The regulations limit night workers’ average shift to eight hours and mean that employers have to offer staff health assessments, ensure minimum daily and weekly rest periods at work – 11 hours of continuous rest in a 24-hour period and a 20-minute break after more than six hours – and four weeks of paid annual leave.
Until 2003 workers in the UK were allowed to opt out of a 48-hour week to work longer hours. GPs are not covered by the EWTD because they are self-employed.
These rules applied to all workers with a few exceptions such as doctors in training, who were given longer before coming under the same arrangements. This affected junior doctors’ hours, which the EWTD said should come down to 58 per week by 2004, 56 by 2007 and to 48 hours a week by 2009.
The impact of cutting junior doctors’ hours started a sea change in nursing in terms of how it is planned, coordinated and led. The result of this was a shift of responsibility from doctors to nurses and a raft of new opportunities for nurses.
Different working patterns, skill mixing, and new and extended nursing roles have resulted from these changes, including more nurses running clinics, performing minor surgery, admitting and discharging patients, requesting tests and investigations.
One of the major pilots that came about as a result of this change was the Hospital at Night project backed by the Department of Health, the former NHS Modernisation Agency, the BMA and royal colleges.
Pilots are now running at 20 trusts, looking at how to redefine how medical cover is provided in hospitals during the out of hours’ period and creating a more nurse-led, multi-disciplinary model for night working.
Key changes have included supervised multi-specialty handover in the evenings, bleep filtering, moving non-urgent work from nights to evenings and having nurses take on some of the junior doctors’ responsibilities.
Initial evaluations of the pilots said patient care has improved as a result and there has been no detrimental effect on doctors’ training.
The EWTD has helped to spur many developments in nurses’ roles such as expansion in nurse prescribing, dedicated nurse-led night teams, night nurse practitioners who carry out tasks such as cannulations, defibrillations, and patient assessment, and implement education programmes.
Updated: September 2006