Title: Improving patient safety, workforce wellbeing and NHS efficiency through improved shift patterns for nursing staff
Funder: The Academy of Medical Sciences

Abstract: AIM This project aims to identify how to improve nurses' shift patterns. OBJECTIVES: to identify which shift work characteristics staff value; to identify important outcomes according to staff and patients when it comes to scheduling practices; to identify what works and does not work in scheduling practices; to elicit staff preferences of shift patterns through a Discrete Choice Experiment. BACKGROUND Nurses form a substantial part of the clinical workforce, but there are significant problems of retention and absenteeism. My research demonstrated how the introduction of shifts of +12 hours is associated with higher nurse burnout, sickness absence and intention to leave. Nurses working 12-hour shifts are also more fatigued, and this poses a risk to patient safety. However, some nurses reported preferring 12-hour shifts. METHODS This study will use multiple methods. I will conduct focus groups and interviews with nursing staff, Trust managers, and patients to identify nurses' preferences and constraints around shift patterns; managers' requirements when modifying shift patterns; and patients' concerns and views. These will inform changes to shift patterns, which will be proposed to nurses through a Discrete Choice Experiment; nurses will be presented with different scenarios and trade-offs to elicit which changes to shift patterns would be acceptable and preferred. ANTICIPATED IMPACT This project will provide evidence to inform improvements to shift patterns, and it will pave the way for a trial where modifications to shift patterns will be tested; if effective, improved shift patterns can reduce staff turnover, improve patient safety, and reduce staffing costs.

Lay abstract: What is the problem? If the COVID-19 pandemic has taught us something, it is how important the wellbeing of the health workforce is. Nurses form a big part of the health workforce, yet many leave their job because of poor working conditions. In recent years, hospital managers introduced long shifts for nurses, hoping nurses would be happier with their work-life balance. However, my research found that long shifts have negative effects for nurses and patients. We still do not know what good shift patterns look like. What will I do? I will identify possible improvements to shift patterns that work for nurses, their managers and patients. I will interview nurses and their managers to understand what they value when it comes to shift rostering. I will talk with a group of patients to understand what good care looks like to them. I will then run an online experiment. In this experiment I will present staff with a series of modified shift patterns. Using statistics, I will understand which shift patterns staff prefer. Why is this important? If we find changes to shift patterns that are acceptable for nurses, managers and patients, I can trial these changes in a real-life experiment. If the experiment - called "trial"- shows that changes to shift patterns work, fewer nurses will leave their jobs. If we find how to make nurses’ work less tiring, they will make fewer mistakes that compromise patient care. In addition, if fewer nurses leave, healthcare systems will save money.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE