Family-Friendly Policy and Optimum Shifts for Nurses - Essay Example

Introduction The use of shifts is a popular method of providing 24 hour critical services used in many industries, including nursing. In a recent Labour Force survey, 3.7 million employees across the UK were determined to be shift workers (i.e. almost 14% of the entire workforce) (Royal College of Physicians, 2006). There have been numerous studies investigating the negative health risks related to shift work and their impact on nurses. The UK, to date, has the longest working hours in Europe, and is note as the only nation to not include maximum hours allowable to work, in their policy. It has been suggested that the UK economy is dependant on workers who work long hours, and if the EU chooses to remove the "opt-out" clause the UK will bode poorly (Cooper, 2003; Parker, 2006). At present, the UK Government wishes to be informed of the multitude of views of stakeholders affected by the consequences of long working shifts. Input is expected to be used to collaboratively construct better legislation and policies that focus on the health and well being of shift workers. Inclusive deliberation over policy aligns UK best practices with those of the European Union (EU), which is currently renewing the 1993 Working Time Directive (93/104/EC) (Department of Trade and Industry [DTI], 2004). This paper aims to review shift working patterns and family friendly policies for nurses in the UK. Firstly, family friendly policies with regard to labour in the UK will be presented. Secondly, shift pattern differences between 8 and 12 hours shall be discussed with regard to family life. Thirdly, the effects of shift patterns on older nurses and their perceptions of shift work affects on family life will be delineated. Next, recommendations for best practices within the UK shall be provided. Finally, a conclusion shall synthesise the main points of the paper. Family Policy It has been stated by the UK Government that it will implement changes to the European Working Time Directive (what is known as the Horizontally Amending Directive or HAD) so as to be inclusive of workers who were not included originally (Royal College of Physicians, 2006). The concern with long working hours without breaks or rest periods had serious consequences for the health, safety and social functioning of these workers. It is reported that a large number of workers in the UK work in excess of a 48 hours (Royal College of Physicians, 2006). Family friendly policies focus on the psycho-social aspects of work, and highlight the importance of values and interaction between children and caregivers, not only to these parties, but also to the wider community, and subsequently social environments that overlap with work (Nickson, Warhurst, Lockyer & Dutton, 2004). Children gain from family friendly policies by way of; socialisation; well being; education; reduced risk of anti-social behaviour; and alternative models for the female role (i.e., as equal participants). Caregivers have the opportunity for increased identity integration and satisfaction with life in general by participating in family-oriented activities. An organisation such as a hospital or other health care delivery environment will benefit from enhanced work performance, better communication and interpersonal skills of staff, and increased high quality care for patients, resulting in both patient and employee (Equal Opportunities Commission [EOC], 2006). From a social point of view, enhanced family functioning, intergenerational and inter gender relationships, combined with a positive view toward childbearing, can boost and maintain a sustainable economy. A good example of inclusive family policies is reflected in the recognition of fatherhood as a valuable psycho-social experience. Since the 1960s radical changes within family structure have taken place (e.g., nuclear families may now be extended to include relatives, step-, bi-racial; adopted; same-sex or single-parent). As such, prioritise have changed, and the contemporary dad wants to spend as much time as with his child or children as possible. At present, there are an estimated 5.4 million dads across the UK, meaning that over a third of male workers have dependant child/children (EOC, 2006). Research supports "investment" in childhood and childcare, introducing policies as early as 1997, with free part-time care for 3 and 4 year olds, and over 500, 000 new childcare places, in combination with tax credits to give increased financial support (EOC, 2006; Nickson et al., 2004). Some see the childcare gap as closing, although many parents still report difficulties in obtaining high-quality care that is affordable to their needs. The UK government has a 10 Year Childcare Strategy that aims to develop Children's Centres within every community. Flexible free nursery access for 3 and 4 year olds with additional help with costs seeks to provide every parent with after-school childcare options through the Extended Schools as well as investment in the ongoing quality of the workforce within childcare (EOC, 2006). April of 2003 saw the introduction of paid paternity leave. Dads are now entitled to two weeks paid leave (EOC, 2006). Almost 80% of dads take paternity leave, sometimes combined with other leave entitlements. Each parent has the right to 13 weeks unpaid paternal leave during the first five years of a child's life, 18 weeks for parents of children with a disability. Parents also have the right to time off for emergency issues with those who are dependant on them. However, at present there is no statutory right to be paid. Also, parents of children under the age of six had the right to flexible working arrangements. Employers are obliged to consider each request in light of significant business consequences. The European Working Time Directive sets a 48-hour maximum working week, but there is an opt-out for British employees. Most employees who work long