A New Approach to Scheduling in Nursing Presentation

The Change Model Description

The Johns Hopkins Nursing EBP Model:

• a problem-solving model;
• appropriate to promote the nurse’s decision-making;
• relevant to the nursing practice (Melnyk & Fineout-Overholt, 2011, p. 271).

Includes several steps:

• Practice question:
  • Step 1 and 2: Recruit Interprofessional Team and Develop the EBP Question.
  • Step 3: Define the Scope of the EBP and determine stakeholders.
  • Step 4 and 5: Determine Responsibility of Team Members and Organize team meetings.
• Evidence:
  • Step 6 and 7: Conduct Internal/External Search for Evidence and Appraisal.
  • Step 8 and 9: Summarize and Synthesize the Evidence.
  • Step 10: Recommendations.
• Translation:
  • Step 11 and 12: Fit, Feasibility and Appropriateness of Recommendations and Action Plan.
  • Step 13 and 14: Secure Support and Resources and Implement Action Plan.
  • Step 15 and 16: Evaluation and Reporting Outcomes.
  • Step 17 and 18: Identify Next Steps and Disseminate Findings (Dearholt & Dang, 2012).

PICO Question

In nurses working in clinics and hospitals, how does a choice to work an 8-hour shift five days a week compared to working a 12-hour shift three days a week influence the decrease in the nurse’s level of fatigue?

• P– (Patient, population, or problem): Nurses working in clinics and hospitals.
• I– (Intervention): The work in an 8-hour shift five days a week.
• C– (Comparison with other treatment/current practice): The work in a 12-hour shift three days a week.
• O– (Desired outcome): The decreased level of the nurse’s fatigue.

Scope of the Problem

• Nurses working for 12 hours during 3 consecutive days cannot overcome fatigue (Chen, Davis, Daraiseh, Pan, & Davis, 2014);
• Medical errors occur more often (Clark & Walker, 2011).
• The turnover in medical organizations increases (Griffiths et al., 2014).
• The practice of 12-hour shifts is common for the majority of facilities in the USA (Lin, Kang, Chiang, & Chen, 2015);
• Patients’ dissatisfaction increases (Stimpfel, Sloane, & Aiken, 2012, p. 2501).

Team and Stakeholders

• The team requires the participation of:
  • the charge nurse (develop a new schedule);
  • the financial manager (estimate the costs of the project and budgetary limits);
  • 3 registered nurses (skilled in interviewing, conducting surveys, and analyzing data).
• Stakeholders include:
  • medical workers;
  • patients;
  • hospital administrators.

Evidence to Implement Change

• Fatigue:
  • Nurses working an 8-hour shift five days per week are less likely to experience fatigue (Sloan, 2006; Trinkoff et al., 2011).
  • The level of fatigue in nurses working 12-hour shifts increases with each following shift (Stimpfel et al., 2012).
  • Nurses cannot overcome the exhaustion fully during the days off (Chen et al., 2014).
• Patient Satisfaction:
  • The adoption of the 12-hour shift leads to the patients’ dissatisfaction (Lin et al., 2015; Stimpfel et al., 2012).
  • Patient outcomes decrease significantly when nurses choose 12-hour shifts and the overwork (Chen et al., 2014; Stimpfel et al., 2012).
• Quality of Work:
  • The decreased attention caused by exhaustion leads to affecting the quality of work negatively (Clark & Walker, 2011).
  • Nurses working short shifts demonstrate higher performance results in contrast to nurses working long shifts (Chen et al., 2014; Stimpfel et al., 2012).
  • Longer working hours contribute to the increased mortality in medical organizations due to nurses’ fatigue (Trinkoff et al., 2011).

Action Plan

1. Secure the support of hospital administrators informing them about the 8-hour shift benefits.
2. Develop a new 8-hour shift schedule for nurses.
3. Inform nurses about the new policy.
4. Implement the new schedule in one unit of the hospital.
5. Conduct the follow-up assessment surveying nurses and patients in two units.
6. Compare the efficiency of 8-hour and 12-hour shifts and scheduling methods.
7. Synthesize and present results in a written report.
8. Distribute the results to hospital administrators.

