The impact of nurse working hours on patient safety culture: a cross-national survey including Japan, the United States and Chinese Taiwan using the Hospital Survey on Patient Safety Culture

Abstract

BackgroundA positive patient safety culture (PSC) is one of the most critical components to improve healthcare quality and safety. The Hospital Survey on Patient Safety Culture (HSOPS), developed by the US Agency for Healthcare Research and Quality, has been used to assess PSC in 31 countries. However, little is known about the impact of nurse working hours on PSC. We hypothesized that long nurse working hours would deteriorate PSC, and that the deterioration patterns would vary between countries. Moreover, the common trends observed in Japan, the US and Chinese Taiwan may be useful to improve PSC in other countries. The purpose of this study was to clarify the impact of long nurse working hours on PSC in Japan, the US, and Chinese Taiwan using HSOPS.MethodsThe HSOPS questionnaire measures 12 sub-dimensions of PSC, with higher scores indicating a more positive PSC. Odds ratios (ORs) were calculated using a generalized linear mixed model to evaluate the impact of working hours on PSC outcome measures (patient safety grade and number of events reported). Tukey’s test and Cohen’s d values were used to verify the relationships between nurse working hours and the 12 sub-dimensions of PSC.ResultsNurses working ≥60 h/week in Japan and the US had a significantly lower OR for patient safety grade than those working <40 h/week. In the three countries, nurses working ≥40 h/week had a significantly higher OR for the number of events reported. The mean score on ‘staffing’ was significantly lower in the ≥60-h group than in the <40-h group in all the three countries. The mean score for ‘teamwork within units’ was significantly lower in the ≥60-h group than in the <40-h group in Japan and Chinese Taiwan.ConclusionsPatient safety grade deteriorated and the number of events reported increased with long working hours. Among the 12 sub-dimensions of PSC, long working hours had an impact on ‘staffing’ and ‘teamwork within units’ in Japan, the US and Chinese Taiwan.

Nursing perceptions of patient safety climate in the Gaza Strip, Palestine

“…We found nurses who worked 35 h weekly were more positive towards safety culture than those worked >35 h. A study conducted by Wu et al. () found that longer working hours were associated with low patient safety grade, and Rogers et al. () reported a 3.29 times increased chance of making an error among nurses who worked for a longer duration (>12.5 h shift in 24‐h period).…”

“…Therefore, at least one nurse has to work with a volunteer nurse on evening and night shift duty together (17 consecutive hours). We found nurses who worked 35 h weekly were more positive towards safety culture than those worked >35 h. A study conducted by Wu et al (2013) found that longer working hours were associated with low patient safety grade, and Rogers et al (2004) reported a 3.29 times increased chance of making an error among nurses who worked for a longer duration (>12.5 h shift in 24-h period). In contrast, an increasing number of reporting errors could be a sign of positive patient safety culture when staff work in an organization characterized by a blame-free environment and feel free to speak up and report errors.…”

Patient Safety Culture and Factors that Impact That Culture in Tehran Hospitals in 2013

“…Hospital management must have a central role in developing safety culture at the system level within hospitals to ensure that nurses caring for patients do so safely (34). Previous studies have revealed that patient safety scores have deteriorated and that the number of reported events increases with longer working hours (35,36). Therefore, managers should decrease long working hours.…”

Nurse staffing models in medical‐surgical units of acute care settings: A cross‐sectional study

“…Previous research has shown that working extended hours can lead to missed nursing care and medical errors, which in turn negatively impact patient safety and the quality of patient care (Ball, Murrells, Rafferty, Morrow, & Griffiths, 2014;Reed, 2013;Rogers, Hwang, Scott, Aiken, & Dinges, 2004;Wu et al, 2013). Working many hours per week might subject nurses to fatigue and render them unable to perform all necessary nursing care activities.…”

“…Working many hours per week might subject nurses to fatigue and render them unable to perform all necessary nursing care activities. Previous research has shown that working extended hours can lead to missed nursing care and medical errors, which in turn negatively impact patient safety and the quality of patient care (Ball, Murrells, Rafferty, Morrow, & Griffiths, 2014;Reed, 2013;Rogers, Hwang, Scott, Aiken, & Dinges, 2004;Wu et al, 2013). For instance, a study conducted in Hong Kong on the effect of workload on the survival of critical patients found that a patient was less likely to survive to hospital discharge if they were cared for by a nurse working greater than 52 hours per week.…”