Are we measuring nursing workflow correctly? A literature review

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.