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Perceptions of Health Workers of 12-Hour Shift on Fatigue

Abstract

Nursing is an important career in the health care industry. More than in any other career, nurses are faced with long working hours. These long hours have been blamed for performance concerns as well as the well-being of the nurses themself. It has been appreciated in various studies that long hours at work induce fatigue in nurses and other health care personnel. Fatigue hinders nurses from being effective in their duties which in turn impact negatively services at the health care institution.

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No institution can achieve its service delivery objectives if the employees are not safe. Studies have indicated that long working hours contribute to various forms of injuries. They include injuries from hypodermic needle jabs (coming into contact with blood or body fluids), musculoskeletal disorders and vehicle accidents. These are personal injuries which nurses suffer due to fatigue. Nurses are intimately involved with patients too. They perform various duties including administration of medicines. It is feared that nurses under fatigue may administer the drug wrongly or overdose the patient. Therefore, fatigue not only affects the individual nurse but also the patient.

In a bid to reduce the foregoing deficiencies, stakeholders in the nursing industry have recognized the use of work shift programs to take off some pressure from the nurses. Shift rosters are an excellent way to manage fatigue in nurses. Recently, institutions have developed a particular preference for a participatory approach by the nurses as stakeholders when designing the shift roster program. The 12-hour shift roster has been preferred as the best model for the nursing community.

However, limited studies have been carried out to ascertain the health care workers’ perceptions of the effects of the 12-hour shift on fatigue and performance. This study will focus on workers’ perceptions and find out the best work shift structure applicable to the local nursing community. Proper population demographics will also be availed on the population most affected by the 12-hour work shift roster.

Introduction

Extended working hours for nurses has the concomitant effect of fatigue and also affects performance. Studies show that nurses work for long hours more than workers in other industries. Extended hours at work can deprive the nurses of sleep which is important in giving them much needed rest (Bennett, Smith & Wedderburn 1982, p. 3). This problem cuts across the entire health care workers community from training residents to veteran physicians and nurses. It is acknowledged that fatigued health care workers contribute to the deficiencies of the healthcare system (Gaba &Howard 2002, p. 2).

It is not possible to utilize nurses throughout the day given the demanding nature of the job. In the same breathe, healthcare institutions must work throughout the 24-hour period of the day (Bloodworth et al 2001, p. 5). Clearly, shift work is unavoidable in healthcare institutions. What then is the best model of shift work program for the healthcare institutions? Zhao, Bogossian &Turner (2008, p. 5) describe a nine-point best practice roster design criteria to help in the management of fatigue in nursing institutions.

The 12-hour shift system was developed and is viewed as the solution to the problem of fatigue and performance, especially for the nurses. This liberal process has led to satisfaction from the nursing community and cooperation for its implementation (McVicar 2003, p. 8). However, limited studies have been carried out to measure the extent of satisfaction of nurses regarding work shifts. Reviewing the perceptions of health care workers on the 12-hour shift program vis a vis other shift programs however can give more insight into its advantages and disadvantages for purposes of improving health care.

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This study will explore the perceptions of the health care workers on the 12-hour shift program currently in use in health care programs (Fitzpatrick, While & Roberts 1999, p. 5). The research will in addition examine its level of satisfaction among the various groups of professionals in the health care industry.

Background, significance, and review of the literature

There are many sources of data illustrating the effects of fatigue or stress on the delivery of service in health care institutions. The various studies carried out by other researchers drawn from various continents have established the association between causes of fatigue/stress and performance (Fountain, Cursio & Hunt 1996, p.352). In addition to the poor performance, there are also concerns that fatigue precipitated by extended working hours, rotating shifts, and night shifts have a significant effect on the safety of the nursing community. These effects have been found to be detrimental to both the health care worker and the patient and his or her care.

The injuries so imposed can be life-threatening in the sense that the health care worker is exposed to the blood or body fluids of the patient just as there is the overwhelming possibility of giving incorrect medication or wrong dosage (Dwyer et al 2007, p. 9).

There are several sources of fatigue for nurses including “workload, leadership/management issues, professional conflict, and emotional demands of caring” (Drouin &Potter 2005, p. 72). Whereas leadership/management issues, professional conflict and emotional demands are vital contributors to nurses’ fatigue, workload was ranked highest. Further, they reported that the characteristics of workload are keys to the evaluation of stress for the nurses.

However, stress from workload also depends on the area of practice; they are not particularly the same for different nursing departments. Furthermore, there exist differences in stress hardiness, age, experience, and the level of workplace support (Duffield & O’Brien-Pallas 2002, p. 140). Nurses must interact with other professionals, especially physicians. As a result of this relationship, conflicts are bound to arise. As such, conflicts are common at the workplace pitting the professionals against each other (Brooks 2000, p. 36).

