title: Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety.
abstract: BACKGROUND
  Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs.
  
  
  OBJECTIVE
  To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone.
  
  
  METHODS
  Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries.
  
  
  RESULTS
  A total of 50% of nurses worked shifts of ≤ 8 hours, but 15% worked ≥ 12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥ 12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13-1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10-1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09-1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51-1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23-1.42), and more care left undone (RR=1.29; 95% CI, 1.27-1.31).
  
  
  CONCLUSIONS
  European registered nurses working shifts of ≥ 12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.
authors.affiliation: *Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK †Università degli Studi di Milano Bicocca, Milan, Italy ‡Inselspital Berne University Hospital and Institute of Nursing Science, University of Basel, Bernoullistrasse, Basel, Switzerland §King's College London, National Nursing Research Unit, London, UK ∥Karolinska Institutet, Medical Management Centre, Tomtebodavägen, Stockholm, Sweden ¶Radboud University Medical Centre, the Netherlands and University of Southampton, Centre for Innovation and Leadership in Health Sciences, Southampton, UK #Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA.
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
authors.forename: Chiara
authors.initials: C
authors.lastname: Dall'Ora
authors.forename: Michael
authors.initials: M
authors.lastname: Simon
authors.forename: Jane
authors.initials: J
authors.lastname: Ball
authors.forename: Rikard
authors.initials: R
authors.lastname: Lindqvist
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Rafferty
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
mesh_terms: D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D006801:Humans; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000592:standards / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D014940:Work Schedule Tolerance