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12+ hour hospital nursing shifts linked to increased risk of burnout and job dissatisfaction

Findings similar across 12 European countries, and run counter to perceived value of longer shifts

BMJ

Working 12+ hour shifts is linked to a heightened risk of burnout, job dissatisfaction, and intention to leave among hospital nurses in 12 European countries, finds research published in the online journal BMJ Open.

The findings run counter to the perceived value among both nurses and employers of working longer shifts, which are increasingly common practice in England, Ireland, and Poland, say the researchers.

Job satisfaction and burnout are global concerns in the nursing workforce, because of the potential impact they have not only on the quality and safety of patient care, but also on retention.

And nursing shifts have been lengthening, driven by the perception that they boost efficiency and productivity and offer increased flexibility and more full days off work. But these extended working patterns have not been comprehensively evaluated, say the researchers.

They therefore surveyed 31 627 registered hospital nurses (response rate 62%), excluding those in intensive or long term care units, in 488 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, The Netherlands, Norway, Poland, Spain, Switzerland and Sweden, between 2009 and 2010.

The survey included a total of 118 questions, relating to the demands and experience of the job itself; the most recent shift worked; and personal details. Burnout was assessed, using an internationally validated three-dimensional measure (MBI), and participants were asked directly about their levels of job satisfaction and intentions to leave.

The average age of the respondents was 38, and most were women. Almost two thirds worked in hi-tech and/or teaching hospitals. Over half (57%) worked in medical units; the remainder worked in surgical units.

The most common shift length was 8 or fewer hours (50%); almost a third (31%) worked 8-10 hours; 4% worked 10 to less than 12 hours; and 14% worked 12-13 hours. Just 1% worked more than 13 hours.

But 12 hour+ shifts were more common in certain countries, with 39% of respondents in England, 79% in Ireland, and 99% in Poland, working this shift length. And more than one in four of the entire sample (27%) had worked overtime on their last shift.

Around one in four (27%) reported high emotional exhaustion, while 10% said they experienced high depersonalisation and 17% low personal accomplishment--the three dimensions of burnout.

Around one in four expressed dissatisfaction with their job; a similar proportion were equally dissatisfied with their work schedule flexibility, and a third said they planned to leave their current job.

The analysis of the responses showed that shift length of 12+ hours was associated with greater levels of burnout in all three dimensions; job dissatisfaction; working schedule dissatisfaction; and intention to leave.

For example, job dissatisfaction rose to 40% among those clocking up shifts of 12+ hours compared with those working shifts of 8 hours or less, while the intention to leave rose to 31%.

Furthermore, working 8 hour shifts was associated with poorer job satisfaction, while working overtime was linked to unfavourable outcomes in all domains, irrespective of the actual additional hours worked.

This is an observational study, so no definitive conclusions can be drawn about cause and effect. But the findings run counter to perceived wisdom and practice, say the researchers.

"Current literature tends to report that 12 h shifts represent a way to retain nurses in hospital clinical practice because it is believed to be the preferred shift length and that nurses are more satisfied with their jobs: our results suggest the opposite," they write.

"Therefore, our findings pose substantial questions for managers, most notably because job satisfaction is a consistent and robust predictor of remaining in a job," they say.

They add that employers need to be aware of the potential effects of burnout, which include a heightened risk of making a mistake, poorer quality of care, compromised wellbeing, and increased absenteeism and high staff turnover.

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