Overtime and alertness of rotating-shift nurses: An observational study using ecological momentary assessment

J Clin Nurs. 2023 Jan;32(1-2):199-207. doi: 10.1111/jocn.16218. Epub 2022 Jan 16.

Abstract

Aims and objectives: This study aimed to determine the effect of overtime on alertness at work among rotating-shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts.

Background: Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work.

Design: A prospective observational study was employed. The study followed STROBE checklist for observational studies.

Methods: Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real-time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed-effect models were employed to investigate the association between overtime and alertness.

Results: A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous-day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous-day overtime hours and consecutive overtime days in all shifts.

Conclusions: The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty.

Relevance to clinical practice: Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

Keywords: actigraphy; alertness; ecological momentary assessment; extended work hours; fatigue; nurses; overtime.

Publication types

  • Observational Study

MeSH terms

  • Ecological Momentary Assessment
  • Humans
  • Nurses*
  • Personnel Staffing and Scheduling
  • Republic of Korea
  • Sleep
  • Work Schedule Tolerance*