Nursing Research Report: Health Impact of Long Working Hours in Nurses

This nursing research report presents a pilot study investigating the impact of long working hours on the health of nursing professionals in an acute healthcare setting. The research addresses the increasing absence rates attributed to extended shifts, focusing on the relationship between work-life balance, stress, and physical and mental health. The report outlines the research question, aim, and hypothesis, supported by key pieces of evidence from existing literature. It details the research pilot design, background analysis, feasibility considerations (time, cost, and adverse events), and methodology, including the research approach, sampling, data collection, and analysis methods. The study also addresses research ethics, evidence supporting decisions, and barriers to implementation, concluding with recommendations to improve the well-being of nursing staff. This report is a valuable resource for understanding the challenges faced by nurses and the importance of addressing workplace factors to improve their health and job satisfaction.

Running head: NURSING RESEARCH
Nursing research
Name of the student
University name
Author’s note

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Table of Contents
Introduction..................................................................................................................................2
Research question, aim and hypothesis........................................................................................3
Aim:.................................................................................................................................................3
Research question............................................................................................................................3
Hypothesis.......................................................................................................................................3
Key pieces of evidence relevant to chosen scenario....................................................................3
Research pilot design...................................................................................................................6
Background analysis........................................................................................................................6
Feasibility of the research................................................................................................................8
Time.................................................................................................................................................8
Cost..................................................................................................................................................9
Adverse events.................................................................................................................................9
Effect size......................................................................................................................................11
Methodology of the research......................................................................................................11
Research approach.........................................................................................................................12
Sampling........................................................................................................................................12
Data collection...............................................................................................................................13
Data analysis..................................................................................................................................13

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Research ethics..............................................................................................................................13
Evidence in support of decisions and approaches.........................................................................14
Discussion of barriers in implementation of the research objectives............................................15
Conclusion.................................................................................................................................16
References..................................................................................................................................18

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Introduction
Work life balance is one of the most talked about concepts within the current day
workplace scenario as stress in the place of work has been seen to affect the physical and mental
health of individuals considerably. The current study focuses upon the impact of long working
hours upon the health of nurses within an acute healthcare setup. The current research project
conducts a pilot study of the various factors within a workplace setting that can have a profound
effect on staff health and attendance. Here, sudden increases in the absence of the nursing staffs
have been noted which could be attributed to long working hours. The sudden changes in the
shift duration of 7.5 hours to 12 hours have drastically increased the sickness rate among the
staffs.
The longer duration of work, lack of sleep and rest can be some of the instigating factors
in deteriorating the health of employed nurses within a health care set up. Reports and evidence
have also directly correlated increased rate of accidents to overtired healthcare staffs (Leow &
Chan, 2017). The absence of an adequate number of staffs can also affect the care quality and
the services offered within a clinical, set up. In the current assignment, we have tried to focus
upon the key pieces of evidence which reflect upon the chosen scenario. The methodology of the
research had also been designed in accordance with the requirements of data analysis and
interpretation. The goal of the assignment is to highlight the contributing factors towards
increasing work pressure which has a negative impact on the mental, emotional and physical
well being of a staff. Apart from longer shift durations, there are other contributing factors which
also affect the well being of the staff such as workplace infrastructural support which is a
necessary component and should be planned carefully (Penkunas et al., 2016).

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Research question, aim and hypothesis
Aim:
To investigate the claim about the effect of significant long working hours over the health of
nursing professionals
Research question
What is the impact of long working hours upon the health of nursing professionals?
Hypothesis
H0= Long working hours are not responsible for deterioration of health of the nursing staff
H1= Long working hours are responsible for health deterioration in the nursing staff
Key pieces of evidence relevant to chosen scenario
There has been evidence in the past where an overtired nurse has forgotten to brief
regarding the most important details pertaining to the health of a patient in emergency trauma
care to the concerned staff during shift change. As commented by Lin, Liao, Chen & Fan (2014),
such overtired staff has also been represented by a massive number of employee or staff
turnover. Therefore, a detailed study had been conducted over here exploring the different areas
of work division and maintenance of work-life balance within an acute care setup. As
commented by Zboril-Benson (2016), long durations combined with rotational shifts may
actually take the health of the nursing staff adding to fatigue which may impact the quality of
healthcare services. However as argued by Kuo, Lin & Li (2014), despite regulations for

