MSN590 Scholarly Nursing Research Paper

12-hourShifts, Friend or Foe?

Karen Watkins

MSN 590

Purdue Global University

Abstract

The aim of this project is to explore current research of nurse fatigue in 12-hour shift lengths or longer and to and identify effective prevention strategies associated with patient safety. Increasing emphasis about the impact of nurse’s fatigue with shift lengths and patient quality of care has challenged the policy of moving to longer shifts. The work schedules of nurses suggest that there should be industry-wide major concerns about fatigue and health risks to nurses as well as the safety of patients in their care.

Nurses work schedules, especially long work hours, can lead to nurse fatigue, job dis-satisfaction and a growing body of research supports nurse fatigue as a major donor to nursing staff shortages and adverse patient outcomes.Although nurses are reporting to prefer the 12-hour shift lengths, they also report they are very tiring, and the evidence on the risk of longer shifts is building.

This project explores evidence-based practice pilot studies, scholarly literature review articles and nationwide patient and nurse survey data who provided full time direct patient care on medical-surgical and critical care units in large teaching hospitals.The growing concern of nurse’s fatigue levels, patient safety, and the dis-satisfaction vs satisfaction associated with 12-hour shift lengths were examined.

The goal for this project is for stakeholders, administrators and managers to support and provide healthful work schedules, support acomprehensive approach to fatigue management, favorable work environments, appropriate nurse/patient ratios, and assistance to improve nurses’ sleep quality and quantity.

Keywords: Nurse fatigue, 12-hour shifts lengths, patient/nurse safety, job satisfaction vs dissatisfaction, sleep deprivation,

Section 1: Introduction

Nurses did not always work 12-hourshifts;my nursing career began over twenty years ago when 8-hour shifts were the norm and the option to pick up an extra 4 or 8 hours when available. However, when the 12-hour shifts were introduced it was initially in certain areas, but then I woke up one day and 12-hour shifts had spread like wild fire.

Before we realized 8-hour shifts were a thing of the past. The sound of working 5 days a week to 3 days a week and still a full-time employee with benefits was music to our ears, and nurses quickly began to treasure having more time off with the same pay or sometimes more with the extra time off to pick up other shifts.

Today in hospitals, and long-term care facilities 12-hour shifts schedules have become the norm and, in most cases, there is no other option. “It was advocated as a cost-effective strategy to reduce the overall work-force requirements, but evidence show it may have led to unintended consequences of reduced efficiency and effectiveness in delivering high quality safe care due to increased fatigue”(Griffiths, P., Dall’Ora, C., Simon, M., Ball, J., Lindqvist, R., Rafferty, A., Schoonhoven., Lisette., Tishelman, Carol., Aiken, Linda H., 2014, p.980).

A notable amount of the nursing workforce today has never even worked a schedule other than twelve hours. However, for quite some time there has been an industry wide growing concern of nurses working 12-hour shifts andhave become the topic of discussion in healthcare everywhere.

The goal of this project is to continue to protect the prestigious legacy and respect of the nursing profession by increased job satisfaction, eliminating the risk of nurse fatigue and burnout, and increasing patient safety.It is important for the target audience of nursing administrators, stakeholders and the nursing workforce to advocate and embrace a change in policy.

Evidence based practice (EBP) research of nurses working 12- hour shifts on various units is building and has continued to conclude, job dis-satisfaction,increased nursesfatigue related to sleep deprivation,and appropriate patient workloads, increasednurse’s safety and medical problems with, needle sticks and musculoskeletal issues, and increased patientsafety with medication errors, related to longer shift periods.

The Design of the project according to the target population of advanced nurses in leadership roles learning domains were assessed. According Adams (2015, p.153), Blooms taxonomy theory to promoting higher forms of thinking   1. remember it, 2. understand it, and 3. analyze it first, will enable me to advance new knowledge in improving job satisfaction and patient safety. Affective and cognitive teachings domain as it relates to my topic was used in the project.

