Nurses play a crucial role in healthcare delivery, often working demanding shift patterns that can impact their physical health, mental wellbeing, and overall quality of life. Shift length, timing, and rotation are all factors that can affect nurse wellbeing, and it's essential to organise these shifts in ways that promote their health and job satisfaction, thus allowing for greater retention for the health system. However, finding the right balance between meeting service demands and respecting nurses' preferences can be challenging. A recent study published in the journal of clinical nursing offers insights into the factors considered by nurses when choosing shifts.
Snapshot survey of nursing staff: demographics, shift patterns and job satisfaction
The anonymous cross-sectional survey was conducted among nursing staff in the United Kingdom and Ireland, targeting registered nurses, healthcare assistants/support workers, and nursing associates. Excluding those in managerial or academic roles, responses were collected between June and October 2021 through targeted NHS trusts in the South of England and open invitations via social media and nursing journals. After filtering out ineligible responses, 873 valid responses were obtained, with the majority from open calls. The respondents, predominantly female and working in NHS hospital inpatient units, had an average age of 42 years. Most cited acute adult care as their primary area of practice, and a significant portion reported childcare responsibilities, with some sharing responsibilities with their spouse/partner. The majority of nurses (66.4%) reported working long shifts (≥11 h), with 26.2% working short shifts (≤9 h) and 7.4% working medium shifts (9.1–10.9 h). About half of the nurses (52%) typically worked night shifts as part of a rotating schedule. Satisfaction with shift patterns varied among nurses: 10.7% were very dissatisfied, 18.3% were moderately dissatisfied, 19.2% were neither satisfied nor dissatisfied, 33.5% were moderately satisfied, and 18.3% were very satisfied. When analysed, half of the nurses (51.8%) reported overall satisfaction with their shift patterns, with the highest satisfaction seen in those working day shifts (including evening/late shifts) and the lowest in those working rotating shifts (60.9% vs. 44.1%, respectively). Concerning choice, 59.1% of nurses stated having little or no say in their shifts, while 68.5% mentioned that their shifts were mostly or completely determined by their employer.
Work-life balance is the key to job satisfaction
A total of 778 valid responses were gathered in response to the question posed to nurses: ‘If you could choose your shift patterns, what would be the most important factor in that choice?’. These responses typically comprised three components: the factors themselves, the reasons behind their importance, and what would facilitate or impede achieving those factors. Thematic analysis yielded 54 distinct codes categorised into eight groups, which were then condensed into three overarching themes: ‘When I want to work’, ‘Impacts to my life outside work’ and ‘Improving my work environment’. Nurses' preferences were influenced by their desire for work-life balance, with factors such as childcare responsibilities and personal health considerations playing a significant role. The concept of work-life balance should not be limited to making time for family roles and responsibilities, but be approached more holistically, making room for more priorities, including rest, social time and leisure. As work-life balance may be defined differently among individuals, ward managers should take actions to understand what factors nurses have in mind when stating this concept.
Best scheduling practices: reduced adverse shift patterns, improved consistency and increased flexibility
Although guidance advises against the use of adverse or non-ergonomic shift patterns, such practices may not be given priority in resource-constrained settings. The ongoing health workforce crisis has led nurses to work longer hours and endure more challenging schedules to maintain minimal ward coverage. This study corroborates these challenges, as nurses highlighted difficulties with non-ergonomic shift patterns. Working under such conditions has negative ramifications, including higher rates of sickness absence, decreased job satisfaction, and lower retention rates. These outcomes are likely due to increased burnout, disrupted recovery, and a poor work-life balance.
Consistency and predictability in work schedules were also highlighted as crucial factors for nurses' overall experiences both at work and in their personal lives. Nurses emphasized the importance of working consistent shift types, start times, and having the same working days and days off each week. Having rosters published in advance helps nurses manage personal commitments, but lack of consistency in planned shifts can still hinder their ability to plan and engage in activities outside of work. Additionally, a recent pan-European survey revealed that high levels of employer-enforced variability in work hours negatively impacted workers' self-rated health, wellbeing, and sleep quality.
Finally, nurses expressed a desire for increased flexibility in their shift patterns, aligning with previous studies where flexibility was defined more by choice and control rather than unpredictable changes. Recent NHS guidance advocates for flexible working policies to empower nurses with more control over their schedules and reduce obstacles to requesting alternative arrangements. These could involve fixed patterns, staggered start/finish times, or compressed/extended work hours, accessible to all staff. Research indicates that healthcare workers with high worktime control tend to choose more variable shift types and lengths without compromising ergonomic recommendations.
In conclusion, nurses' shift pattern preferences are influenced by a range of factors, many of which are linked to their priorities beyond the workplace, including personal health, social time, and caregiving responsibilities. This underscores the importance of designing shift patterns that promote a healthy work-life balance to support nurses' overall wellbeing. The study’s findings challenge assumptions about the superiority of specific shift types and highlight the need for individualised approaches. Nurses emphasised the importance of ergonomic recommendations, consistency, predictability, and flexibility in scheduling practices, which align with existing evidence of their benefits. Implementing these practices, however, requires careful consideration of organisational needs and patient care alongside efforts to address nursing staff retention and shortages. Balancing these factors is crucial for sustaining a supportive work environment for nurses while maintaining high-quality patient care.
Source: Wiley
Image Credit: iStock
