Longer Shifts and Overtime May Lead To Lower Quality and Safety of Nursing Care

Dr. Peter Griffiths PhD, RN Centre for Innovation and Leadership in Health Sciences University of Southampton, Southampton, UK MedicalResearch.com Interview with:
Dr. Peter Griffiths PhD, RN
Centre for Innovation and Leadership in Health Sciences
University of Southampton, Southampton, UK

Medical Research: What are the main findings of the study?

Dr. Griffiths: This study found that hospital nurses who are working on a 2 shift system, where care is provided by nurses working long shifts of 12-13 hours, report lower quality and safety of care than nurses who work a traditional three shift system where nurses typically work shifts of 8 hours. We also found that nurses who were working overtime reported lower quality and safety of care. We found that these shifts are common in some European countries – most notably Poland, Ireland and England.

Medical Research: What was most surprising about the results?

Dr. Griffiths: One of the most surprising results was that long shifts and overtime were also associated with nurses reporting that they were more likely to have necessary nursing care care undone.  Also, while it seems obvious after the fact that longer working hours and overtime give poorer quality of care, arguments have been made that the 2 shift system can improve quality and safety and one would expect that overtime working would, if anything, be used to finish necessary care. The results weren’t simply a product of staffing differences as we controlled for that in our analyses.

Medical Research: What should clinicians and patients take away from your report?

Dr. Griffiths: Long shifts are probably a fact of life where they have been implemented. It seems that nurses might prefer them because the compressed 4-day working week means that they have more days off. Working three shifts of 12-13 hours means that a nurse can have 4 whole days off. However, hospitals that have not yet implemented them should consider that any anticipated benefits and savings might not be delivered. Hospitals that use them should recognise the risk and pay close attention to ensuring that other aspects of shift work – rest periods between shifts, cumulative hours worked and other factors – are optimised.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Griffiths: This research only looked at nurse reported quality. Research from the United States also suggests negative impacts on patient experience and possibly even hospital death rates. However, the context of care in Europe is quite different and we certainly need more research to see if these other outcomes are adversely affected and whether it is a result of long shifts and overtime or because these working patterns are associated with hospitals that are failing in other ways.


Nurses’ Shift Length and Overtime Working in 12 European Countries: The Association With Perceived Quality of Care and Patient Safety
Griffiths P1, Dall’Ora C, Simon M, Ball J, Lindqvist R, Rafferty AM, Schoonhoven L, Tishelman C, Aiken LH; For the RN4CAST Consortium.

 Med Care. 2014 Sep 15. [Epub ahead of print]

Christos V. Rizos, Michael S. Kostapanos, C. Rizos, Alexandros D. Tselepis, and Moses S. Elisaf

J CARDIOVASC PHARMACOL THER 1074248414549419, first published on September 18, 2014 doi:10.1177/1074248414549419


Last Updated on September 22, 2014 by Marie Benz MD FAAD