Commitment to Nursing: Transforming The Role of The Nurse

Introduction

The aim of this paper is to explore, analyse and evaluate an area of practice that has changed and transformed the role of the nurse, commitment to nursing since I last practiced seven years ago. In this case, it relates to changes in shift length, which before consisted of half days and two hours less on a night shift compared to now, which is twelve and half hour shifts with an hour break. It is important to note, that in some special circumstances, flexible working hours can be granted due to health, child care issues and other extenuating circumstances. To fully address professional guidelines and the Data Protection Act (2018), confidentiality will be maintained and information provided will not identify wards or localities (Dimond 2015; Nursing and Midwifery Council 2018).

Nurses' Commitment to Nursing Workload

In an attempt to recognize the effect of shift work on nurses, studies have been undertaken and include a broad range of evidence (Ball J. & Pike G 2009). Implementing flexible work methods that understand the variety of the life of a nurse finds it is not surprising that shift patterns had an effect on nurses and their retention in the workplace (Middleton 2018; Brooks, 2000). More evidence demonstrates that employee-friendly shifts are improving retention, encouraging recruitment, return to practice, engagement and reducing absence. However, even with the information at hand, some trusts have decided to implement twelve and half hour shifts as the base-line for working nurses on recruitment, which seems contrary to some findings with more concern growing over quality of care (Stimpfel A. & Aiken L 2013).

The somewhat unpopularity of working longer shifts (amongst numerous other variables) can be a gauge to consider work related ‘job satisfaction’ and ‘well-being’ in some circumstances. Working as a hospital nurse generally involves long working hours and potentially unpopular shifts and taking a job in an area of interest where the long working days are considered the ‘norm’ may become a matter of acceptance. The impetus for change could be due to funding as it appears starting at 7 and finishing at 19:30 ‘falls outside’ the unsociable hours pay (when before the change, working on a late shift and finishing at 21.30 would have given 1.5 hours of unsociable pay). Having to work longer hours changed over at some point around seven/eight years ago and it would have been interesting to investigate how many nurses lodged any form of complaint or resistance to change. Being able to research the amount of complaints/resignations/early retirements/etc would have proved useful to this paper - that specific data is not available. As stated, previous study has been undertaken to investigate shift patterns, suggesting more improvement is needed in the well-being and effectiveness of the nursing population with effective management of shift work an approach to this. This has become more evident as a return to practice student throughout my clinical placement and, on directly asking the question to co-workers, it seems a longer work day is not necessarily a drawback for all individuals, as the opportunity to work longer shifts will benefit some nurses and for them many problems others face may be less (Pryce, 2016). When the change over occurred, some nurses may have perceived this as a lack of choice over a crucial aspect of their lives, such as not being able to work their preferred shift pattern or being rotated to an unfamiliar environment when a ward couldn’t/wouldn’t accommodate them. It could possibly mean the detrimental effects of longer shifts were more likely to adversely affect them specifically – with an influence over shift patterns associating positively with their commitment to nursing. More research found that nurses were no more likely to want to increase their daily working hours or request a change of working hours if it had an impact on their relationships or their private life Lin, Liao, Chen, & Fan, (2014). Any evidence collected would need to be examined further by other variables. Ie. The ward the nurse worked on, particular mood, events of the day, time to participate, age, health, experience and many others. Interestingly, age, or at least experience seemed to play a part in how nurses were satisfied with working longer hours. Some senior nurses seemed more receptive to change and this could be because of a number or factors such as less family commitment (grown up children), not wanting to change environment and more satisfaction in what they are doing (Letvak, Ruhm, & Gupta, 2013).

RCN employment surveys have been completed since 1988 and, usually with a response rate of over fifty percent, find that longer shifts should consider the personal feelings of the nurse with many nurses’ job satisfaction and shift length related. A longer shift coupled with an excessive workload could decrease the levels of job satisfaction making it less likely of remaining in their situation. It was also discovered that the level of independence and involvement in shift decision-making was predictive of work satisfaction. It suggests that a nurse is more committed to their trust or organisation they work in if they have more flexibility over their shift, which in turn may lead to a rota that enables them to choose a system that is least detrimental to their health and private lives (RCN Nursing Employment Survey 2017). Also in the survey, the RCN found that 41.9% compared to 34.4% strongly disagree/disagreed that they are able to balance their home lives effectively while interestingly nearly 50% said they strongly agreed/agreed that they were satisfied with their choice over shift length. There were 7,720 responses that were deemed usable for the data analysis. It recognizes that the physiological and social problems connected with longer shifts could impede performance efficiency and effectiveness, which in turn had consequences for individual workers, patients and employers. These factors may affect the reaction of an individual to change job with 37% considering a change, up from 31% in 2015. It also found that nurses tend to associate their job as ‘rewarding’ 73.6% yet working longer shits made it sometimes ‘unpleasant’. Bogossian, F., Winters-Chang, P., & Tuckett, A. (2014) imply that occupations that are perceived (potentially inaccurately) as involving unpopular working hours are rarely a first choice occupation of any age and when nurses had the choice of different shift patterns that matched their family responsibilities did stress levels occur, (although it is not that unexpected as working in a hospital environment would logically be ‘demanding’ anyway) making their attitude and commitment to a longer shifts more favourable.

