Gates Shifts R

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University of Minnesota Nursing Research Day 2010 presentation concerning staff nurse perceptions of rotating shifts and their impacts.

Transcript of Gates Shifts R

Staff Registered Nurse Perceptions of Shift Work and its Effects

Damon Gates, BSN, RN, CCRN-CMCSue Sendelbach PhD, RN, CCNS, FAHABrian Goodroad, DNP, ANP-BC, AACRN

The Origin of the Question

• Anecdotal experience of the principal investigator suggest that while rotating shifts are commonly used in the Twin Cities, they are rarely used elsewhere in the country.

• Expressions of dissatisfaction with the impact of rotating shifts on a variety of personal and patient care parameters voiced by those working rotating shifts.

Review of the LiteratureMost studies examining the impact of shift

work focus on differences between 8-hour and 12-hour shifts, with varying findings.1-4

Studies examining the effects of rotating shifts evaluated psychological, physiological, and performance impacts.5-7

No studies could be found that evaluated nurses' perceptions of rotating shifts and their effects.

1 Hoffman, A. J., & Scott, L. D. (2003). Role stress and career satisfaction among registered nurses by work shift patterns. Journal of Nursing Administration, 33(6), 337-342. 2 Iskra-Golec, I., Folkard, S., Marek, T., & Noworol, C. (1996). Health, well-being and burnout of ICU nurses on 12- and 8-h shifts. Work & Stress, 10(3), 251-256.3 McGettrick, K. S., & O'Neill, M. (2006). Critical care nurses -- perceptions of 12-h shifts. Nursing in Critical Care, 11(4), 188-197. 4 Tucker, P., Barton, J., & Folkard, S. (1996). Comparison of eight and 12 hour shifts: Impacts on health, wellbeing, and alertness during the shift. Occupational & Environmental Medicine, 53(11), 767-772. 5 Gold, D. R., Rogacz, S., Bock, N., Tosteson, T. D., Baum, T. M., Speizer, F. E., et al. (1992). Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. American Journal of Public Health, 82(7), 1011-10146 Lac, G., & Chamoux, A. (2004). Biological and psychological responses to two rapid shift work schedules. Ergonomics, 47(12), 1339-1349. 7 Skipper, J., J., Jung, F. D., & Coffey, L. C. (1990). Nurses and shift work: Effects on physical health and mental depression. Journal of Advanced Nursing, 15(7), 835-842.

The Research Questions

• Primary aim:1. Examine staff RNs perceptions of shift

work and its effects.

• Secondary aims: 1. Identify correlates of perceived

incidences of illness; and2. Identify nurses’ preference of rotating

and/or fixed shifts.

Significance to nursing• Use of rotating shifts has potential

implications for nursing satisfaction and retention & recruitment.

• Abbott Northwestern Hospital’s ANCC Magnet® designation depends on its ability to address nurse-identified issues.

• Evidence-based practice requires evidence• Evidence-based practice also happens in the

executive suites.1

1 Campbell, G. (2009) Evidence-based administrative decision-making: creating a rational approach to staffing standards. AACN National Teaching Institute, New Orleans.

Methods•Survey developed by task force with equal

labor and management representation. •Survey refined based on recommendations

from ANW Labor/Management team, co-investigators, and Allina IRB.

•“Infrastructure” elements were put in place.• IRB approval secured.•E-mail sent to 1906 ANW/MNA contracted RNs

including a link to the survey. Reminder e-mails sent weekly x3.

•Survey available for response for 4 (four) weeks of August, 2009.

Inclusion/Exclusion Criteria

Inclusion• RNs covered by

the ANW/MNA contract

• RNs who work in inpatient and procedural areas, and the Emergency Department

• RNs who provide direct patient care.

Exclusion• RNs not covered by

the ANW/MNA contract

• RNs who work in outpatient areas, such as clinics

• RNs who work with a caseload of patients (e.g., case managers, diabetes educators.

Response Rate

• 782 of 1906 nurses participated in the survey, completing it to varying degrees.

• Total response rate 41.03%The US Office of Management and Budget requires a > 80% response rate for surveys undertaken for government purposes. However, in academia, 70% response rate may be considered quite high, and response rates of 15-20% are common for mail- or Internet-based surveys.1

• Demographic information completed by each respondent indicates broad representation of ages, shifts worked, years at ANW, and work areas.

1 Fowler, F.J. (2009). Survey Research Methods (4th ed.). Los Angeles: Sage.

Statistical analysis

• Likert Scale questions coded from 1 (strongly negative) to 5 (strongly positive)

• Null Hypothesis: [Response Mean]=3

• Actual survey response mean compared to H0 using two-tail t test with CI =95%.

ResultsOne-Sample Statistics

Rotating shifts effect on: N Mean Std. Deviation

Communication among staff 715 2.54 1.03

Fatigue/freshness 716 2.2 1.19

Quality of “off time” 716 1.99 1.07

Job satisfaction 714 2.32 1.09

Continuity of care 714 2.58 0.99

Health of nurse 714 2.32 1.15

Staff morale 712 2.51 1.05

Critical thinking/performance 715 2.03 1.05

Results

All parameters had a mean score significantly negative compared to the H0

One-Sample Test

Test Value = 3.00

p<0.0001 (two-tailed) 95% CI of difference

Rotating shifts effect on:t df Mean

difference Lower Upper

Communication amongst staff -12.05 714 -0.46 -0.54 -0.39

Fatigue/freshness -17.98 715 -0.8 -0.88 -0.71

Quality of “off time” -25.29 715 -1.01 -1.09 -0.93

Job satisfaction -15.12 713 -0.68 -0.77 -0.59

Continuity of care -11.32 713 -0.42 -0.49 -0.35

Health of nurse -15.99 713 -0.69 -0.77 -0.6

Staff morale -12.37 711 -0.49 -0.56 -0.41

Critical thinking/performance -24.64 714 -1 -1.04 -0.89

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Communication amongst staff

One-Sample Test

Test Value = 3.00

p<0.0001 (two-tailed) 95% CI of difference

Rotating shifts effect on:t df Mean

difference Lower Upper

Communication amongst staff -12.05 714 -0.46 -0.54 -0.39

Limitations

• Response rate

• Voluntary participation

• Self-administered

• Technical issues with the survey.

Translation into Practice

• Evidence-based practice needs to occur at both the bedside and in the executive suites.

• Effective interventions may have retention and recruitment benefits.

• The bedside nurse will be tasked with holding managerial and labor leaders responsible for acting on the evidence.

Future Research

• Survey a larger number of facilities.• Secondary investigations of data.• Additional “heart of the matter”

questions.

Conclusions

• There is significant evidence that suggests registered nurses working in direct patient care at ANW have a negative perception of the impact of rotating shifts.

• While this evidence is useful to guide initial Labor/Management policy, additional research is needed to identify the extent of these perceptions on a broader scale, additional quality-of-care implications, and optimal corrective actions.