How does the length of day shift affect patient care on older people's wards? A mixed method study

Background: Internationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older people’s hospital wards. Objectives: 1) To explore how length of day shift affects patient care in older people’s wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older people’s wards Design: A mixed method case study. Settings: The study was based on two older people’s wards in an acute hospital in England. One ward was piloting two, overlapping 8 hour day shifts for 6 months while the other ward continued with 12 hour day shifts. Participants and Methods: Qualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n=279). Twenty hours of observation of nursing staff’s interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations. Results: There were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8 hour day shift pattern, in a hospital that had a 12 hour day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience. Conclusions There was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older people’s wards.