Affective domain for self-reflection, and personal attribute, and cognitive domains impacted the design by building on existing knowledge. In Blooms taxonomy knowledge is better understood when compared to personal experiences.

According to Waldrop, J. (2016, p. a15). The American Association of Colleges of Nursing, (AACN) clinical scholarships are defined as “those activities that systematically advance the teaching, research and practice of nursing through rigorous inquiry. In the discovery aspect of clinical scholarship, I first considered my own personal experiences in the profession that I was most passionate about in order to produce most salient assessments and implications in the discovery process.

After reflection on existing learning experiences,use of search engines obtainingmost recent evidence-based research (less than 5 years old) for current up to date information was gathered for literature review and gap analysis. MSN590 Scholarly Nursing Research Paper

Section II: Literature Review and Gap Analysis

A literature review promotes validity and reliability by identifying areas of prior documented research to prevent plagiarism and give credit to other researchers, identify inconsistencies like gaps in research, conflicts in previous studies, open ended questions left from prior research and bias. literature review of the scholarly articles and other relevant sourcesusingsearch engines for mostrecent literatureof salient information on credible sites like medical journals from CINAHL, PubMed, ProQuest, Medline, Nursing journals and .org &.edu. MSN590 Scholarly Nursing Research Paper

Also, adding Boolean searches like or & and to help narrow the search for favorable information joined to the topic. There was a substantial amount of research information on the topic of 12 hours shifts and fatigue to be examined in my literature review. The review analysis in theliterature identified gaps from building on the current knowledge, the information was summarized and did point out weaknesses in some of the experimental procedures as well as conflicts, and suggested future regulations for other research. MSN590 Scholarly Nursing Research Paper

The first study is significant on the change of moving back to 8-hourshifts.  All the focus has been on the effects of 12-hour shifts and no studies had been identified that investigated the change. The Journal of Clinical Nursing in January 2019 published a research study where they investigated and performed a qualitative study of 22 nursing staff over a 6-month period where they had nursing staff working 12 hours shifts on one ward and staff on the other ward worked 8-hour shifts with and afternoon overlap. MSN590 Scholarly Nursing Research Paper

Their findings highlighted the 8-hour shifters felt unsatisfied with their delivery of care because they felt too much was left undone and important information was getting lost in handovers. The conclusion stated“changing from 12 hour to 8-hour shifts can be difficult, with nursing staff struggling to adjust, and imposing 8-hour day shifts shift pattern appeared to negatively affect recruitment and retention” (Baillie,& Thomas., 2018, p.148). MSN590 Scholarly Nursing Research Paper

However,a significant amount of otherstudies hasraised persistent concerns about the negative impacts on the quality of care associated with longer shifts lengths. The Journal of the Medical Care section: American public health association publicationon perceived quality of care and patient safety associated with nurse’s shift length and overtime.They conducted a cross-sectional study with 31,627 nurses within 488 hospitals in general medical surgical units across 12 European countries. MSN590 Scholarly Nursing Research Paper

The data from 31,627 respondents concluded European registered nurses working shifts 12 hours or longer and the nurses working overtime reported they experienced lower quality care, had concerns for safety and feeling more work was left undone (Griffiths et al, 2014, p.980). In another article published by The Nebraska Journal of Nursing also conducted a surveystudy that questioned if nurse fatigue effect critical judgement.

They surveyed 605 critical care nurses working full-time and theyreported “Most respondents reported moderately high fatigue, significant sleep deprivation, and daytime sleepiness, all of which affect their ability to be alert, vigilant, and safe” (Nebraska Nurse, 2014, MSN590 Scholarly Nursing Research Paper p.8).

