Ball Jane, Day Tina, Murrells Trevor, Dall'Ora Chiara, Rafferty Anne Marie, Griffiths Peter, Maben Jill
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC), Wessex, Southampton, UK.
University of Southampton, Southampton, UK.
BMC Nurs. 2017 May 25;16:26. doi: 10.1186/s12912-017-0221-7. eCollection 2017.
Twenty-four hour nursing care involves shift work including 12-h shifts. England is unusual in deploying a mix of shift patterns. International evidence on the effects of such shifts is growing. A secondary analysis of data collected in England exploring outcomes with 12-h shifts examined the association between shift length, job satisfaction, scheduling flexibility, care quality, patient safety, and care left undone.
Data were collected from a questionnaire survey of nurses in a sample of English hospitals, conducted as part of the RN4CAST study, an EU 7 Framework funded study. The sample comprised 31 NHS acute hospital Trusts from 401 wards, in 46 acute hospital sites. Descriptive analysis included frequencies, percentages and mean scores by shift length, working beyond contracted hours and day or night shift. Multi-level regression models established statistical associations between shift length and nurse self-reported measures.
Seventy-four percent (1898) of nurses worked a day shift and 26% (670) a night shift. Most Trusts had a mixture of shifts lengths. Self-reported quality of care was higher amongst nurses working ≤8 h (15.9%) compared to those working longer hours (20.0 to 21.1%). The odds of poor quality care were 1.64 times higher for nurses working ≥12 h (OR = 1.64, 95% CI 1.18-2.28, = 0.003). Mean 'care left undone' scores varied by shift length: 3.85 (≤8 h), 3.72 (8.01-10.00 h), 3.80 (10.01-11.99 h) and were highest amongst those working ≥12 h (4.23) ( < 0.001). The rate of care left undone was 1.13 times higher for nurses working ≥12 h (RR = 1.13, 95% CI 1.06-1.20, < 0.001). Job dissatisfaction was higher the longer the shift length: 42.9% (≥12 h (OR = 1.51, 95% CI 1.17-1.95, = .001); 35.1% (≤8 h) 45.0% (8.01-10.00 h), 39.5% (10.01-11.99 h).
Our findings add to the growing international body of evidence reporting that ≥12 shifts are associated with poor ratings of quality of care and higher rates of care left undone. Future research should focus on how 12-h shifts can be optimised to minimise potential risks.
24小时护理工作涉及轮班制，包括12小时轮班。英国在采用多种轮班模式方面较为特殊。关于此类轮班影响的国际证据正在增多。一项对在英国收集的数据进行的二次分析，探讨了12小时轮班的结果，研究了轮班时长、工作满意度、排班灵活性、护理质量、患者安全和未完成护理之间的关联。
数据来自对英国医院样本中的护士进行的问卷调查，该调查是欧盟第七框架资助的RN4CAST研究的一部分。样本包括来自46个急症医院地点、401个病房的31个国民保健服务（NHS）急症医院信托机构。描述性分析包括按轮班时长、超合同工时工作以及日班或夜班划分的频率、百分比和平均得分。多层次回归模型建立了轮班时长与护士自我报告指标之间的统计关联。
74%（1898名）护士上日班，26%（670名）上夜班。大多数信托机构采用多种轮班时长。自我报告的护理质量在工作时长≤8小时的护士中更高（15.9%），而工作更长时间（20.0至21.1%）的护士中则较低。工作时长≥12小时的护士提供低质量护理的几率高出1.64倍（比值比[OR]=1.64，95%置信区间[CI]1.18 - 2.28，P = 0.003）。“未完成护理”的平均得分因轮班时长而异：3.85（≤8小时）、3.72（8.01 - 10.00小时）、3.80（10.01 - 11.99小时），在工作时长≥12小时的护士中最高（4.23）（P < 0.001）。工作时长≥12小时的护士未完成护理的发生率高出1.13倍（风险比[RR]=1.13，95% CI 1.06 - 1.20，P < 0.001）。轮班时长越长，工作不满率越高：42.9%（≥12小时（OR = 1.51，95% CI 1.17 - 1.95，P = 0.001）；35.1%（≤8小时）、45.0%（8.01 - 10.00小时）、39.5%（10.01 - 11.99小时）。
我们的研究结果进一步丰富了国际上越来越多的证据，表明12小时及以上轮班与低护理质量评级和更高的未完成护理率相关。未来的研究应关注如何优化12小时轮班以将潜在风险降至最低。