hours are legally required to consent to do so by signing an opt-out. However, in practice few workers are aware of this (Nickson et al., 2004). The 2005 Work and Families Bill aims to extend Maternity Leave to nine months as of April 2007; one year's paid leave for dads; and dad's having the right to 26 weeks Additional Paternity Leaver (APL), which can be portioned if the mother returns to work (EOC, 2006). The Sure Start Local Programmes are an example of increasing activities to engage dads at the public service level. A new Equality Act, 2006 aims to be a medium for change, deeming public services responsible to reflect on issues such as gender impact and service practices, from April 2007 (EOC, 2006). The way in which gender and familial roles are prioritised in the 21st century alongside working roles is a critical debate. Future increasing pressures see the need to adapt working policies and practices. Shift Patterns Many of the studies that have investigated the consequences of shift work have focused on the type of shift pattern (i.e., 8 hour or 12 hour shift), and whether a rotating shift or a series of the same shifts is a healthier alternative (Royal College of Physicians, 2006). Shift work is recognised as potentially harmful both psycho-socially and physically for nursing staff and their patients (Crofts, 1999; Kurumatani, 1994; Richardson, Dabner & Curtis, 2003). With a 12 our shift, the nurse is not only active for those 12 hours, they tend also to extend their awake time either side of the shift. However, the effects of longer term exposure to extended work days have been relatively ignored with regard to empirical research. Evening shifts especially, can cause a mismatch between circadian rhythms and environmental synchronizers, resulting in the "sleep-wake" cycle to be disrupted (Reid, Robinson, & Todd, 1994; Wise, 2004a). Otherwise known as "shift lag" syndrome, nurses may feel fatigued, sleepy, experience insomnia or disorientation, digestive problems, feel irritable or demonstrate poor mental agility, and have an overall reduce care and communication performance (Smith, Folkard, Tucker & MacDonald, 1998; Wise, 2004b). However, age, gender, and personality characteristics can buffer or exacerbate the affects of shift work. Research that has compared the relative effects of 8 and 12 hour shifts and found that at the organisational level, factors such as; the mode of shift system implementation; attitudes towards shift rotas; sickness absence and turnover; overtime; and moonlighting are important influences on nursing performance (Smith et al., 1998; Crofts, 1999; Wise 2004a). However, the bulk of the evidence suggests few differences between eight and 12 hour shifts in the way they affect nurses. It has also been suggested that there may be benefits to 12 hour shifts in that they appear to result in lower stress levels, better physical and psychological wellbeing, improved durations and quality of off duty sleep as well as improvements in family relations (White, 2002). Although, the limitations of the 12 hour shift are mainly fatigue and safety concerns, as well as disruptions to family and social life. This is unexpected as one of the supposed benefits of 12 hour systems is an increase in time available for social, family, and leisure pursuits. Regardless, numerous studies support this finding (Smith et al., 1998; Crofts, 1999; Wise 2004a). A nurse's choice of the longer shift appears to be related to lifestyle choices. Repeatedly, studies support the finding that nurses who find 12 hour shifts the most difficult are those with school-aged children. Having to leave a shift early to tend to a family emergency often brings with it cultural pressure to not take time off work, and subsequently guilt may arise as the nurse must also consider minimizing costs to her workplace, and the possibility of existing staff shortages (Wise, 2004b). One study found that parents who tended to nurse part-time, in general worked fewer nights than non-parents, suggesting that choices are made to actively avoid "shift-parenting" (Wise, 2004a). As a consequence non-parents must compensate and work the "unsocial" hours. This is a critical finding with regard to workplace interpersonal relationships and the need for a work-life balance for nursing practice. Shift Work Effects and Age It appears that there may be a greater distribution of ages across "unsocial" working hours, particularly for nurses (Wise, 2004a,and b). For example, older nurses were more likely to work in theatres where there were shorter shifts and fewer nights and weekends. In one study, older nurses were much more unlikely to accept 12 hour shifts (i.e., 51% of older nurses in 24/7 in-patient areas worked 12 hour shifts compared to 78% of those under 50) (Wise, 2004a). However, not all managers allow nurses to make the choice not to work longer hours, particularly as empirical evidence supports a variety of shift patterns. Participants in Wise's study were asked: "How has doing the 12 hour shifts affected your ability to balance your work with your home life" A higher proportion of older nurses responded "more difficult" but this difference was not statistically significant (26% compared to 20% of under 50s) (Wise, 2004a). In fact it was the 40-49 age group who were the most likely to find that the 12 hours shifts had made work-life balance more difficult (32%) compared to 20% of 30-39 year olds and 10% of under 30s. Additionally, it has been found that older nurses are no more or less satisfied with their working hours than nurses under the age of 50 (Wise, 2004b). They have also been found to be no more likely to want to change their working hours or to worry at the impact that working hours have on their familial and social relationships (Cooper, 2003; Wise 2004b). Older nurses have also been reported as stating that when their own children were young they worked nights and weekends as this was the only available "flexible" work