There was also a Multi-State Nursing Care and Patient Safety Survey by The Journal of Pediatric Nursing on the risk for fatigue in relation to patient care when nurses work 12-hour shifts. They surveyed 22,000 registered nurses in 577 hospitals using survey tools like four-point Likert scale for nurse job satisfaction, The Maslach Burnout Inventory survey tool measuring nurse’s emotional exhaustion, and Hospital HCAHP survey that annually measures the patient’s perspective on hospital care. MSN590 Scholarly Nursing Research Paper

The concluded resultsstated “when a three-day week turns into more days or additional hours unplanned, the nurse’s satisfaction was decreased, Nurses who worked 12–13 hour shifts and was satisfied with their schedule, was more likely to leave their job than nurses who worked shorter shifts, despite what the literature suggested, and  hospitals with a higher percentage of nurses working greater than thirteen hours on their last shift, had a higher percentage of patients reporting negative ratings and stating they would not recommend the facility to a family member or friend” (Rollins, 2015, MSN590 Scholarly Nursing Research Paper p.164).

Then a nursing policy advisor and researcher published a study in The New Zealand Nursing Journal in 2015 titled “12-hour shifts: the debate continues” were he reviewed a total of 13 high quality studies with a total sample size of 67,967 nurses, including the RN4 cast research on the effects of shift lengths. MSN590 Scholarly Nursing Research Paper

The results findings reported that out of the 13 studies six reported higher rates of error for nurses working 12 hours or more, four reported higher rates of error on shifts of up to eight hours, and three reported no difference.  The concluded report stated “the time has now come to recognize length of shift is one factor that policy and practice should address to the benefit of safer patient outcomes, nurses’ health and workforce retention”. (Walker, 2015, MSN590 Scholarly Nursing Research Paper p.19).

The gap analysis was completed on the above-mentioned research information. “Supporting clinician well-being requires sustained attention and action at organizational, state, and national levels, as well as investment in research and information-sharing to advance evidence-based solutions” (National Academy of Medicine, 2019). In the research information, there were some identified gap differences from prior studies to current research studies. MSN590 Scholarly Nursing Research Paper

According to Baillie & Thomas (2014, p.158) staff on the ward piloting 8-hourshifts, in which some had worked 12-hour shifts for years, did not choose the shift length change and the lack of choice could have affected their attitudes towards the 8-hour shift change. Although concerns of 12-hour shifts and their impact on patient care is increasing attention, research finds that imposing 8-hour day shift patterns seems to negatively affect job satisfaction. MSN590 Scholarly Nursing Research Paper

Another gap identified according to Griffiths et al, (2014, p.979)stating althoughtheir study survey data shows associations between shift patterns and quality and safety it was not clear in the studies whether the adverse associations were the direct result of the number of hours worked because the nurses self-reported, and cultural differences were not explored making it impossible to determine one cause. MSN590 Scholarly Nursing Research Paper

The information of fatigue on job performance have been well documented. Rollins, (2015, p.163) suggest that future research needs to start from a different viewpoint: “not ‘Are 12-hour shifts good or bad?’ but ‘In what conditions can a 12-hour shift system be operated without risk to patient safety or nurse well-being”. MSN590 Scholarly Nursing Research Paper

The learning needs assessment used to identify the educational needs of the targeted population was created according to theaudience’s level of understanding. Thus,the clinical assessment of learning needs is crucial because it will likely lead to change especially if it is linked to practice. My target audience is a group ofwell-educated BSN and MSN adults with prior workforceexperiences as staff nurses. MSN590 Scholarly Nursing Research Paper

This group will need a mastery level strategy, with primarily clinical practice experiences.The use of Bloom’s taxonomy with this group will assist me in organizing my objectives for planning and delivering appropriate information. According to Pilcher (2016, p.189) the targeted population learning needs is a team approach job performance analysis which is done when there is concern regarding incomplete, unsatisfactory, or incorrect performance. MSN590 Scholarly Nursing Research Paper

