“It is really so exhausting”: Exploring intensive care nurses’ perceptions of 24‐hour long shifts

Abstract

Aim and objectives To explore the perceptions and experiences of Cambodian ICU registered nurses regarding their working 24‐hr shifts. Background In Europe and the USA, nurses are moving to a 12‐hr shift, and numerous studies have revealed the positive and negative effects of these. However, lesser known is the impact of 24‐hr nursing shifts on care quality, and health and safety. In Cambodia, 100% of nurses are rostered for these in their shift patterns, but until this study no research had been conducted on such shifts. Design A qualitative descriptive study. Method Three focus group discussions were conducted with 30 registered nurses in July 2019, ten in each group, from three intensive care units of three hospitals in Cambodia. Data saturation was obtained. Data were analysed using content analysis, and the COREQ was applied for reporting this study. Findings The ICU nurses’ perspectives revealed significant and unacceptable effects of working shifts of ~25‐hr length, taking into account staff handover. Two major themes arose: It is so exhausting and Compromised hospital care. Alarmingly, participants worked on average 72 hr per week, were exhausted, and nursed between 6 and 10 critically ill patients per shift. Conclusion To our knowledge this is the first study on nurses working 24‐hr shifts, revealing unacceptable, high risks for the health and safety of nurses and patients, with nursing activities left undone, and a lack of quality care. Relevance to clinical practice Improving nurse and patient health and safety, and quality of care requires hospital leaders to work with government and nursing organisations to develop better shift strategies. Resources need to be provided so that: nurses can work a maximum 12‐hr shifts; the ratio of nurses to patients is improved; and nurses can have decent break times. This has major implications, for not only practice, but also management, administration, budgets and education.

Nurses’ experiences and preferences around shift patterns: A scoping review

“…This concerns more than half of the studies (n = 18). When we consider the length of shift, studies focussing on long (12+ hour) shifts were more common (n = 8, including one study investigating 24-hour shifts, Koy, Yunibhand [ 26 ]). Seven studies compared 12 hour shifts with other lengths of shift, such as 4, 8 or 10 hours.…”

“…They reported feeling guilty about calling in sick, because staff shortages would mean that their shift would have to be covered by a colleague forced to do overtime [ 24 ]. This was amplified by nurses experiencing increased workload as a result of staff shortages during their shifts [ 25 , 26 , 35 , 36 ].…”

“…Relatedly, nurses choosing their own roster were more satisfied with their job [ 43 ]. In contrast, nurses were more reluctant to accept, adapt or prefer a particular shift pattern when it was mandatorily imposed [ 26 , 37 , 44 ].…”

“…Nurses reflected on their experience and preferences around the length of shifts. Our review report on two main lengths of shift, short shifts (<12 hours), including 4-hours [ 35 ], 8- or 10-hour shifts; and long shifts (≥ 12 hours and more), including one study focussing on 24-hour shifts [ 26 ].…”

“…Nurses reported having to pace themselves to complete their shifts, reflecting the necessity for increased physical, mental and emotional stamina when working long shifts [ 44 , 46 ]. Exhaustion during and after working long shifts was also a common feature reported by nurses [ 26 , 33 , 44 ]. They described that working long shifts led to burnout, reduction in physical and mental health [ 49 ].…”