practice that existed at the time. Their choice at the time to work unsocial hours was supported by their partners who were able to care for the children, and "shift-parenting" practices became the norm (Wise, 2004a). However, this presents a critical concern for the NHS of the UK, as older nurses are getting older, and as they move on with their lives (i.e., retirement, volunteerism, death) the remaining nurses will need to take their place at the helm of health care. And across the globe, including the UK, there is a dire lack of nursing staff available and retention of existing nurses is threatened (Cooper, 2003). It is important for nurse leaders to create an environment that will keep older nurses and night-shift workers working. Recommendations A satisfactory shift pattern is highly individual and needs to respond to personal, psycho-social and health/medical concerns. Some considerations when planning a shift include (Royal College of Physicians, 2006); Deciding to make shifts rotate forwards, i.e. from morning to afternoon to night Avoiding early morning start times such as 0500 or 0600 Providing a rest period of at least 24 hours after each set of nights Providing regular time off periods at socially advantageous times, e.g. weekends Keeping schedules as simple and predictable as possible Giving maximum notice of shifts and allow flexibility to swap if at all possible The Government's plans to introduce Additional Paternity Leave should be implemented as rapidly as possible so that parents can choose which of them takes leave to look after their baby (EOC, 2006). There is also the need for further investigation in to higher paternity pay - up to 200 per week to be introduced so that lower-paid dads in nursing can take time off. The Government needs to maintain its focus on provision of quality childcare that is affordable and accessible, providing real choices to nursing parents, and providing children with the best start in life. Also, longitudinal comparative studies would be important investigations into the chronic impact of compressed working weeks for nurses. Conclusion In summary, it is evident that shift work is a crucial topic for debate within the UK health care system at present. The reality of an aging workforce in nursing, dramatic reductions in nursing numbers globally, and an increasing international focus on social welfare and protection, make it clear that discussion of shift patterns is essential for retention of nurses. Family friendly policies implemented in the UK over the past decade remain limited in their ability to provide accessible, high-quality childcare to shift working nursing parents, especially for dads who work part-time. Although, many changes to paternity and maternity payments, and the focus on the Sure Smart programme of childcare provision, seek to amend past weaknesses in the system to support nursing parents. Many research papers have debated the pros and cons of 8 hour shift patterns as compared to 12 hour patterns, but the results continually suggest there is little variance in; nurse satisfaction at work; nurses perceptions of loss of family and social time; and impact of the negative health consequences of working wither shift length. However, it does appear that older nurses tend to work more of the "unsocial" hours, and that non-parents may be compensating for the lack of nursing parents who accept shift work. It is recommended that the Government fully implement its new Paternity Allowance, seek to increase high-quality, affordable and accessible childcare. It is anticipated that this paper will contribute to the better health and psychological functioning of nurses and their families. References Cooper, E. E. (2003) Pieces of the shortage puzzle: aging and shift work. Nursing Economics, Vol 21(2): 75-79. Crofts, L. (1999) Challenging shiftwork: A review of common rostering practices in UK Hospitals. Nursing Progress, Issue 5. http://www.rlhleagueofnurses.org.uk/Education/Nursing_Progress/Issue5/Challenge_shiftwork/challenge_shiftwork.html (Accessed November 6, 2006). Equal Opportunities Commission [EOC] (2006) Twenty-first century dad. http://www.eoc.org.uk/PDF/21st%20_century_dad.pdf(Accessed November 4, 2006). Kurumatani, N., Koda, S., Nakagiri S, Hisashige, A., Sakai, K., Saito, Y., Aoyama, H., Dejima, M. & Moriyama, T. (1994) The effects of frequently rotating shiftwork on sleep and the family life of hospital nurses. Ergonomics, Vol 37(6): 995-1007. Nickson, D., Warhurst, C., Lockyer, C. & Dutton, E. (2004) Flexible friends Lone parents and retail employment. Employee Relations, Vol 26(3): 255 - 273. Parker, H. (2006) The shift: A review of NHS experience. NHS Institute for Innovation and Improvement. http://www.hsmc.bham.ac.uk/news/MakingtheShift6881.pdf (Accessed November 4, 2006). Richardson, A., Dabner, N. & Curtis, S. (2003) Literature Review of twelve-hour shift on ITU: A nursing evaluation. Nursing in Critical Care, Vol 8: 103-107. Reid, N. Robinson, G. & Todd, C. (1994) The 12-hour shift: the views of nurse educators and students. Journal of Advanced Nursing, Vol 19(5): 938-46. Smith, L., Folkard, S., Tucker, P. & MacDonald, I. (1998) Work shift duration. Occupational Environmental Medicine, Vol 55: 217-229. http://oem.bmjjournals.com/cgi/reprint/55/4/217.pdf (Accessed November 5, 2006). White, J. (2002) Working long hours. Sheffield, S3 7HQ, Health and Safety Laboratory. http://www.hse.gov.uk/RESEARCH/hsl_pdf/2003/hsl03-02.pdf (Accessed November 4, 2006). Wise, S. (2004) Older nurses and working hours. Napier University. http://www.napier.ac.uk/depts/eri/Downloads/OlderNursesWH.pdf (Accessed November 6, 2006). Wise, S. (2004) Other people's families: Tensions at work in the NHS. Napier University. http://72.14.253.104/searchq=cache:uHObroCLoJkJ:www.napier.ac.uk/depts/eri/Downloads/EdinburghConf04.pdf+(older+nurses)+%2Bshift+work%2Bfamily&hl=en&gl=au&ct=clnk&cd=1&client=firefox-a (Accessed November 6, 2006). Read More