In a survey conducted by Rogers et al (2004, p.14) on the shift work and work-related injuries among health care workers, they established the “association between shift work and blood or body fluid exposure; the association between shift work and musculoskeletal disorders; and the association between shift work and motor vehicle crashes” (Rogers et al 2004, p. 15). They found out that work shifts had a significant impact on blood or fluid exposure as well as musculoskeletal disorders. Some other studies also indicated that shift work was linked to motor vehicle crashes. This survey summarizes the effect of fatigue on individual nursing professionals which lead to personal injuries.

It was found that health care workers usually came into contact with blood and other body fluids at the end of the shift, thereby creating concerns about the effects of long working hours without adequate rest. The design of shift roster had to take into consideration the effects of fatigue at the end of the shift on the well being of health care workers, especially the nurses in intensive care centers. Adequate rest was to be taken into consideration which had the added advantage of preventing other risks associated with long working hours namely, musculoskeletal disorders and vehicle accidents after work (Fields & Loveridge 1988, p. 190).

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Another survey carried out on medication-related errors reports that fatigue is one of the factors that lead to wrong administration of drugs. Nurses participate in administration of medicines to patients and errors they may commit in the course of duty may compromise the safety of patients. This underscores the significance of fatigue to the safety of patients. This is especially likely when the nurses work for extended hours (Finlayson et al 2002, p. 543).

This can easily be dealt with if a well structured work shift programme is employed in healthcare institutions. In a study “Evaluation of the 12-hour Shift Trial in a Regional Intensive Care Unit” (Smith et al 2005, p. 1) observes that a 12-hour shift roster is a “positive recruitment and recruitment strategy” (Smith et al 2005, p. 3) especially in a nursing institution with limited number or critical care staff. There is a lot of literature indicating the rising problem of decrement in specialist nurses. Following this fact, studies have indicated positives with the 12-hour shift roster program for nurses. Smith et al (2005, p. 5) posits that the 12- hour work shift roster contributes to improved sleep in nurses, a critical factor for refreshing the health care workers. This is contrary to the 8- hour shift roster which brings about lethargy in nurses.

The 12 hour shift led to “improved communication related to patient care both between nurses and other health care professionals” (Smith 2005, p. 5)) and consequently better service delivery in health care institutions. This indicates that the 12- hour shift roster gives the health care workers enough rest which then contributes to service delivery because they remain alert during their assignments.

Studies also indicate increased satisfaction of health care workers with the 12 hour shift because it led to more social time, was less tiresome, and that they were “less likely to make mistakes at the end of the shift” (McVicar 2003, p. 9)). Tired health care workers have been accused for a long time for making mistakes at the end of the shift. In fact, most studies agree that towards the end of long working hours, health care workers were likely to come in contact with blood / body fluids, or give wrong medication to the patients. This is due to mental tiredness after long day’s work with limited time to take a rest.

The main benefit of the 12 hour shift roster program is that there is “improved continuity of patient care.”

Research questions

  1. What are Health Care Workers perceptions of the effects of the 12-hour shift on fatigue and performance?
  2. What group of health care workers are most affected by 12-hour shift-induced fatigue and performance?

Research Design

Qualitative research will be used to answer the research questions in this study. The study will aim to answer the research questions thus: what are Health Care Workers perceptions of the effects of the 12-hour shift on fatigue and performance? Which group of health care workers is most affected by 12-hour shift-induced fatigue and performance? What are the benefits of the 12-hour shift roster? This will be done through administration of purposive questionnaires to the local nursing community over a stipulated period of time.

Design for the Study

This study is designed as qualitative research. Open-ended questions will be sent to the participants through their mailboxes or emails and respondents will be required to give their own opinion regarding the subject.

Setting Participants

Since participants are to be found locally, invitations will be sent through their mailboxes, emails or by phone call. The number of participants to be invited is already determined.

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Methods and procedures

The study will be a qualitative descriptive study involving purposive sample of staff from local healthcare institutions.

  • A purposive questionnaire will be prepared according to the requirements of the research objectives
  • Questionnaires will be distributed to the sample population on 12-hour work shift
  • Nurse managers, medical doctors, and other health personnel will be invited to participate
  • Respondents will be asked give their opinion using the Likert scale
  • Questionnaires will be to the participants’ mailboxes and await feedback
  • There will be monitoring feedback from participants and where necessary remind those participants when they take too long to respond

Upon receipt of feedback, the data will be analysed using social analytical tools preferably SPSS. Social-demographic data so mined will then be summarized by using appropriate descriptive statistics.

