Comparing the 12-Hour to the 8-Hour Duty Roster for Nurses - Research Proposal Example

Research Proposal on Comparing the 12-Hour to the 8-Hour Duty Roster for Nurses Name Course: Tutor: Date: Abstract While some researchers argue that the 12-hour shift has adverse effects on nurses’ fatigue levels and their performance, others oppose this argument by stating that there is no notable difference in fatigue levels among nurses who work the 12-hour shift and those who work the 8-hour shift. Due to this controversy in literature, this research seeks to find out if there is indeed any effect on exhaustion levels and hence performance, by comparing the perceptions that nurses who work on both the 12-hour and the 8-hour shift have regarding the subject. The proposed research will compare the perceptions that nurses have regarding effects of the 12-hour shift and the 8-hour shift on their sleep patterns, physical well-being and psychological well-being. Introduction Working on shift is a common feature in any nurse’s career. However, it is quite apparent that the shift system has an impact on the performance and wellbeing of nurses. More so, the shift system has an impact on the sleep patterns of the nurses. As Smith et al (1998, p. 217) note, without adequate rest, the nurses performance and the quality of care they extend to patients is affected negatively. The proposed research therefore seeks to compare the effects that the 12-hour shift and the 8-hour shift has on the nurses’ sleep patterns, physical well-being and psychological well-being. In particular, the research seeks to find out if indeed fatigue occurs when a nurse works over long hours, and whether the same has any effects on the nurse’s job performance. Research Background This research will be based on the effects of sleep duration, quantity and quality in relation to nurses’ performance. Specifically, this research seeks to find out the relationship between extended working hours, sleep deprivation, fatigue and the effect that they have on nurses performance and by extension patient safety. In this research’s context, fatigue will be defined as the exhaustion, lack of energy, or tiredness which affects one’s physical and cognitive functioning (MedicineNet.com). More specifically, the research will relate fatigue to extended work hours and lack of enough sleep. The research will also seek to find out if indeed nurses working either the 12-hour or the 8-hour shift are aware of the effects that the amount of time they work have on their fatigue levels and performance. Literature review There are numerous studies conducted on the effect of prolonged working hours among health care workers. As Rodgers (2008, p.3) notes however, little attention has been paid on establishing the effect of the prolonged work hours on the nurses and their performance at work. Instead, most studies have focused on establishing how satisfied the nurses are with the 12-hour schedule (Landrigan et al., 2004, p. 1838). However, other studies (Rodgers, 2003; Rodgers, 2004, p.202-212; Scott et al., 2006, p. 30-37) have established that though most nurses in Australia have developed a preference for the 12-hour shift, the long working hours often result in less sleeping time, which consequently leads to the nurses experiencing difficulties trying to stay awake while on duty. This in turn means that the risk of nurses making errors while on duty is increased significantly (Rodgers 2008, p. 4). According to Rogers (2008, p.1), people rotating prolonged work hours on a daily basis rarely have enough time to sleep. This is especially so for people who work night shift, and sleep during the day. A study conducted by Czeisler et al. (1980, p. 1264) indicated that people working night shifts only manage between 1 and 4 hours of sleep daily. If such people were to work on rotating 12 hour shifts for a whole week, the research indicates that they would have a sleep debt large enough to impair their vigilance, decision-making, planning, execution and information processing by the end of the week. This observation is also supported by Krueger (1994, pp. 311-326) and Harrison and Horne (2000, p. 236). In most cases however, the person who is sleep-deprived may not recognise the fact that sleep deprivation is affecting his or her performance, and may only do so when the effects are severe, or when the fatigue caused by the same becomes too much to bear (Dinges et al., 1996; Rosekind et al. 1999). One of the ways through which nurses can detect that they are suffering sleep deprivation is by constantly falling asleep when on duty (Rogers, Hwang and Scott, 2004(b), p.A170). In a study conducted by (Lee, 1992, p. 493) 20 percent of all nurses working night shifts every other night for a whole week stated that they had struggled to stay awake at least once every week. When the 12-hour shift was pioneered in Australia Campolo, Pugh and Thompson (1998, pp. 112-115) found out in a research study that the new shift had no identifiable effect on the work performance of the nurses, as the longer shift did not negatively affect the nurses’ well-being. Notably however, this research was conducted on nursing staff working 12-hour night shifts, followed by 12-hour day shift. The nurses took three off days per week. Considering that the Campolo, Pugh and Thompson (1998, pp. 112-115) research was done approximately 12 years ago, there is a possibility that the perceptions that nurses had regarding the 12-hour shift have changed with time. In a research conducted by Baulk et al.