The problem of burnout and a high turnout is a frequent issue in the nursing profession. One of the major drivers for such situation is the work time division. While the accepted shift duration for the nurses has always been 8 hours, some modern approaches suggest changing it to a 12-hour or even 13-hour period (Griffiths et al., 2014). According to those who promote such modernized schedule pattern, it is aimed at the economy of time and resources connected with the peculiarities of nurses’ work. For instance, it is considered that a 2-shift working day as opposed to a 3-shoft one will save time on shift overlaps and handovers and will enhance the nurses’ work-life balance (Griffiths et al., 2014). However, in spite of the outlined advantages, there are some limitations to such altered shift division. For one thing, the nurses get more tired during a longer shift, which results in their incapability of paying proper attention to the patients. For another thing, the level of burnout due to exhaust gets higher and leads to frustration and the desire to quit the job. Therefore, making shifts longer presents more disadvantages than advantages, and should be seriously reconsidered. The current literature review provides the opinions of many scholars on the duration of shifts and its outcomes for the nurses and their patients.
The Review of Literature
Stimpfel, Sloane, and Aiken (2012) provide the results of a survey which was aimed at finding out the impact of long shifts on the nurses’ job satisfaction and the patients’ opinion of such schedule. The survey results indicated that the majority of nurses (80 percent) were contented with their hospitals’ scheduling rules (Stimpfel et al., 2012). However, the analysis of the patients’ answers showed that with the growth of shift length, their satisfaction with the nurses’ performance decreased. Moreover, longer shift hours led to higher burnout among nurses. Thus, scholars suggest that hospital managers should pay more attention to providing the nurses with appropriate rest time and encourage their self-esteem (Stimpfel et al., 2012). Meanwhile, Caruso (2013) not only agrees with Stimpfel et al. (2012) about the adverse outcomes of long shifts but also considers any shift work a serious threat to sleep pattern of nurse workers. The author argues that long work hours and shift work lead to such dangerous conditions as the insufficient amount of sleep, traumas, obesity, and a large number of chronic illnesses (Caruso, 2013). Caruso (2013) recommends the hospital managers to plan the work hours in such way which would allow the nurses to have a satisfactory amount of sleep and rest.
The adverse outcomes of long work hours may be traced in various hospital settings. Stimpfel, Lake, Barton, Gorman, and Aiken (2013) investigate the impact of long shifts on the pediatric nurses’ performance. The authors conclude that the nurses working 12-hour shifts or longer are less likely to demonstrate the high quality of care in comparison with those who work 8-hour shifts (Stimpfel et al., 2013). To enhance the level of patients’ wellbeing at pediatric departments, it is recommended to make work time shorter (Stimpfel et al., 2013). Ward et al. (2013) analyze the nurses’ performance in the intensive care units (ICUs). The authors remark that long working hours result in nurses’ poor performance. Ward et al. (2013) delineate some other problems which impact the quality of work. The most crucial limitations, as delineated by the authors, are the understaffing, frequent necessity to stay at work after the shift ends, and high employee turnover (Ward et al., 2013). The scholars suggest that to eliminate such problems, hospital managers should organize regular staff reassessment and proper work time division. Also, Ward et al. (2013) note that the number of patients assigned to one nurse in the ICU should not exceed fourteen in order to provide satisfactory work conditions.
Apart from nurses’ job dissatisfaction and burnout, the long work shifts have an adverse impact on the patients. Hunsaker, Chen, Maughan, and Heaston (2015) analyze how emergency department nurses’ fatigue results in their attitude to the patients. The authors conclude that the higher the nurses’ exhaust level is, the less compassion to the patients they express. Hunsaker et al. (2015) suggest that the managers should pay attention to making appropriate work schedule. By doing so, the authors are convinced, the nurses’ empathy and compassion towards the patients will be promoted (Hunsaker et al., 2015). The study by Ball, Murrells, Rafferty, Morrow, and Griffith (2013) investigates the issue of time pressure which the authors refer to as “missed care” (p. 116). Ball et al. (2013) remark that with a higher nurse/patient ratio, there is a higher possibility of one or more nursing care activities being omitted. The authors recommend hospital managers to pay attention to the understaffing problem and schedule of shifts.
