12个欧洲国家护士的轮班时长与加班情况：与感知到的护理质量及患者安全的关联

Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety.

作者信息

Griffiths Peter, Dall'Ora Chiara, Simon Michael, Ball Jane, Lindqvist Rikard, Rafferty Anne-Marie, Schoonhoven Lisette, Tishelman Carol, Aiken Linda H

机构信息

*Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK †Università degli Studi di Milano Bicocca, Milan, Italy ‡Inselspital Berne University Hospital and Institute of Nursing Science, University of Basel, Bernoullistrasse, Basel, Switzerland §King's College London, National Nursing Research Unit, London, UK ∥Karolinska Institutet, Medical Management Centre, Tomtebodavägen, Stockholm, Sweden ¶Radboud University Medical Centre, the Netherlands and University of Southampton, Centre for Innovation and Leadership in Health Sciences, Southampton, UK #Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA.

出版信息

Med Care. 2014 Nov;52(11):975-81. doi: 10.1097/MLR.0000000000000233.

DOI:10.1097/MLR.0000000000000233

PMID:25226543

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4196798/

Abstract

BACKGROUND

Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs.

OBJECTIVES

To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone.

METHODS

Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries.

RESULTS

A total of 50% of nurses worked shifts of ≤ 8 hours, but 15% worked ≥ 12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥ 12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13-1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10-1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09-1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51-1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23-1.42), and more care left undone (RR=1.29; 95% CI, 1.27-1.31).

CONCLUSIONS

European registered nurses working shifts of ≥ 12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.

摘要

背景

尽管有人担心护士长时间轮班工作时能否可靠且高效地履行职责，但为减少交接班、人员配备重叠以及由此产生的成本，许多医院每天安排两个12至13小时轮班的模式正变得普遍。

目的

描述欧洲护士的轮班模式，并调查轮班时长和超出合同工时（加班）是否与护士报告的护理质量、安全性以及未完成的护理工作相关。

方法

对12个欧洲国家488家医院普通内科/外科病房的31627名注册护士进行横断面调查。

结果

共有50%的护士轮班时长≤8小时，但15%的护士轮班时长≥12小时。典型的轮班时长因国家而异，在一些国家内部也有所不同。轮班时长≥12小时的护士更有可能报告患者安全状况不佳或存在问题[优势比（OR）=1.41；95%置信区间（CI），1.13 - 1.76]、护理质量差/一般（OR = 1.30；95% CI，1.10 - 1.53）以及更多护理工作未完成（相对危险度（RR）=1.13；95% CI，1.09 - 1.16）。加班也与患者安全状况不佳或存在问题的报告相关（OR = 1.67；95% CI，1.51 - 1.86）、护理质量差/一般（OR = 1.32；95% CI，1.23 - 1.42）以及更多护理工作未完成（RR = 1.29；95% CI，1.27 - 1.31）。