Longer staff shifts on mental health and community hospital wards linked to increased patient incidents

A study conducted at the University of Southampton has shown a significant increase in the risk of patient incidents in mental health and community wards when the majority of shifts in a ward-day are 12 hours or longer.

The new research found that as the proportion of nursing staff on a ward working 12 hour plus shifts rose above 70 percent daily, the number of incidents of self-harm, threatening behaviour and violence against staff on that same day increased significantly.

The study was funded by the National Institute for Health and Care Research Applied Research Collaboration Wessex (NIHR ARC Wessex) which runs a research theme around Workforce and Health Systems . Findings are published in the Journal of Nursing Management .

Researchers looked at records from mental health and community hospitals in Hampshire, in what is the first study of its kind in England. Incident data recorded by two NHS trusts was matched with the records of nursing staff shift patterns over a three-year period.

Dr Chiara Dall’Ora , an Associate Professor in Health Workforce in the School of Health Sciences at the University of Southampton, who led the study, comments: “The consequences of patient incidents such as self-injury and disruptive behaviour are serious, and using high proportions of long shifts is associated with higher risk rates of such incidents in mental health and community hospitals.

“Nurse managers and those in charge of creating rotas for nursing staff should avoid implementing 12 plus hour shifts as a blanket intervention for all staff.”

Previously Dr Dall’Ora worked to examine the impact of longer nursing shifts and staff burn-out in NHS hospital settings. In a previous publication she found that limited choice around working hours, short staffing and lack of breaks were a factor in nursing staff exhaustion and burn out.

The work of Dr Dall’Ora, Dr Zoé Ejebu and Professor Peter Griffiths from the University of Southampton is part of a focus on creating safer patient care and improving working conditions for nursing staff in the NHS.

Professor Peter Griffiths has recently published a study looking at recommended NHS staffing levels and patients’ safety. It has led to a change in advice for staffing by NHS England.

He says: “We know that the health workforce are an asset and in short supply. As part of our ARC research we are looking at the best ways for staff to work - for example where and when. We also want to improve conditions - in part by ensuring they have time to do the jobs we are asking them to do.”