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Are we measuring nursing workflow correctly? A literature review

26 November 2020
Volume 29 · Issue 21


When it comes to determining what constitutes nursing workload, there are a number of approaches that represent and characterise the work of nursing across the three traditional shift patterns (morning/day, afternoon/evening and night). These are observational, self-reporting and work-sampling techniques. A review of the quantitative and qualitative literature to examine workload distributions between the three nursing shifts was undertaken. Using data sourced from the CINAHL, Scopus and Medline databases, the findings suggest that there is an inadequacy in establishing nursing productivity that is perhaps representative of the methods used to decipher nursing workload. This may contribute to poor quality care, and the high cost of excess nursing time contributes to the increasingly high costs of care. Linked to this is the nurse's job satisfaction. Quality of care and job satisfaction are important factors for the sustainability of the nursing workforce. There are few high-quality nursing articles that detail the workload distributions across the three nursing shifts and this is a potential area for further research.

In most cases, hospital nurses provide 24-hour care that can encompass a variety of roles and set procedures that are required to support patients during each nursing shift. Undoubtedly, time is a limited resource, it is dynamic and it costs healthcare services money (Jones, 2010). The Australian Institute for Health and Welfare (2016) identified the need to improve the productivity of the workforce and the need to address growing service demands as key areas for healthcare reform and cost reduction.

Historically, hospital-based nursing shifts traditionally worked on an 8-hour shift pattern (Ball et al, 2014) with a day/morning (7am–3.30pm), afternoon/evening (2.45pm–11.15pm) and night shift (10.45pm-7.15am). However, over the past 25 years, there has been a change in the nursing shift pattern to include 12-hour shifts, which were seen as a means of improving work satisfaction, increasing continuity of care (Battle and Temblett, 2018) and lowering healthcare costs (Estabrooks et al, 2009). However, Griffiths et al's (2014) review of quality of care and patient safety relative to nursing shift pattern across 12 European countries found that not all countries were adopting the 12-hour shift pattern, with many opting instead for the more traditional 8-hour shift pattern. For example, in surveying 33 659 nurses from 488 hospitals, only 14% of nurses were contracted to work 12-hour shifts; in just two countries, the Republic of Ireland and Poland, 12-hour shifts were the norm (Griffiths et al, 2014). Additionally, Ball et al's (2015) review of nursing patterns in the UK identified a 20% increase over a 4-year period in the use of 12-hour shift patterns, similar to the reasons identified previously—a shortage of nurses, continuity of care, managing home life more effectively and shorter shift rotations.

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