The use of affective teachings as it relates to my topic, I would incorporate self-reflection, and use of personal attributes.There is a significant amount of literature on the topic, pulling out the most recent salient information would interest this group the most. The teaching model is a short PowerPoint presentation that focus on recent evidenced based findings including providing a free survey tool web site created by The National Academy of Medicinethatmeasure fatigue, and job satisfaction for health professionals with an action plan they could utilize on their units. MSN590 Scholarly Nursing Research Paper

Section III: Implementation

Inter-professional education (IPE) is essential and has the capacity to affect both the healthcare providers and patients. According to (Sullivan, Kiovsky, Mason, Hill & Dukes ,2015).IPE allows for a better understanding of shared values and respect for the roles of other healthcare professionals. The targeted population for this project involved IPE with a group of various departmental heads and clinical nurse specialist. MSN590 Scholarly Nursing Research Paper

I was able to witnessand be a part of inter-professional departmental collaborations meeting that occurred once a month. This provided me with the opportunity to observe shared skills and knowledge between professions, and I was also able to assess this group of well-educatedadults during the meeting for a better understanding of how to deliver my project. MSN590 Scholarly Nursing Research Paper

After assessment, I decided to present a PowerPoint presentation to provide most salient information with current research findings, build on existing experiences and knowledge, provideadvanced EBP strategies and a fatigue/burnout/job satisfaction survey tool to assistin recognizing and improving clinical well-being. MSN590 Scholarly Nursing Research Paper

An important skill set for the 21^stcentury is recognizing and respecting diversity. The cultural aspects of my targeted audience influenced the design of my final EBP project was our common beliefs, values and decision-making processes for our patients. I also considered other variables of age and education with my targeted audience, the benefit of baby boomers, generation X and millennials that would be in attendance when delivering information to increase awareness and change.

“Cultural competence is complex integration of knowledge, attitudes and skills that enhance cross‐cultural communication and effective interactions with others” (Henderson, Horne, Hills, & Kendall, 2018,MSN590 Scholarly Nursing Research Paper p.591).

In promotion of the American Nursing Credentialing Centers (ANCC) second and third aspects in scholarship of teaching to the targeted audience was engaging them in the learning process by asking questions during my presentation, use of imaginative artistic and resourceful translation with my PowerPoint images, I also introduced salient information that could transform and push the borders of practice, and provided evidence that interplay between knowledge and practice policy development. MSN590 Scholarly Nursing Research Paper

Interdisciplinary integration is crucial, to not only reveal, but prove how this knowledge can change or increase awareness to the profession.They were also provided a valid and reliable quick survey tool link to help strengthenconcrete meaning to the results and implemented supportive information from the project that would increase the benefits of applying interdisciplinary integration. MSN590 Scholarly Nursing Research Paper

Section IV: Interim results: expected outcomes and conclusions

In the 2015 issue of Science Daily, report “The number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020” (AACN, 2019).Where do we go from here?  The literature support that 12-hour shifts are not going anywhere due to a couple of reasons 1.

Cost containment (easier for scheduling wise, coverage) and 2. About 67% of nurses favored the schedule because they like the convenience despite what the research findings are, and 3. A lot of the patient prefer 2 nurses for the day instead of 3 or 4, (a chance to build trust. MSN590 Scholarly Nursing Research Paper

What’s happening is they have been instituting innovative ways to combat fatigue and nursing errors associated with fatigue,1. mandatory breaks/lunch with dedicated nurses lounge, they want managers to be aware of shift staffing (your baby boomers, your nurses with medical issues, your pregnant nurses), and nurses need to be educated of the physical and mental risk of shift lengths. MSN590 Scholarly Nursing Research Paper

Advocating for policy changes to effectively reduce nurse fatigue, improve patient safety, and job satisfaction in a profession with ongoing supply and demand challenges is complex, however improving outcomes like patient safety and job satisfaction can and will be the driving forces for change if we are looking to retain and attract nurses to the industry. MSN590 Scholarly Nursing Research Paper