The Nurse’s Role

• The nurse’s role is to:
  • contact stakeholders;
  • coordinate the work of the project team;
  • coordinate the development of the new schedule;
  • inform the staff on the policy implementation;
  • monitor the action plan activities;
  • adjust the activities to the plan;
  • address the unexpected challenges;
  • coordinate the program implementation process;
  • assess the program results;
  • analyze and compare the results;
  • present the written report on the completed project.

Procedures

1. Contact the hospital administrators and develop the cooperation.
2. Organize the team for working on the project.
3. Conduct scheduled meetings.
4. Develop the project plan timeline.
5. Analyze strategies to developing nursing schedules in terms of influencing fatigue, quality of work, and patient outcomes.
6. Choose the appropriate strategy to integrate the schedule with an 8-hour shift.
7. Develop a new 8-hour shift schedule for nurses.
8. Approve the project plan and the new schedule.
9. Inform nurses about the new policy.
10. Implement the new schedule in one unit of the hospital.
11. Conduct the survey for nurses working 12-hour and 8-hour shifts.
12. Conduct the survey for patients in two units.
13. Assess the results regarding fatigue, quality of work, and patient outcomes.
14. Compare the efficiency of 8-hour and 12-hour shifts and scheduling methods.
15. Synthesize and present results in a written report.
16. Inform hospital administrators and nurses on results.

Forms to Be Used

• Maslach Burnout Inventory assess the level of nurses’ fatigue and burnout (Sloan, 2006, p. 21).
• The questionnaire created by the researcher is helpful to determine if patients are satisfied with medical services.

Resources

• The nurse investigator;
• The team;
• Internet resources;
• Assessment tools;
• Analysis tools.

Summary

• Problem:
  • The increased level of fatigue in nurses working 12-hour shifts.
  • The decreased quality of care.
  • The negative effects on the patient satisfaction.
• Purpose:
  • To propose the effective scheduling scheme based on the 8-hour shifts for nurses.
• Goal:
  • By the end of the project, to demonstrate that the level of fatigue typical for nurses working 12-hour shifts is higher than the level of fatigue typical for nurses working 8-hour shifts leading to the increased quality of work and patient satisfaction.

References

Chen, J., Davis, K., Daraiseh, N., Pan, W., & Davis, L. (2014). Fatigue and recovery in 12-hour dayshift hospital nurses. Journal of Nursing Management,22(5), 593-603.

Clark, A. R., & Walker, H. (2011). Nurse rescheduling with shift preferences and minimal disruption. Journal of Applied Operational Research, 3(3), 148-162.

Dearholt, S., & Dang, D. (2012). Johns Hopkins Nursing Evidence-based Practice: Models and Guidelines. New York, NY: Sigma Theta Tau.

Griffiths, P., Dall’Ora, C., Simon, M., Ball, J., Lindqvist, R., Rafferty, A. M., … & Aiken, L. H. (2014). Nurses’ shift length and overtime working in 12 European countries: The association with perceived quality of care and patient safety. Medical Care, 52(11), 975-981.

Lin, C. C., Kang, J. R., Chiang, D. J., & Chen, C. L. (2015). Nurse scheduling with joint normalized shift and day-off preference satisfaction using a genetic algorithm with immigrant scheme. International Journal of Distributed Sensor Networks, 501(1), 595-419.

Melnyk, B., & Fineout-Overholt, E. (2011). John Hopkins Nursing Evidence-Based Practice Process. New York, NY: Lippincott Williams & Wilkins.

Sloan, G. (2006). Clinical Supervision in Mental Health Nursing. New York, NY: John Wiley & Sons.

Stimpfel, A., Sloane, D., & Aiken, L. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. HealthAffairs, 31(11), 2501-2509.

Trinkoff, A., Johantgen, M., Storr, C., Gurses, A., Liang, Y., & Han, K. (2011). Nurses’ work schedule characteristics, nurse staffing, and patient mortality. Nursing Research, 60(1), 1-8.