Conclusion
The performed literature review makes it possible to draw some conclusions about time division of nurses. Long shifts may present some benefits to the organizations, but they also produce some adverse outcomes on the employees and patients. On the part of nurses, the negative effect results in increased burnout and fatigue which leads to low self-esteem and high job dissatisfaction. Nurses who have to work long hours or stay after the shift are more likely to quit and cannot find a balance between their work and personal life. What concerns the patients, they also suffer from nurses’ excessive work duration. When nurses experience fatigue, they cannot give sufficient attention and care to their patients. As a result, patients’ satisfaction levels fall, and the healing process does not evolve as it should. To prevent the negative outcomes of patients and nurses, hospital managers are advised to reconsider the long shift duration even though it may have economic benefits for the hospitals. Also, the scholars recommend a regular reassessment of nurse workers and allowing them to have time for rest and education. These measures will enhance the nurses’ job satisfaction and the patients’ satisfaction.
The Suggested Framework for EBP Proposal and Rationale for Choosing the Theory
To implement the evidence-based proposal connected with the education of nursing staff and hospital managers, it is necessary to employ a change theory. The choice of the theory is based on the fact that it may enhance the managers’ and staff’s awareness of the potential adverse outcomes of long work hours. Lewin’s change model seems rather suitable in this case (Mitchell, 2013). The model comprises three stages: unfreezing, moving, and refreezing (Mitchell, 2013). During the first phase, the problem is to be investigated, and reasons for the change are evaluated. The second stage is characterized by the involvement of the employees in the change process, instructing them about the necessary procedures, and the implementation of the change. The last phase is concerned with gaining the stability of the alterations, constituting the new manner of conduct, and rewarding the achieved results (Mitchell, 2013).
To apply Lewin’s change model, it will be necessary to organize all the three stages in an effective way. At the unfreezing stage, a general meeting of all the nurses and managers should be organized. At this meeting, the staff will be informed about the suggested alterations in their work, which will presuppose the education about the negative outcomes of long shifts and the ways in which these disadvantages may be eliminated. Also, the staff will be given an opportunity to ask questions about the changes proposed and give their suggestions about the project. During the moving stage, the employees will attend educational courses regularly and receive information about the efficacy of short work hours and the positive impact of such work time division on the nurses’ attitude towards their job and the patients’ satisfaction levels. At the stage of refreezing, the results of the educational process will be analyzed. The advantageous changes will be discussed, and the new schedule will be suggested and approved. As a result of the theory’s implementation, it is expected that the staff will be more satisfied with their job and will provide the patients with better care.
The rationale for choosing Lewin’s theory is connected with the availability of its implementation and the productivity of the outcomes. By dividing the process into three definite stages, it will be possible to make the framework comprehensible for each member of nursing and management teams.
References
Ball, J. E., Murrells, T., Rafferty, A.-M., Morrow, E., & Griffith, P. (2013). ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Quality and Safety, 23(2), 116-125.
Caruso, C. C. (2013). Negative impacts of shiftwork and long work hours. Rehabilitation Nursing, 39(1), 16-25.
Griffiths, P., Dall’Ora, C., Simon, M., Ball, J., Lindqvist, R., Rafferty, A.-M.,… Aiken, L. (2014). Nurses’ shift length and overtime working in 12 European countries: The association with perceived quality of care and patient safety. Medical Care, 52(11), 975-981.
Hunsaker, S., Chen, H.-C., Maughan, D., & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47(2), 186-194.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.
Stimpfel, A. W., Lake, E. T., Barton, S., Gorman, K. C., & Aiken, L. H. (2013). How differing shift lengths relate to quality outcomes in pediatrics. JONA: The Journal of Nursing Administration, 43(2), 95-100.
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509.
Ward, N. S., Afessa, B., Kleinpell, R., Tisherman, S., Ries, M., Howell, M.,… Kahn, J. (2013). Intensivist/patient ratios in closed ICUs: A statement from the society of critical care medicine taskforce on ICU staffing. Critical Care Medicine, 41(2), 638-645.