Nurses' Shift Length and Overtime Working in 12 European Countries: The Association With Perceived Quality of Care and Patient Safety

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. Objectives: 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.