The impact of hospital staff nurse shift length on nurse and patient outcomes / Amy Witkoski Stimpfel.

Stimpfel, Amy Witkoski.
xi, 145 p. ill. ; 29 cm.
Medical subjects:
Dissertations, Academic.
Local subjects:
Penn dissertations -- Nursing.
Nursing -- Penn dissertations.
Hospital staff nurses typically use a shift work model of scheduling to care for patients around-the-clock. Traditionally, nurses worked five 8 hour shifts per week, however, now most hospital staff nurses work three 12 hour shifts per week to achieve better work-life balance. The impact of working extended shifts on nurse or patient outcomes was not fully evaluated prior to widespread implementation of this shift pattern. While many nurses report being satisfied with working longer but fewer shifts, there is evidence to suggest patient safety may be suffering. The purpose of this study is to expand our understanding of the relationship between nurses' shift length and nurse and patient outcomes. A cross sectional, secondary analysis was completed on nurse survey data, hospital administrative data, and the Hospital Consumer Assessment of Healthcare Providers and Systems survey data, collected in 2006--2007. A sample of 577 hospitals and 22,275 registered nurses was analyzed. Outcomes of interest for the nurses were burnout, job dissatisfaction and intent to leave their employer in one year. Nurse reported patient outcomes (e.g. falls, infections) and patients' assessments of hospital care were also examined. Regression models were built, adjusting for individual nurses' demographics, nursing organizational features and hospital characteristics. A significant relationship was noted between shift length and nurse outcomes; nurses who reported working ≥ 12 hours or overtime on their last shift were associated with increased odds of burnout, job dissatisfaction and intent to leave. Nurses from hospitals with a high proportion of nurses working ≥ 12 hours or overtime were also associated with increased odds of intent to leave. Further, nurses from hospitals with a high proportion of shifts ≥ 12 hours or overtime were associated with a greater likelihood of reporting frequent central line infections. Finally, an increase in the proportion of nurses working ≥ 12 hour shifts was associated with an increase in patients who would not recommend the hospital to friends and family. These results suggest that shifts of ≥ 12 hours in length and overtime may impact patient care as well as nurses' well-being, which is relevant to policy makers, administrators, nurses and patients.
Adviser: Linda H. Aiken.
Thesis (Ph.D. in Nursing) -- University of Pennsylvania, 2011.
Includes bibliographical references.
Aiken, Linda H., advisor.
University of Pennsylvania.
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