Research Critique of the Article “The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Dissatisfaction” by Amy Witkoski Stimpfel, Douglas M. Sloane and Linda H. Aiken
It is a commonly known fact that the psychological well-being of a person affects his or her work productivity. Nurses are no exception though people often forget about it. Society expects nurses to be responsible, hardworking and altruistic. Not surprisingly, extended work shifts are a common phenomenon in the medical environment. Furthermore, when long shifts evolve into overtime, nurses are at risk of burnout, which is likely to compromise patient care. Thus, meeting social demands can often affect work productivity, job satisfaction, and patient satisfaction negatively. While the cases of nurses’ burnout are widely represented in the existing research, its consequences for patient care lack public attention. Therefore, the study by Witkoski Stimpfel, Sloane and Aiken is worth one’s attention.
In the given research, the authors raise the issue of extended nurses’ work shifts and their consequences. There are four research questions in this study. In particular, the first research question seeks to answer what kind of relationship exists between hospital nurses’ shift length and nurse burnout. The second question determines the type of relationship between hospital nurses’ shift length and job dissatisfaction. The third question is about the relationship between hospital nurses’ shift and intention to leave the job. After that, the authors reveal the relationship between burnout, job dissatisfaction, and patient satisfaction. Moreover, researchers try to unveil whether nurses’ shift length is associated with patient satisfaction.
The hypothesis of the study is that the unregulated working shift of nurses negatively affects patient satisfaction. This supposition is grounded on the previous knowledge that nurses who experience burnout and job dissatisfaction are unable to perform their work duties properly. As extended shifts affect nurses’ well-being and may lead to job dissatisfaction, they can contribute to patient dissatisfaction, as well. According to this logic, when the proportion of hospital nurses’ working shifts of more than thirteen hours increases, patients ’ dissatisfaction with care will increase too. The results of the study confirmed the hypothesis. The authors of the investigation discovered that nurses’ shift length was associated with patient satisfaction, based on the indices of the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The latter is a national, standardized data set containing information about patients’ evaluation of nursing care in acute care hospitals.
The research showed distinct regularities between the length of the shift and other variables. Thus, in a majority of cases, hospital working shifts of more than thirteen hours affected nurses’ productivity and patients’ satisfaction negatively. According to the study findings, the relationship was as follows, “increases in the proportion of nurses working shifts of more than thirteen hours were associated with increases in patient dissatisfaction” (Witkoski Stimpfel, Sloane & Aiken, 2012). Besides, increases in shift length led to enhancements in the levels of burnout, job dissatisfaction, and intention to leave the job. The proportion was preserved even after changing the number of working hours. Thus, the nurses who worked 8 – 9-hour shifts were satisfied with their job, but nurses who worked 10 – 11-hour shifts were more dissatisfied and intended to leave the job. Accordingly, those nurses who worked 12 – 13 hour shifts were even more likely to leave the job and be dissatisfied with it. Naturally, nurses who worked shifts of more than 13 hours were most likely to leave the job, experience burnout and be unable to leave the patients satisfied.
The procedure chosen to confirm the hypothesis was a secondary analysis of cross-sectional data from surveys of three different sources related to the healthcare field. Thus, the authors of the study heavily relied on the data obtained from questionnaires and most likely evaluated via a four-point Likert scale-type question. In particular, these were used for assessment of nurses’ satisfaction with the job. Meanwhile, similar measures were applied to assess patient satisfaction. To examine the relationships between the nurses’ shift length and other variables, the authors used descriptive statistics, namely the statistical analysis software SAS.
Unfortunately, the authors did not provide readers with a literature review. The introduction section of the study has implicit references to the previous research marked by the footnotes. However, the authors did not directly indicate their theoretical framework and other scholars who explored a given issue. As a matter of fact, the authors admitted that their study is the first one to explore whether nurses’ shift length is associated with patient satisfaction. Incidentally, Linda Aiken, one of the researchers, has already explored the topic of job burnout and job dissatisfaction (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). Still, the issue of extended shifts and patient care was not present there. So far, there is limited research on the influence of long shifts on the quality of care, which nurses provide to patients. Accordingly, it is impossible to present the previous research due to the absence of one. To add even more, none of the scholars have had an adequate understanding of how patients’ satisfaction is affected by the extended work hours of nurses.
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The research is current and relevant to the existing health issues, especially because there are no national work-hour policies for registered nurses. Therefore, this problem is still awaiting its solution. This study will hopefully contribute to the existing body of knowledge and encourage the government to take important measures.
Since this research is a cross-sectional study, it belongs to the descriptive studies. It means that compared to experimental research, there are not any experimental manipulation and random selection of groups. Furthermore, this study describes existing information to uncover new facts. To obtain the data, the authors used questionnaires, interviews, and observation. They employed samples of more than 20 000 registered nurses from different hospitals in California, New Jersey, Pennsylvania, and Florida. The sample ranged from 10 to 39 nurses per hospital. Moreover, the authors of the study had specific selection criteria. In particular, they tried to exclude nurses not working directly with patients, including those in supervisory roles. Nurses working in outpatient services, long-term care, and the operating room were excluded, as well. It was done because these nurses did not have the same shift patterns as inpatient hospitals. Thus, Witkoski Stimpfel, Sloane and Aiken collected the data to acquire the description of nurses working long shifts in order to determine the influence of their work on patient satisfaction. Hence, their study can act as a facilitator for other types of quantitative research methods. The sample was appropriate for the research and free of biases.
This work seems of significant practical value to future nurse practitioners. First, it reveals the problem of the negative impact of a lack of national work-hour policies on registered nurses. Therefore, there is a need for restricting the number of successive hours of work. According to the researchers, study results encourage policy development at national and institutional levels. From my point of view, such a study raises awareness of the nursing essence, which is self-sacrifice. People who choose to nurse as their vocation should be ready to sacrifice their time and energy for the sake of their patients. Without that attitude, hardly ever would people make good nurses and health practitioners. Due to this article, I learned that being a nurse is not trouble-free and dealing with stressful environments is an integral part of this profession. This research is one of those studies that “can influence nurses’ quality of care, productivity, job satisfaction, and retention” (Burns & Grove, 2011). In my opinion, the study could have been improved if it covered several more states. However, the authors claim that their findings correspond to the existing body of knowledge. Thus, I do not consider the scale of a study as a serious flaw.
The language of the article is comprehensible and straightforward. The study is divided into several sections with clear headings, making it easy to grasp the meaning of what authors strive to say. At the same time, further research can be conducted on this subject. This study can become on a national scale. It would expand even more on the existing body of knowledge and probably elucidate some nuances unnoticeable at first sight.
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To conclude, “The Longer the Shifts for Hospital Nurses, the Higher the Levels of Burnout and Patient Dissatisfaction” by Amy Witkoski Stimpfel, Douglas M. Sloane and Linda H. Aiken is a significant study in the field. The authors made the first step into the unknown territory and that is their main contribution. Additionally, the research is contemporary and relevant to the existing health issues. To the best of my knowledge, there is still no national policy regulating nursing working hours. Therefore, the practical value of this article is to stimulate some change. However, the implementation of new regulations usually demands a larger scale of the problem. Probably, the researchers should have tried to cover more states in their research. Besides, their article is easy to read and understand. It gave me some important insights into what a nursing job is and I hope it would help other people to reveal its the most controversial aspects.