Implications for Patient Care

As a nurse who used to work half days, but now works twelve and half hour shifts, it would be fair to say that tiredness is a factor and the question should be asked whether a longer shift, coupled with extra fatigue is really a way to give patients efficient care. It stands to reason that a patient will look negatively on their care if a nurse is irritable and tired and the impact on the patient’s health could be compromised by an overworked or exhausted nurse. Studies have been undertaken to examine the relationship between working longer hours and its impact on patient care and mortality rate, with many finding a link between longer shifts and quality of care (Griffiths P, Dall'Ora C, Simon M, et al, 2014). In their European study, it found that there was more nurse fatigue, patient safety was compromised and more work left unfinished as working longer hours would appear detrimental to care outcomes. As fatigue is common in longer shifts, finding a working way around this would prove useful, such as not working more than two long days at a time or going straight from long days to successive nights for example. It would be assumed that a nurses’ rota would be sensible in that it wouldn’t consist of three long days immediately followed by nights as it could be argued that this would exhaust a nurse and have potential implications for the - the only ‘positive’ would be the continuity of care. There may be examples of annual leave where the nurse would want to ‘condense’ a working week in order to have an extended holiday, where it may be a case of ‘getting through it’ just to achieve this, but again it brings to the forefront the implications for the patient. You would at least expect the ward manager to question this and look at how this would promote ‘safe practice’ as patient care should be at the very core of any shift decisions. Having a number of reduced and longer shifts would result in fewer handovers and a decrease in overlap between shifts, and from a manager’s point of view, this could be viewed as a ‘positive’ in terms of patient care, with more continuity of care and far less ‘newer faces’ for the patient to become accustomed to. From an employment perspective, working longer days would give the nurse (theoretically) more days off and maybe less travel expenses.

Working longer shifts could see a problem with a loss of concentration which could lead to drug errors putting a patient at risk – of course, errors are made anyway, but a fatigued and stressed nurse may have the potential to make more mistakes. To compound this, a tired nurse working longer hours may not be totally complicit when it comes to observing all the correct procedures when it comes to issues like infection control policy or sharps, which again puts the patient at risk. These are speculative ‘issues’, with many variables like individual nurse attitude, number of ill patients to look after – but they could all have a strong factor when longer hours and fatigue comes in to the equation.

Research

Research is an important part of nursing as it makes a difference to quality of education, care giving and professionals should adhere to evidence based practice. How to search for information that it ‘relevant’ and of a ‘good standard’ is very important as certainly not all articles are worthy and, especially on the internet, can be very biased especially if a product is being introduced or attempting to be sold. A lot of articles need to be checked for limitations and weakness with the ability to search, read and review clinical research papers important. Examining a paper includes making a balanced judgment of its values and merits. It ought not to be thought of as ‘concentrating’ on the negatives of the paper, but moreover recognizing and deciding its qualities and shortcomings.

Search Strategy

The search was carried out using databases such as Cochrane (although this returned a small number of results with the chosen search criteria), Google Scholar and Cinahl (utilising the free trial). The university library was also accessed to gather relevant literature. Some examples of keywords used when searching were ‘nurse/s/nursing/shift length/nurse hours/patient care’. Also, some reference books were used, but books do date quickly.

The overall search yielded limited results with a search span of 2015 - 2019. It was decided that although research needed to be as current as possible, a broader time range was required. The search was then widened to 2009 – 2019. Additional methods of research consisted of a manual exercise of viewing Journals such as Journal of Advanced Nursing, Nursing Standard etc. Extending the search to the World Wide Web using Google Scholar as a search engine revealed research pointing to, among others, health issues relating to nursing and inflexible shift issues were indexed under several hundred authors, and related to social/domestic problems, depression, injury, impact of patient care and retention/job satisfaction. After ‘narrowing’ the search down, it is still beyond the scope of this paper to review all the available literature.