(2007, pp.74-77), it emerged that although compressing the work week by taking longer work periods acts as a motivation for most people due to the off days they get afterwards, fatigues especially due to sleep deprivation during those days that a person moves working the long hours is inevitable. Fatigue was especially common among people who had to attend to high and demanding workloads (Baulk et al., 2007, p. 74). Considering that nursing is a demanding career where the nurse needs to constantly attend to the needs of the patients, fatigue could be a likely scenario, which has the possibility of affecting how nurses relate and attend to the patients in need of assistance. Loudon (2008, p. 1-21) investigated the relationship between working a 12-hour shift and non-work conflict. Specifically, the author examined how the prolonged hours at work affect one’s sleep time, and the how people spend social and leisure time away from work. Addressing the sleep issue, Lowden et al. (1996) indicates that though the 12-shift workers may have more off days that those who work for lesser hours, many often use their days off, which would otherwise be used for leisure to sleep in an attempt to recover their sleep debt. Those who have to make time for their families or friends, often do so by reducing their sleeping time (Oginska, Pokorski and Oginska, 1993). Notably however, Akerstedt (1988) observed that the conflict occurs in 12-shift workers who work on night shifts. However, those who work 12-hour day shifts experience less sleep disruption, and therefore less conflict in their internal-timing mechanisms. As a result, Akerstedt (1988) concludes that since 12-hour day shift workers goes home in good time to rest for the night, they are less likely to experience fatigue caused by insufficient sleep and are therefore less likely to register lower performance. In findings that contrast others in highlighted in this literature review section, Dwyer et al. (2007, p. 716) found out that nurses who worked the 12-hour shift regardless of the time they worked reported having better sleep and therefore were able to attend to their duties more attentively. One of the cited reason why respondents in the Dwyer et al (2007, p. 716) research reported better quality sleep was that they were exhausted after the long hours of work, and were therefore able to fall asleep easily and sleep for longer hours. Despite these findings, there is no ignoring the fact that scholars such as Rosa (1995), have noted that there exist concerns about excessive fatigue caused by the prolonged work workers as experienced in the 12-hour shift, which is thought to be a possible source of accidents in the work place, and a source of health deterioration in the long term. According to the Institute of Medicine (2004, p. 226), although nurses still make mistakes even when they are not fatigued, their fallibility increases after working long hours, since such cause fatigue and consequently contributes to a nurse’s likelihood to make errors. Research question According to Polibius (2007, p.2), a well formulated research question makes it easier for the researcher to find good and appropriate answers for the same. This is especially so because the question acts as a defence against irrelevant research and against confusion. An identified question also needs to be relevant to the study that the researcher intends to conduct, and also due to its precision to the study subject. In addition, the researcher has discovered through a review of existing literature that none of the reviewed authors have satisfactorily answered the question. As such, the researcher’s motivation towards finding relevant answers to the same is motivated by the need to contribute to the existing gap in knowledge. Polibius (2007, p. 15) suggests that a good research question should be motivating to the researcher, should spark his her own thoughts , should be based in a theoretical foundation, should be researchable, should be neither too narrow nor too broad, and the information about the same should be available, accessible and collectable. Having understood all these, the researcher identified the question to be answered in this study as: What are the healthcare workers perceptions of the effects of the 12-hour shift on fatigues and performance? Research design This research will rely on qualitative data gathered through a one-on-one interview, whose source will be a structured questionnaire. According to Seller (1998, p.1), qualitative research provides an in-depth exploration technique of information gathering, which allows the researcher to establish the perceptions, feelings or decision-making processes of the targeted research sample. While the use of focus groups is a common method used in qualitative research, this study will specifically use one-on-one interviews on the research respondents since this will allow the researcher to observe the reaction of the respondents during the interviews. In order to ensure that the right questions are used on the respondents, the researcher will formulate a questionnaire, which will be used as a reference point during the interview. Though the researcher will be recording each and every interview, the printed questionnaires will also be a