Longer hours worked by nurses to help save hospitals money is hitting safety and patient care, according to a large international survey of nurses.
Results of the poll of more than 30,000 nurses across Europe show that nurses who work longer shifts and more overtime are more likely to rate the standard of care delivered on their ward as poor, give a negative rating of their hospital’s safety and omit necessary patient care.
Involving researchers at the University of Southampton and the National Nursing Research Unit at King’s College London, the RN4CAST survey of nurses in over 450 hospitals across 12 European countries is part of an international research programme looking at links between nursing workforce issues and patient outcomes.
“This is compelling evidence that policy makers in England need to take note of”
Results showed that nearly a third of nurses in England are working shifts of more than 12 hours, something which is becoming more common in English hospitals.
Hospitals are adopting long shifts to reduce the number of handovers between nurses and to save costs. Some nurses seem to prefer them because they work fewer days in a week.
Nurses working these long shifts were 30% more likely to report poor quality of care compared with nurses working traditional eight hour shifts, according to the study published in the journal Medical Care.
They were also 41% more likely to report failing or poor standards of safety and reported leaving more necessary nursing care undone than nurses working shifts lasting eight hours.
“Rather than over-rely on hospital staff working lengthier shifts or overtime, the NHS must undertake the sensible long-term workforce planning and investment”
Nurses working overtime in their last shift were also likely to report lower standards of care, safety and care left undone.
Professor Peter Griffiths, chair of health services research at the University of Southampton, led the study.
He said: “These findings raise questions for healthcare organisations, especially in the current economic climate, where employers in many countries including England are aiming to use the existing workforce more efficiently, either to reduce expenditure or because of nursing shortages.
“Moving from three shorter shifts per day to two longer ones has been claimed to save up to 14% of salary costs,” he said. “But at what cost to the patient? This strategy needs to be looked at in much more detail. If nurses perform less effectively and less safely, what’s the point?”
He added: “This is compelling evidence that policy makers in England need to take note of.
“Although eight hour shifts are still common, a lot of nurses are working these longer shifts, but this study shows that this could be counterproductive,” said Professor Griffiths.
“Additionally, the increased flexibility associated with working overtime may not deliver the desired goals for employers.”
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Patient care is being jeopardised by insufficient nurse staffing levels.
“Nurses want to deliver the best possible quality of care but when there are too few nurses available then they have less time to spend with their patients and safety is undermined.
“The health service has limited resources to cope with rising numbers of patients, which is leading to massive pressures on the system and severely overstretched staff,” he said
“Rather than over-rely on hospital staff working lengthier shifts or overtime, the NHS must undertake the sensible long-term workforce planning and investment needed to make sure there are enough nurses to provide high quality patient care at all times,” he added.