The Working Hours of Hospital Staff Nurses and Patient Safety

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Table of Contents

Authors
Research Purpose, Research Question, and Hypothesis
Framework
Research Design
Variables
Population and Sample
Discussion
Conclusion
Reference

This is the selected research article for analysis: Rogers, A. E., Hwang, W., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212. The notable message from the publication is that prolonged working hours and shifts for nurses tend to increase their chances of making medical errors (Rogers et al., 2004). This paper begins by detailing the authority or credibility of its authors. It goes further to highlight the research question, hypothesis, and purpose guiding the experts. The next part identifies and describes the conceptual framework relevant to the selected article. This is followed by the adopted variables, population, and sample for the entire study. The last two sections of the research article describe in detail the emerging conclusions, limitations, and lessons for transforming the future of the healthcare sector. The specific purpose of this paper is to critically evaluate the completed article and describe its overall applicability in nursing to help minimize sentinel events.

Authors

Several authors have collaborated to complete the selected article and deliver the much-needed information. The professionals possess adequate qualifications and credentials that make the work relevant, timely, and informative. The three elements to consider for author credibility include professional achievements, personal reputation, and prior publications in the field. Ann Rogers is credible since she works as an associate professor in the field of nursing, has advanced degrees in medical practice, and has published numerous works before on the same subject matter. Wei-Ting Hwang is as a professor at the University of Pennsylvania, has several advanced degrees, and is an authority in biostatistics. Linda Scott is an associate professor, has the relevant academic credentials, and has published numerous works in the past (Rogers et al., 2004). Linda Aiken is a professor specializing in nursing leadership, has adequate academic credentials, and has proper institutional affiliations. David Dinges is a professor in the field of chronobiology, has proper academic achievements, and has completed a number of studies in the past.

Research Purpose, Research Question, and Hypothesis

The researchers wanted to learn more about work schedules and arrangements and how they affected care delivery. Specifically, the research purpose was to “examine the work patterns of hospital staff nurses and to determine if there was a relationship between hours worked and the frequency of errors” (p. 203). The research problem was that many stakeholders were unaware of the potential implications of shifts in nursing and how they affected patient outcomes and safety. This problem is critical to the nursing profession since its solution can guide more institutions to come up with better schedules to improve the process of care delivery while reducing sentinel events. The primary research question the article intends to answer is: what is the relationship between working shifts and the occurrence of clinical errors? After going through the work, it is evident that the authors do not include any identifiable hypothesis. However, the reader can guess the proposition guiding the entire study. The most acceptable one is that poor work arrangements and shifts in nursing practice triggers clinical errors.

Framework

To complete their work, the researchers did not employ the use of a nursing theory or framework. Nonetheless, the failure does not appear to compromise the overall quality and relevance of their study. However, the professionals could have used an effective conceptual framework to guide the research process. This strategy entails the presentation of interrelated concepts that appear to influence or trigger a specific phenomenon. The structure would have guided the research study by outlining nursing shortage and poor staffing models as possible predictors for medical or sentinel events. Based on such an initiative, the scholars would have created the best foundation for developing their study (Rogers et al., 2004). Such an approach would become the best model or conceptual map for guiding the entire research study. These attributes reveal that the adoption of a proper conceptual framework would have been appropriate for the specific article and help deliver the much-needed findings.

Research Design

While the authors do not identify the specific design, the reader would acknowledge that the article follows a cohort design. To achieve the intended results, the analysts conducted a detailed investigation of registered nurses (RNs) using a demographic questionnaire (Rogers et al., 2004). The successful candidates worked full time and were required to fill two logbooks. The researchers chose the design since it seemed to resonate with the intended goals. Based on the instruments adopted and approach to the study, it would be agreeable that the authors made a good decision. The strategy was capable of addressing the outlined propose and problem associated with the study (Rogers et al., 2004). This outcome was possible since the selected group or cohort of RNs worked in clinical settings and was conversant with shortages and prolonged working hours. The group would be in a position to shed more information regarding the problematic issue of errors.

