The impact of moving to a 12h shift pattern on employee wellbeing: A qualitative study in an acute mental health setting.

BACKGROUND: Against a backdrop of increasing demand for mental health services, and difficulties in recruitment and retention of mental health staff, employers may consider implementation of 12 h shifts to reduce wage costs. Mixed evidence regarding the impact of 12 h shifts may arise because research is conducted in divergent contexts. Much existing research is cross sectional in design and evaluates impact during the honeymoon phase of implementation. Previous research has not examined the impact of 12 h shifts in mental health service settings. OBJECTIVE: To evaluate how employees in acute mental health settings adapt and respond to a new 12 h shift system from a wellbeing perspective. DESIGN: A qualitative approach was adopted to enable analysis of subjective employee experiences of changes to organisation contextual features arising from the shift pattern change, and to explore how this shapes wellbeing. SETTING(S): Six acute mental health wards in the same geographical area of a large mental health care provider within the National Health Service in England. PARTICIPANTS: 70 participants including modern matrons, ward managers, clinical leads, staff nurses and healthcare assistants. METHODS: Semi-structured interviews with 35 participants at 6 months post-implementation of a new 12 h shift pattern, with a further 35 interviewed at 12 months post-implementation. RESULTS: Thematic analysis identified unintended consequences of 12 h shifts as these patterns changed roles and the delivery of care, diminishing perceptions of quality of patient care, opportunities for social support, with reports of pacing work to preserve emotional and physical stamina. These features were moderated by older age, commitment to the public healthcare sector, and fit to individual circumstances in the non-work domain leading to divergent work-life balance outcomes. CONCLUSIONS: Findings indicate potential exists for differential wellbeing outcomes of a 12 h shift pattern and negative effects are exacerbated in a stressful and dynamic acute mental health ward context. In a tight labour market with an ageing workforce, employee flexibility and choice are key to retention and wellbeing. Compulsory 12 h shift patterns should be avoided in this setting.

The impact of extending nurse working hours on staff sickness absence: Evidence from a large mental health hospital in England.

BACKGROUND: A pressing international concern is the issue of mental health workforce capacity, which is also of concern in England where staff attrition rates are significantly higher than in physical health services. Increasing demand for mental health services has led to severe financial pressures resulting in staff shortages, increased workloads, and work-related stress, with health care providers testing new models of care to reduce cost. Previous evidence suggests shift work can negatively affect health and wellbeing (increased accidents, fatigue, absenteeism) but can be perceived as beneficial by both employers and employees (fewer handovers, less overtime, cost savings). OBJECTIVE: This study reports an evaluation of the impact of extending the shifts of nurses and health care assistants from 8 to 12 hours. Using data before and after the policy change, the effect of extended working hours on short term sickness (< 7 days) on staff is examined. SETTING: The setting is six inpatient wards within a large mental health hospital in England where the shift extension took place between June and October 2017. The Data come from wards administrative records and the analysis is performed using weekly data (N=463). METHODS: Causal inference methods (Interrupted Time Series and Difference-in-Difference) are used to compare staff sickness rates before and after the implementation, where the outcome variable is defined as the ratio of total sickness hours over the total scheduled working hours (full time equivalents) in a given week. Patient casemix, staff demographics, ward and time variables are included as controls. RESULTS: Estimation results establish that the extended shifts are associated with an increased percentage of sickness hours per week of between 0.73% and 0.98%, the equivalent of a complete shift per week per ward. CONCLUSION: This is the first study to use causal inference to measure the impact of longer shifts on sickness absences for mental health workforce. The analysis is relevant to other providers which may increasingly look towards these shift patterns as a means of cost saving.