title: Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards.
abstract: OBJECTIVE
  This paper reports an examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week on acute psychiatric wards.
  
  
  BACKGROUND
  Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and staff. Previous research suggests that the arrival of inexperienced new staff may trigger more adverse incidents. Findings on the relationship between incidents and the weekly routine are inconsistent.
  
  
  METHODS
  A retrospective analysis was conducted of formally reported incident rates, records of nursing student allocations and junior doctor rotation patterns, using Poisson Regression. Variance between days of the week was explored using contingency table analysis. The data covered 30 months on 17 psychiatric wards, and were collected in 2002-2004.
  
  
  RESULTS
  The arrival of new and inexperienced staff on the wards was not associated with increases in adverse incident rates. Most types of incidents were less frequent at weekends and midweek. Incident rates were unchanged on ward-round days, but increased rates were found on the days before and after ward rounds.
  
  
  CONCLUSIONS
  Increased patient tension is associated with raised incident rates. It may be possible to reduce incident rates by moderating stimulation in the environment and by mobilizing support for patients during critical periods.
authors.affiliation: Psychiatric Nursing, St Bartholomew School of Nursing and Midwifery, City University, London, UK. l.bowers@city.ac.uk
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
authors.forename: Debra
authors.initials: D
authors.lastname: Jeffery
authors.forename: Alan
authors.initials: A
authors.lastname: Simpson
authors.forename: Christina
authors.initials: C
authors.lastname: Daly
authors.forename: Jonathan
authors.initials: J
authors.lastname: Warren
authors.forename: Henk
authors.initials: H
authors.lastname: Nijman
mesh_terms: D000208:Acute Disease; D000328:Adult; D000374:Aggression / Q000523:psychology; D004924:Escape Reaction; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000451:nursing* / Q000523:psychology; D009741:Nursing Staff, Hospital; D010561:Personnel Staffing and Scheduling; D010563:Personnel Turnover; D011567:Psychiatric Department, Hospital; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000451:nursing / Q000523:psychology; D013997:Time Factors; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*; D000078329:Workforce