprivation into the themes of the article, and they provide many references to literature that ties these themes to 12-hour shifts. They state, "The work schedule component most frequently related to mortality was that of lack of time away from the job. This has been found also to be important for nurse injury and fatigue..."(1).
The main conclusions focus on the need to fill the gap in the literature and a call to confront the assumed popularity of 12-hour shifts among nurses. The authors conclude, "Attention to work schedule is now warranted on the basis of the impact of scheduling on patients as well as nurses. Therefore, policies should be refocused on the work schedule as a means of improving patient care and nursing working conditions" (1).
For further reading, check out my previous commentary on sleep deprivation and a discussion with A.M. Trinkoff and J. Geiger-Brown, two nurse researchers (one is an author of this study-see below citation) that have contributed a tremendous amount of literature on sleep and the 12-hour shift.
1. Trinkoff, A., Johantgen, M., Storr, C., Gurses, A., Liang, Y., & Han, K. (2011). Nurses' Work Schedule Characteristics, Nurse Staffing, and Patient Mortality. Nursing Research, 60(1), 1-8.