Variables

The nature of the selected study permitted the use of different variables. The researchers used these key independent variables in the study: age, gender, race, professional experience, and marital status (Rogers et al., 2004). The consideration of workers’ sex was essential to understand if it impacted overall performance and the possibility of errors. The inclusion of gender as a variable was intended to present more information on how it impacts care delivery and work shifts. Similarly, the investigators took interest in the marital statuses of the selected population and monitor if it had a significant effect on the recorded errors. The purpose of including the race independent variable helped the researchers learn more about its possible impact on the working arrangements and outputs for nurses. Professional experience in terms of years in service was purposeful to examine the impact of personal competence and skills on the possibility of errors.

The dependent variables the authors adopted in the study included presence of burnout, recorded clinical errors, and patient outcomes. The purpose of such a variable was to learn more about the overall implications of prolonged working conditions on patient safety (Rogers et al., 2004). In the study, the author did not use any controlled variable due to the nature of the completed investigation. Through the application of such variables, the investigators would find no significant differences in the outcomes emerging from the gender, age, or marital status of each of the respondents.

Population and Sample

The target population for this study included Registered Nurses (RNs) who were enrollees of the American Nurses Association (ANA). To achieve the intended results, the authors relied on the power of purposive sampling technique. Such a method is practical since it empowers the investigator to apply his or her knowledge when selecting the most informed participants. Through a voluntary approach, the technique allowed the investigators to identify and include the right number of RNs with diverse backgrounds and skills sets. To select the right sample, the scholars mailed cover letters to 4,320 ANA members. Only 1,725 of such professionals were willing to be part of the study. From these individuals, the researchers selected 891 respondents based on their eligibility. Those who returned their detailed were 393, thus forming the study’s sample size (Rogers et al., 2004). Based on the inclusion criterion, it is agreeable that the sample size was sufficient and capable of meeting the needs of the study.

The selected RNs with diverse backgrounds were willing to be part of the process and provide the much needed insights. The researchers protected the rights of human subjects by ensuring that personal information was not shared. The professionals coded the acquired information and protected the returned logbooks from any form of unauthorized access (Rogers et al., 2004). The University of Pennsylvania’s Institutional Review Board approached the specific study to ensure that it met all the minimum requirements of an acceptable research study.

Discussion

After completing the study, the scholars concluded that long working hours triggered by nursing shortage in the United States impacted care delivery. Specifically, Rogers et al. (2004) indicate that “the long and unpredictable hours suggest a link between poor working conditions and threats to patient safety” (209). Mandatory overtime initiatives exceeding 12 hours intended to address the problem of nursing shortage have remained controversial and capable of hindering practice. Professionals working for more hours than expected tend to experience fatigue that impacts their competencies negatively, thereby undermining the overall quality of available medical care. Tired nurses tend to be at risk of reporting medication errors in their respective units (Rogers et al., 2004). These findings and conclusions form a strong basis for guiding a paradigm shift and ensuring that the relevant stakeholders collaborate to address the challenge of nursing shortage.

The researchers went further to identify key limitations associated with the study. For example, they admitted that the analysis had a small sample. Additionally, the scholars failed to use an effective tool or framework to measure errors in healthcare settings (Rogers et al., 2004). Key limitations notable from the article include failure to include patient acuity and workload as key variables and the small size of the selected sample.

Conclusion

The researchers of the analyzed study began by selecting the correct sample from a population of RNs enrolled as members of the ANA. The paper has relied on a cohort study to include professionals with diverse backgrounds. The use of purposive sampling made it possible for the experts to get the right candidates and learn more about the implications of prolonged working hours. The 393 staff nurses who returned their logbooks indicated that they worked longer than required. By providing their services for 12 hours or more a day, most of affected the nurses had increased chances of making errors. The reader is able to learn a number of things from the presented findings. First, nursing shortage is a common challenge contributing to prolonged working hours for nurses. Second, existing frameworks increase chances of committing numerous medical errors. Third, proper policies would be recommendable to allow RNs to work for shorter sessions. Stakeholders in the United States’ healthcare sector should consider these emerging observations and implement the presented ideas to help maximize patient safety.

Reference

Rogers, A. E., Hwang, W., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212.

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