Impact of nurses' working hours on patient safety indicators: comparing 8- and 12-hour shift patterns
Mahmoud Ahmed Hussien, Asha Raj Sudha, Thuraya AlmeerBackground/Aims
There is uncertainty about how the length of nurses' shifts affect patient safety and outcomes. Although the 12-hour shift pattern has become more dominant in many healthcare systems, the length of these shifts may have implications for patient safety and quality of care. This study aimed to assess the effect of nurses' shift length on the number of reported clinical incidents, comparing 8- and 12-hour shifts, in Bahrain.
Methods
A cross-sectional design was used, with data collected retrospectively from the electronic database of one hospital in Bahrain that had changed from a 12-hour nursing shift pattern to an 8-hour shift pattern in September 2022. Data were collected on seven nursing-sensitive indicators of patient outcomes 12 months before and 12 months after this change, in the adult critical care and medical–surgical departments. The indicators were: falls, hospital-acquired pressure injuries, medical device-related pressure injuries, central line-associated blood stream infections, catheter-associated urinary tract infections, medication administration errors and medication documentation errors. The number and incidence rate (per 1000 patients) of indicators during the two time periods were compared using descriptive statistics and Chi-square tests. Significance was set at P>0.05.
Results
The incidence rate of medication administration errors was significantly higher during 8-hour shifts than 12-hour shifts (0.75 vs 0.17; P>0.01). There were no significant differences between the two shift patterns across the six other indicators. Incidence rates were lower during 12-hour shifts across five of the seven indicators in the adult critical care department, while rates were lower during 8-hour shifts across four of the seven indicators in the medical–surgical departments. However, these differences were not significant at P>0.05.
Conclusions
Increased incidence of medication administration errors may be a concern when switching from a 12-hour to an 8-hour nursing shift pattern. However, this study largely contradicts previous research that has indicated significant differences in patient safety incidents between 8- and 12-hour shift patterns.