Increasing The Personal Safety of Nurses Through Reduction of Working Hours

 Executive summary

A substantial portion of the healthcare providers consists of registered nurses. In providing 24/7 care, the nurses habitually work for long hours and sequential shifts with no rest breaks and sufficient meals. The providers develop fatigue because of the working conditions coupled with significant psychological and physical stresses in carrying out of their work. It ultimately results in safety issues on them and patients. Concerning the nurses, these hazards can impair their health acutely and in a long duration. Therefore, the present paper discusses an initiative that increases the personal safety of nurses. Additionally, it highlights the method involved in making the intervention practical. Overall pieces of literature suggest that reduction of the working hours in the nursing shift substantially improve their health and safety.

Problem Statement -Purpose of the quality improvement initiative

Long working hours in the hospital shifts brutally affects the health of nurses. Foremost, they develop sleeping complications with studies showing that they are more likely to suffer from long term insomnia. Fatigue and sleep deprivation foster occupational injuries to practitioners. Injury risks are higher at night shifts than in the morning and afternoon shift. Also, nurses working 12 hours or more have a 68% increased probability of getting needlestick injuries (Witkoski & Dickson, 2010). Nurses, primarily in hospitals, are required to work on holidays and weekends, thus disrupting their social life.

If the issue is not solved, long-term effects may happen to the predisposed group. The lengthy work schedules have been linked with gastrointestinal problems and high risks of developing colon cancer. Further, shift work exacerbates preexisting chronic diseases like hypertension, asthma, and insulin-dependent diabetes In regards to psychological aspects, concerns such as depression, relationship difficulties and personality changes happen..

Fatigue results in behavioural, cognitive, and psychomotor impairment. In hospital and laboratory settings, the impairments increase medical errors, reduce motivation and compromise the ability to solve problems in the required tasks. In a 5-year period (ending in 2018) health workers were compensated with nearly $1 million due to needle stick injuries (Bae & Fabry, 2014). Generally, regular working shifts show to cause critical health issues to nurses and the quality of care. Thus an initiative like shortened working hours is imperative.

Literature Review

Audience

Nurses fatigue is one of the significant factors that directly affect healthcare performance, patient care and decision making. It is a significant issue as it leads to the breakdown of relations between the practitioner and the team, patient, and family. More so, it escalates the potential of mistakes in the observation of patients and medicine’s administration (Bae & Fabry, 2014). Due to these factors, the primary audience of this initiative; reduction of working hours, are the healthcare settings.

Nonetheless, there is a secondary audience who can benefit from this intervention. The article by Witkoski and Dickson (2010) show that there exist several regulations- both federal and state- that define the working conditions in healthcare settings. Through the article, it is evident that policymakers are secondary audiences.

Benefits of the Initiative- Shortened working hours.

Reducing the working hours in the consecutive shits of nurses shows to offer numerous benefits. This notion is defended by the work of Gyllensten et al. (2017). The authors carried a study at an orthopedic surgery department in a prominent hospital based in Sweden. From their results, shortened working hours had positive impacts on the working conditions, work-life balance of nurses, and quality of care.

All the participants confirmed that the initiative created a sustainable working condition. Previously, working fulltime posed multiple difficulties due to physical work demands. However, through the initiative, most of them were able to work full-time. Further, they showed an improved recovery by working on afternoon shifts after finishing the evening shift the day before. The participants declared that the work climate had improved because interprofessional collaboration had increased.

In terms of their work-life balance, participants indicated that they balanced the two better. They had more time and energy to perform leisure activities. The shift regime of before would exhaust their energy, and by the time they left the work they had none left. Additionally, they stated that through the intervention, they had better control of their lives and that it was easier to handle their stress. They had stopped surviving and started to live the life they wanted.

Finally, there was improved work performance in the department as the nurses were more able to focus on doing an excellent job in their operations. The initiative ensured the effective use of available resources. For instance, the operating theatre was used in a more substantial part of the day.

Methodology

On receiving funds, the study of the initiative will be conducted in a primary care hospital based in the state. However, the working hours will be reduced first from a small group of nurses, then followed by all the staffs after three months. The regular shifts in the hospital take 9 hours. The working hours will be changed to 6 hours in a day, and the salaries will remain the same. Currently, the working schedule entails a morning shift (0700-1700hrs) and afternoon shift (1230-2130hrs). They will be changed to three shifts minus the lunch break.

Interprofessional Collaboration

In conducting the change, occupational health nurses will be employed as they are better suited. They have skills in the development of collaborative connections that address the work environment and safety of employees. The skills are screening, surveillance and education. These nurses will work with managers in the organization to develop and enforce policies.

Evaluation

The initiative will be evaluated by collecting data of all the healthcare providers. They will be invited to participate in the research by the use of letters. Obtaining data will be through semi-structured interviews and will take place at the facility after their working hours. The questions are open-ended and will be based on previous studies on the psychosocial working situations and their health-related issues on the nurses (Smith et al., 2013). Specifically, the questions will be on recovery from work, psychosocial work features, work-family conflict, health and economics.  For verbatim purposes, the interviews will be transcribed and tape-recorded.

IPA (interpreventive phenomenological analysis) will be used to analyze the data collected (Noon, 2018). The analysis focuses on explaining how participants make sense of the world through the process of interpretative activity. Therefore, this method is best suited for the study, as it will explore the experiences of the participants in the context of shortened working hours.

Budget for Three months

Shifts in a day will be changed from two to three. The extra shift will require two additional nurses who will need to be funded by the initiative.

References

Witkoski, A., & Dickson, V. V. (2010). Hospital staff nurses’ work hours, meal periods, and rest breaks: A review from an occupational health nurse perspective. Aaohn Journal, 58(11), 489-497.

Noon, E. J. (2018). Interpretive phenomenological analysis: An appropriate methodology for educational research. Journal of Perspectives in Applied Academic Practice| Vol, 6(1).

Bae, S. H., & Fabry, D. (2014). Assessing the relationships between nurse work hours/overtime and nurse and patient outcomes: systematic literature review. Nursing outlook, 62(2), 138-156.

Gyllensten, K., Andersson, G., & Muller, H. (2017). Experiences of reduced work hours for nurses and assistant nurses at a surgical department: a qualitative study. BMC nursing, 16(1), 16.

Smith, J., Fisher, G., Ryan, L., Clarke, P., House, J., & Weir, D. (2013). Psychosocial and lifestyle questionnaire. Survey Research Center, Institute for Social Research.