Nurses’ Work-Life Balance and Patient Safety

Background of Study

The clinical problem of the study can be introduced with the help of the PICOT question. For the study by Estryn-Behar, Van der Heijden, and the NEXT Study Group (2012), it will be as follows. In healthcare employees, do 12-hour shifts compared to 8-hour shifts have an impact on nurses’ fatigue, health, satisfaction, work/family balance, and patient safety, in a year period.

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PICOT question/statement

  • P: In healthcare employees
  • I: do 12-hour shifts
  • C: compared to 8-hour shifts
  • O: have an impact on nurses’ fatigue, health, satisfaction, work/family balance, and patient safety,
  • T: in a year period.

The research problem is to reveal the connection between the work schedule and work/family balance, health, and patient safety. It will help to develop efficient work schedule practices and thus provide nurses’ job satisfaction and increase patients’ safety.

The issue of nurses working longer shifts and patient safety has already been reviewed in many researches. For example, Liu (2012) investigated the association between nurse workload and nurse-sensitive patient safety outcome indicators; de Magalhaes, Dall’Agnol, and Marck (2013) studied nursing workload and patient safety; Welp, Meier, and Manser (2015) dedicated their research to emotional exhaustion and workload as predictors of clinician-rated and objective patient safety.

The significance of the current study is in the analysis of 12-hour shifts which are gaining popularity due to the increased employee satisfaction “with working hours and free time” (Estryn-Behar et al., 2012, p. 4283). However, recent research proves that 12-hour shifts influence nurses’ fatigue and health thus threatening patient safety.

The purpose of the study is to conduct a secondary multivariate analysis to reveal the influence of work schedule on work/family balance, health, and patient safety, “after adjustment for various risk factors” (Estryn-Behar et al., 2012, p. 4283).

The research questions can be formulated as follows:

  1. Do work schedules influence work/family balance?
  2. Do work schedules and work content have an impact on employees’ health?
  3. What are the determinants for family and personal satisfaction?
  4. What are the determinants for health and safety?
  5. What are the determinants for stability in the job?

I suppose that the purpose and research questions are related to the problem under consideration.

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Methods of Study

The NEXT study team involved participants from various healthcare institutions in ten countries across Europe. To consider the risk of possible refusal in participation, the researchers contacted the institutions (hospitals, nursing homes, and home care) directly to reach both employees and employers and get their agreement for the participation. Moreover, the participants received pre-paid envelopes to avoid refusal because of financial issues. There is no data concerning the informed consent from the participants or institutional review board approval, but the agreement for the participation was obtained from employers and employees. There is no evidence of any enforcement concerning participation. Thus, it is possible to conclude that the employees participated in the study voluntarily.

The analysis contained twenty explanatory variables. The variables were used as indicators for some research issues. Thus, variables for personal risk factors included “age; seniority; gender; occupational level; personal-family situation; enough child care when at work; satisfaction with pay” (Estryn-Behar et al., 2012, p. 4284).

The variables concerning working conditions included ” Being satisfied with staff handovers when shifts change; Being confronted with not knowing what a patient or a patient’s family ought to be told about the patient’s medical condition and its treatment; Have many interruptions and disturbances in the job;” etc. (Estryn-Behar et al., 2012, p. 4284). The article does not contain detailed definitions for then variables because they were published in the previous publications of the researchers.

It this study, the data was collected through the written questionnaire which was returned to the researchers by post. The authors did not provide any rationale for using this data collection method. The time period for data collection is not identified.

The participants received questionnaires, completed them, and then sent back by post in pre-paid envelopes. Bivariate tables were created to manage the major variables. Pearson’s Chi square test was applied in data analysis. For every dependent variable, multivariate analysis with the application of SPSS 12.0 software was conducted (Estryn-Behar et al., 2012). The authors did not discuss the rigor of the process.

There were no specific measures used to minimize the effects of researcher bias. However, to provide the ability to generalize the research findings, the participants were divided into three groups according to the type of the institution such as hospitals (147); nursing homes (185); and home care institutions (76) (Estryn-Behar et al., 2012). There were 39,898 participants who responded to the survey out of 77,681 who received it.

Results of Study

The researchers interpret the results in accordance with the research questions. They provide tables with variables and quantitative data and their analysis. I believe that the findings are valid and reflect the reality because the research sample was big and diverse.

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The researchers did not identify any limitations of the study. However, a possible limitation can be that the research sample included only European healthcare institutions and thus cannot be generalized on the international level.

The research findings were presented logically according to the research questions. The study has come implications for nursing practice. For example, the findings can be used to develop standards of nursing workload aimed to reduce employees’ fatigue and family conflicts and to increase patients’ safety. Further study can be dedicated to the development of measures such as “extended child care, association of nurses for the elaboration of their rota, 9- or 10-hour shifts in the afternoon, allowing naps during night shifts, and reduction of changing shifts at short notice and to study its effects” (Estryn-Behar et al., 2012, p. 4290).

Ethical Considerations

There is no information on the approval of the study by Institutional Review Board. There is also no proof of participants’ privacy protection but I believe the survey was anonymous due to the big sample and no significance of personal details other than age or gender for the study. There were no ethical considerations regarding the treatment because the study is dedicated to the issue of work schedule for nurses. The only ethical concern applicable to the study is threat to patients’ safety because of nurses working long hours.


The thesis statement in this research discloses the problem which is going to be investigated and comprises the issues which are revealed in the research questions. On the whole the study is a useful contribution to nursing practice. It proved the dependence of long shifts and nurses’ home conflicts which, in their turn, negatively influence patient safety. The study results can be used in nursing practice to develop schedules which leave enough time for handover, provide social support and empower teambuilding. The study is an example of a quantitative research with representative sample and valid results. The analysis strategies and application of statistical software enabled researchers to present study findings explicitly.


Estryn-Behar, M., Van der Heijden, B., & the NEXT Study Group. (2012). Effects of extended work shifts on employee fatigue, health, satisfaction, work/family balance, and patient safety. IOS Press, 41, 4283-4290. Web.

Liu, L.-F. (2012). Exploring the association between nurse workload and nurse-sensitive patient safety outcome indicators. The Journal of Nursing Research, 20(4), 300-309. Web.

de Magalhaes, A.M., Dall’Agnol, C.M., & Marck, P. (2013). Nursing workload and patient safety – A mixed method study with an ecological restorative approach. Revista Latino-Americana De Enfermagem, 21(Spec.), 146-154.

Welp, A., Meier, L.L., & Manser, T. (2015). Emotional exhaustion and workload predict clinician-rated and objective patient safety. Frontiers in Psychology, 5, 1-13. Web.

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