Ethical implications

Ethical clearance will have to be received before the study is undertaken from the relevant authorities. It is a requirement before the study is conducted which is beneficial to both the researcher and the participants. Since this study touches on feelings of respondents in their profession, it is ethically correct that their opinions be accorded due privacy. Reservations about their time must be respected.

Research Findings

After collecting feedback from the 65 health care workers, the study found the following perceptions on the 12 hour shift program;

  1. Most health care workers were satisfied with the 12 hour shift program. 76% participants reported that they had enough sleep and that they felt refreshed on the following shift. A notable point is that they did not feel lethargic on the line of duty.
  2. The majority of participants (77%) noted that the 12 hour shift program contributed to continuity in care of patient. They noted that the relationship between the workers as well as patients had improved significantly. Most importantly, the respondents argued that the relationship of the workers and the patient had positive impact on the patient well-being given that the shifts start early.
  3. Participants reported that the 12 hour shift had led to more social time. They could now enjoy more time with their family and friends. Moreover, they could also find ample time to attend to private matters outside their work schedule.
  4. The participants also reported that the 12 hour shift system favored all groups of health care workers. None of the professional group delivered a negative verdict on the system.

Conclusion

The study about the perceptions of 12 hour shit on fatigue and performance within the local health care institution showed extensive acceptance of the roster program. It has proved to impact positively on the physical well-being as well as psychological strength. The 12 hour shift has been praised among all divisions of the health care system; from resident nurses to medical doctors and the experienced certified nurses.

References

Bennett, S, Smith, PA & Wedderburn, AW 1982, Towards a synthesis of research findings for application with shift workers. Journal of Human Ergology, vol. 11, pp. 13-19.

Bloodworth, C, Lea, A, Lane, S & Ginn, R 2001, Challenging the myth of the 12-hour shift: a pilot evaluation, Nursing Standard Journal, vol. 15, no. 29, pp. 33–36.

Brooks, I 2000, Nurse Retention: moderating the ill-effects of shift work, Human Resource Management Journal, vol. 10, no. 4, pp. 16–31.

Duffield, C & O’Brien-Pallas, L 2002, The nursing workforce in Canada and Australia: two sides of the same coin, Australian Health Review, vol. 25, no. 2, pp. 136-144.

Drouin, R & Potter, M 2005, Flexible scheduling, Australian Journal of Nursing, vol. 105, no. 11, pp. 72.

Dwyer, T, Jamieson, RN, Moxham, RN, Austen, D & Smith, K 2007, Evaluation of the 12-hour Shift Trial in a Regional Intensive Care Unit, Journal of Nursing Management, vol. 15, no. 1, pp. 1-10.

Fields, W & Loveridge, C, 1988, Critical thinking and fatigue: how do nurses on 8- & 12-hour shifts compare, Nursing Economics Journal, vol. 6, no. 4, pp. 189–191.

Finlayson, B, Dixon, J, Meadows, S & Blair, G 2002, Mind the gap: policy response to the NHS nursing shortage, British Medical Journal, vol. 325, pp. 541–544.

Fitzpatrick, JM, While, AE & Roberts, JD 1999, Shift Work and Its impact upon nurse performance: current knowledge and research issues, Journal of advanced Nursing, vol. 3, no. 2, pp. 1-12.

Fountain, I, Curzio, J & Hunt, J 1996, Issues involved in introducing the 12-hour shift, NT-Research, 1, pp. 349–357.

Gaba, DM & Howard, SK 2002, Fatigue among Clinicians and the Safety of Patients, Patients Safety Journal, vol 83, no. 3, pp. 1-7.

McVicar, A 2003, Workplace stress in nursing: a literature review, Journal of Advanced Nursing, vol. 44, no. 6, pp. 1-10.

Rogers, AE, Hwang, T, Scott, LD, Aiken, LH & Dinges, DF 2004, Working hours of Hospital Staff Nurses and Patient Safety, Health Affairs Journal, Vol. 3, pp. 1-16.

Smith, PA, Milia, L, Smith, A, Gee, W & Mackay, R 2005, Managing fatigue through roster design, Journal of Work, Environment and Health, vol. 2, no. 1, pp. 1-10.

Zhao, I, Bogossian, F& Turner, C, 2008, Shift work and work related injuries among health care workers: A systematic review, Australian Journal of Advanced Nursing, vol. 27, no. 3, pp. 1-14.

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