good place to note some of the vital points made by the respondents. Design for the study The questionnaire will contain 20 open-ended questions, which will be straightforward and easy to understand in order to avoid misinterpretation by the respondents. According to Reza (2008, p. 6), open-ended questions gives respondents the opportunity to sat whatever thing they consider significant to then survey. The researcher is therefore able to get more information from the respondents. Before the interview starts however, each respondent will need to sign a consent form indicating that she or he voluntarily agreed to participate in the study. All respondents will also be informed that their responses will be treated with utmost confidence. Setting participants The questionnaires will be issued to 100 nurses working the 12-hour shift, and 100 nurses working the 8-hour shift. In order to establish if there are any differences in perceptions regarding the effect that amount of time spent at work have on nurses’ fatigue levels and performance, the 100 questionnaires in each category will be divided equally to nurses working on night and day shifts. That means the research sample will consist of 50 nurses working the 12-hour day shift, 50 nurses working the 8-hour day shift, 50 nurses working the 12-hour night shift and 50 nurses working the 8-hour night shift. Methodology and procedures Having established through a review of relevant literature that indeed sleep deprivation affects the performance of health workers, this research will use a structured questionnaire to find out the perception that nurses have regarding the effects of the 12-hour shift. Since getting willing participants from one hospital is impossible, the researcher will conduct the one-on-one interviews among willing respondents in 10 hospitals in New South Wales. As such, each hospital will average 20 respondents. The study will be conducted over a period of two weeks, after which the questionnaires will be collected ready for analysis. Analysis of the results will be done by first listening to the recorded interviews and grouping like answers together. The results will then be keyed-in to a computer and analysed using the data analysis software – SPSS. Since Rogers Hwang and Scott (2004, p. A170) has indicated that “sleep deprivation can cause nurses to be more irritable, the researcher will request respondents to be honest and take no offence on any of the questions asked. Since the research will also seek to establish if the long hours increase a nurse’s likelihood to make an error (and whether indeed the respondent had ever made a mistake due to fatigue after long hours of work), the researcher will have to reassure each and every respondent of the confidentiality of the research. Ethical implications According to Chalmers (2001, p. A-7), the National Health and Medical Research Council (NHMRC) stipulates the ethics to be followed by any researcher in the 1992 NHMRC Act as integrity on the researcher’s part, respect for respondents, and beneficence, which the researcher should express by expressing his or her responsibility to reduce the discomfort or risk of harm that the respondents are exposed to as a result of their participation in the research. Chalmers (2001, p. A-6) further expound that surveys are done for purposes of systematically collecting information in order to test a hypothesis; discovering findings or practices that would increase people’s understanding about a specific object; or for administering or analysing data gathered during surveys, opinion polling or interviews. In regard to the above explanations, the researcher of the proposed research hopes that all concerned parties will get a better understanding of the exact nature of the 12-hour shift and how it is perceived by those who work in such shifts, and those who work for lesser hours. Further, the researcher will have to conduct him or herself in dignity and also ensure that the respondents are not exposed to any harm, since that are the ethical demands placed on every researcher by the NHMRC. References Akerstedt, T 1988, ‘Sleepiness as a consequence of shift work,’ Sleep, vol.11, no.1,pp. 17-34. Baldwin Jr, D.C., Daugherty S.R 2004, ‘Sleep deprivation and fatigue in residency training: results of a national survey of first-and second-year residents,’ Sleep, vol.27, no. 2, pp. 217-23. Baulk, S., Kandelaars, K., Lamond, N., et al. 2007, ‘Does Variation in workload affect fatigue in a regular 12-hour shift system?’ Sleep and biological rhythms, vol.5, pp. 74-77. 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Harrison Y. & Horne J A 2000, ‘The impact of sleep deprivation on decision making: a review,’ Journal of Exp Psychology Application, vol. 6, no. 3, pp. 236-49. Institute of Medicine 2005, Keeping patients safe: transforming the environment of nurses, National Academies Press, New York. Krueger G 1994, Fatigue, performance, and medical error. In: M. S. Bogner, eds. Human error in medicine. Lawrence Erlbaum Associates, Hinsdale, NJ, pp. 311-326. Landrigan CP, Rothschild JM, Cronin JW, et al. 2004, ‘Effect of reducing interns' work hours on serious medical errors in intensive care units,’ New England Journal of Medicine, vol.351, pp. 1838-48. Lee K. A 1992, ‘Self-reported sleep disturbances in employed women,’ Sleep, vol. 15, no. 6, pp. 493-98. 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