According to The National Academy of Medicine(2019) Supporting clinician well-being requires sustained attention and action at organizational, state, and national levels, as well as investment in research and information-sharing to advance evidence-based effective solutions. MSN590 Scholarly Nursing Research Paper

Reference MSN590 Scholarly Nursing Research Paper

1. American Association of Colleges of Nursing (2019). Nursing Shortage. Retrieved from:            https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage
2. Adams N. E. (2015). Bloom’s taxonomy of cognitive learning objectives. Journal of
3. the Medical Library Association: JMLA, 103(3), 152–153. doi:10.3163/1536-5050.103.3.010. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511057/.
4. Baillie, L., Thomas, N . (2018). Changing from 12hr to 8hr day shifts: A qualitative exploration
5. of effects on organizing nursing care and staffing.Journal of Clinical Nursing. https://doi.org/10.1111/jocn.14674.
6. Griffiths, P., Dall’Ora, C., Simon, M., Ball, J., Lindqvist, R., Rafferty, A.,Schoonhoven.,
7. Lisette., Tishelman, Carol., Aiken, Linda H.(2014). Nurses’ Shift Length and Overtime Working in 12 European Countries.Journal of MedSurg Nursing 52(11),975-981.doi:10.1097/MLR.0000000000000233.https://journals.lww.com/lww-medicalcare/pages/articleviewer.aspx?year=2014&issue=11000&article=00007&type=Fulltext.
8. Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare
9. in the community: A concept analysis. Health & Social Care in the Community, 26(4), 590.doi: 10.1111/hsc.12556.Retrieved from https://www-wiley-com.libauth.purdueglobal.edu/en-us
10. National Academy of Medicine (2019). Action collaborative on clinical well-being and
11. resilience. Retrieved from: https://nam.edu/initiatives/clinician-resilience-and-well-being/
12. Nebraska Nurse (2014). Fatigued nurses more likely to regret their clinical decisions. Nebraska
13. Journal of Nursing,47(1), 8.Retrieved from: http://www.nursingworld.org/snas/ne/index.htm
14. Pilcher, J. (2016). Learning needs assessment: Not only for continuing education. Journal of
15. Nurses Professional Development, 32(4), 122-129. doi: 10.1097/NND.0000000000000245
16. Sullivan. M, Kiovsky.R, Mason. D, Hill. C, Dukes. C. (2015). Interprofessional
17. collaboration and education. American Journal of Nursing, 115(3), 47-54. doi: 10.1097/01.NAJ.0000461822.40440.58.
18. Rollins, J. (2015). The 12-hour shift. Journal of Pediatric Nursing, 41(4), 162-164.
19. Retrieved from:https://wwwajj.com/services/publication-services
20. Walker, L., Clendon, J. (2015). 12-hour shifts the debate continues. Kai Tiaki Nursing Journal
21. New Zealand, 21(5), 18-19. Retrieved from: https://www.thefreelibrary.com/12-hour shifts:the debate continues. -a0419149164.
22. Waldrop, J. (2016). What is Clinical Scholarship and How Can You Contribute? The Journal
23. for Nurse Practitioners (JNP), 121(4), A15-16. Retrieved from https://doi.org/10.1016/j.nurpra.2016.03.006.

Karen – I’m sorry to say but your paper really is not at the level it should be. I’m giving you the opportunity to go to the writing center with this paper to get assistance. It must be turned in no later than Tuesday night at 1159 without exception. This is not a diary or journal it’s a scholarly paper. MSN590 Scholarly Nursing Research Paper

Most of your paper is written as if it’s a diary or journal-to use the word I or my this is not how it should be written. You have multiple APA errors with your citations as well. You need to contact the writing center immediately or I will grade it as it is. Please let me know what you want to do. Thank you so very much 🙂 Dr. T MSN590 Scholarly Nursing Research Paper