Balancing the rota: registered nurses’ preferences for shift patterns – a discrete choice experiment
Chiara Dall’Ora, Hannah Ruth Barker, Talia Emmanuel, Ourega-Zoé Ejebu, M Jamal HossainObjective
To elicit and quantify registered nurses’ (RNs’) preferences for key shift attributes and to estimate the trade-offs between shift pattern characteristics and pay.
Design
Cross-sectional online discrete choice experiment with d-efficient design; 12 choice tasks per respondent. Preferences were estimated using multinomial logit models with clustered standard errors; willingness to accept (WTA) values were derived as ratios of attribute coefficients to the pay coefficient.
Setting
United Kingdom.
Participants
1449 registered nurses (RNs) recruited via the Nursing and Midwifery Council distribution list.
Primary and secondary outcome measures
Utility coefficients (β) for shift length, schedule predictability, shift request flexibility, weekend working frequency, pay level and night-shift frequency; WTA derived from the pay attribute; subgroup and interaction analyses by age, pay band, current shift status, caring responsibilities, sector and satisfaction.
Results
All six attributes were statistically significant predictors of shift pattern choices. The strongest aversions were to night-only working (β=−1.113) and having no whole weekends off (β=−0.790), which required an estimated 29% additional compensation in the primary model and 21% additional compensation, respectively. Unpredictable rotas (β=−0.220), restricted shift-choice flexibility (β=−0.189 for only swaps) and absence of pay increase (β=−0.525) also reduced utility. Nine-to-ten-hour shifts were preferred over 8-hour shifts (β=0.144), whereas 12.5-hour shifts were disliked (β=−0.179). Subgroup analyses showed significant heterogeneity by age and current shift status, with more limited evidence of pay-band differences. Interaction analyses suggested broadly consistent aversion to night work and weekend loss across the nursing workforce.
Conclusions
Nurses strongly prefer rota designs that avoid exclusive night work and protect whole weekends off. Predictability and meaningful scope to request shifts also matter. These preference estimates provide policy-relevant benchmarks for rota design and unsocial-hours compensation.