Background: Twenty-four hour nursing care involves shift work including 12-h shifts. England is unusual in\ndeploying a mix of shift patterns. International evidence on the effects of such shifts is growing. A secondary\nanalysis of data collected in England exploring outcomes with 12-h shifts examined the association between shift\nlength, job satisfaction, scheduling flexibility, care quality, patient safety, and care left undone.\nMethods: Data were collected from a questionnaire survey of nurses in a sample of English hospitals, conducted as\npart of the RN4CAST study, an EU 7th Framework funded study. The sample comprised 31 NHS acute hospital Trusts\nfrom 401 wards, in 46 acute hospital sites. Descriptive analysis included frequencies, percentages and mean scores\nby shift length, working beyond contracted hours and day or night shift. Multi-level regression models established\nstatistical associations between shift length and nurse self-reported measures.\nResults: Seventy-four percent (1898) of nurses worked a day shift and 26% (670) a night shift. Most Trusts had a\nmixture of shifts lengths. Self-reported quality of care was higher amongst nurses working ââ?°Â¤8 h (15.9%) compared\nto those working longer hours (20.0 to 21.1%). The odds of poor quality care were 1.64 times higher for nurses\nworking ââ?°Â¥12 h (OR = 1.64, 95% CI 1.18ââ?¬â??2.28, p = 0.003).\nMean ââ?¬Ë?care left undoneââ?¬â?¢ scores varied by shift length: 3.85 (ââ?°Â¤8 h), 3.72 (8.01ââ?¬â??10.00 h), 3.80 (10.01ââ?¬â??11.99 h) and were\nhighest amongst those working ââ?°Â¥12 h (4.23) (p < 0.001). The rate of care left undone was 1.13 times higher for\nnurses working ââ?°Â¥12 h (RR = 1.13, 95% CI 1.06ââ?¬â??1.20, p < 0.001).\nJob dissatisfaction was higher the longer the shift length: 42.9% (ââ?°Â¥12 h (OR = 1.51, 95% CI 1.17ââ?¬â??1.95, p = .001);\n35.1% (ââ?°Â¤8 h) 45.0% (8.01ââ?¬â??10.00 h), 39.5% (10.01ââ?¬â??11.99 h).\nConclusions: Our findings add to the growing international body of evidence reporting that ââ?°Â¥12 shifts are associated\nwith poor ratings of quality of care and higher rates of care left undone. Future research should focus on how 12-h\nshifts can be optimised to minimise potential risks.
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