Literature Review

A literature review examines and summarises articles about a chosen topic, this is an essential stage in any research process. It should be done in order to find out what has already been written and researched about the chosen topic, that way research will not be repeated unnecessarily.

Some articles were researched using a quantitative method, whilst others articles adopted a qualitative approach. It has been established that many arguments exist concerning qualitative and quantitative research and one research method is not superior to the other, what is of great importance is that the chosen method of research is appropriate to the aim of the study.

Articles reviewed had clearly constructed titles that addressed the chosen research area. The titles indicated that they were all relevant to the research area, while the authors of the literature reviewed had a range of qualifications ranging from PhD, MSc and BSc and associated to Medical and/or Business/Management. Some authors provided evidence that influence over shift patterns and realisation of preferred shift pattern were positively associated with commitment to nursing, although not all the evidence reviewed was considered ‘strong’ - The participant’s inclusion in some studies may be biased as it could be assumed that nurses believe that more control over shift patterns would actively improve working conditions. Some authors provided evidence that influence over shift patterns and realisation of preferred shift pattern were positively associated with commitment to nursing, although not all the evidence reviewed was considered ‘strong’ - The participant’s inclusion in some studies may be biased as it could be assumed that nurses believe that more control over shift patterns would actively improve working conditions.

Choice of Critical Appraisal Tool

The choice of Critical Appraisal Tool is an vital one. Buyers of inquire about (analysts, chairmen, teachers and clinicians) habitually utilize standard basic examination instruments to assess the quality of distributed investigate reports Be that as it may, there's no agreement with respect to the foremost suitable basic evaluation tool for allied health/social inquire about. The choice of Basic Examination Apparatus which is able be utilized to examine the taking after report will be the taken from CASP (2019). While not all the questions will be significant to dissect the report, this Basic Examination Apparatus will permit for Quantitative explanatory assessment of the quality of the think about.

Analysis of Critical Appraisal Tool

This Critical Appraisal Tool has been developed to explore the feasibility of undertaking systematic reviews of research literature on effectiveness and outcomes in health and social care. It will assist in the critical appraisal of Quantitative research studies and mixed design studies in which Quantitative design includes use of data collection methods.

Whilst there are many Appraisal Tools to choose from, CASP offers avenues to ask many relevant questions regarding the quality of the report. It is recommended that consumers of research carefully select their choice of appraisal tools to meet their needs. Any selected tool appraising published evidence should have the validity of items and reliability of interpretation, as well as guidelines for use, so that the tool can be applied and interpreted in an understandable and standardised manner. CASP offers the researcher clear guidelines on its use and a comprehensive list of questions to make sense of published data. As a consequence, allied health research utilising CASP will specifically benefit from having critical appraisal tools that reflect best practice research approaches which embed specific research requirements. With job satisfaction, fatigue and potential for safety of patients and their care in mind, with the permission of the ward manager, a small survey was taken in which the participants were kindly asked if they would like to take part and if so, were asked a series of pre-defined questions.

References

1. Ball J. & Pike G. (2009). Shift length: A literature review. Nursing Management (Harrow), 16(4), 22-25.
2. Bogossian, F., Winters-Chang, P., & Tuckett, A. (2014). Extended work shifts and the impact on patient safety, productivity, and employee health. Advances in Nursing Science, 37(1), E1-E16.
3. Brooks, C. (2000). Shift length in nursing practice: An evidence-based review of the literature. Journal of Nursing Administration, 30(10), 458-465.
4. Griffiths, P., Dall'Ora, C., Simon, M., et al. (2014). Nurses' shift length and overtime working in 12 European countries: The association with perceived quality of care and patient safety. Medical Care, 52(11), 975-981.
5. Middleton, J. (2018). Nursing shift length and nurse job satisfaction: An integrative review. Journal of Nursing Management, 26(5), 479-486.
6. Nursing and Midwifery Council. (2018). The Code: Professional standards of practice and behavior for nurses, midwives and nursing associates. Retrieved from https://www.nmc.org.uk/standards/code/
7. Pryce, J. (2016). Work-life balance and the shift lengthening agenda: Implications for nurse managers. British Journal of Nursing, 25(3), 146-150.
8. RCN Nursing Employment Survey. (2017). Royal College of Nursing. Retrieved from https://www.rcn.org.uk/professional-development/publications/pub-007487