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cumulative shift length for residential physicians and workers in other industries such policy and
framework are lacking the nurses. The long working hours have been seen to result in greater
amount of ‘burnout’ within the nursing professionals (Steinmetz, de Vries & Tijdens, 2014).
Burnout could be characterised by emotional exhaustion, lack of attachment to patients, which
could greatly impair the care services (Jamieson, Kirk, Wright & Andrew, 2015).
In this respect, additional data collection and research analysis mentioned that nurses
working overtime would often not communicate well with the patients; neither were some of the
crucial things such as pain well managed or controlled (Volpe et al., 2014). Some of the
regulatory bodies such as Accreditation Council for Graduate Medical Education (ACGME)
have restricted the working or shift hours of the physicians. In this respect, three separate aspects
could be discussed in detail which consecutively impacts the health of the nursing professionals
such as lack of sleep, extended work hours and rotational shifts. The lack of sleep has been one
of the most common factors affecting the health of the nursing professionals. As commented by
Griffiths et al. (2014), less sleep can result in a number of problems such as mood disorders,
deficit of attention at place of work. These factors can significantly contribute to the
deterioration of overall health and well being of a person. The extended work hours and
consecutive shifts have often been related to digestive disorders, hypertension within the nursing
staffs. Reports and evidence have shown that a clear link exists between sleep deprivation and
obesity. As commented by Allen, Holland & Reynolds (2015), short sleep duration has been seen
to develop the tendency of glucose tolerance and promote incidents of diabetes in women. In this
respect, insufficient sleep has been seen to result in occurrences of cardiovascular diseases
among the healthcare professionals. Additionally, less sleep has been seen to cause hormonal
misbalance by disturbing the levels of leptin, cortisol and thyrotropin (Gross, 2017). Some of

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these hormones have been seen to control the menstrual cycles in women. Thus, disruption in the
normal hormonal levels can result in mood disorders and related health problems.
The lack of sleep has also been correlated with less immunity in the healthcare staff
(Sanso et al., 2015). However, workings for more than 40 hours per week affect the health of the
nursing professional to a great extent (Jennings, Clifford, Fox, O’Connell & Gardner, 2015). The
extended shifts have been associated with increased musculoskeletal injuries, cardiovascular
conditions and development of hypertension. The increased neck and muscular discomfort due to
working long hours have also been seen to affect the staff attendance (Sacco, Ciurzynski, Harvey
& Ingersoll, 2015). In this respect, the nursing professionals have often been seen to take longer
holidays or miss duties owing to stiffness or pain in the body. As asserted by Arnold, Teijlingen,
Ryan & Holloway (2015), a satisfied staff have been seen to reduce incidents of massive
turnover at workplace.
Hierarchy of evidence

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Figure 1: Hierarchy of evidence
(Source: Allen, Holland & Reynolds, 2015)
The literature sources used above are cross-sectional studies conducted under
randomised control trials and helps in comparing between control and intervention groups. The
hierarchy of evidence can be further divided into seven different levels or cycles. The level 1
emphasizes upon systematic review of randomised controlled trials. In the second level, the
search strategy is further narrowed down where singly randomised trials are taken into
consideration. From level 3 to 4 correlational and observational studies are conducted where
different case studies are analysed further to find out the common patterns. This further helps in
addressing the identified gaps or loopholes in the current situation. The level 5 to 6 focuses on
data collection methods such as quantitative/qualitative research design. For the present study,
we have taken into consideration face-to-face interview methods along with survey for collection
of data regarding the problem situation of increased rate of health-related absence from work.
The responses will be further compared with expert opinions and management authorities in
charge of the nursing services delivery.
Research pilot design
Background analysis
There have been incidents where the nurses have failed to keep a record of the exact
medication doses to be delivered to the patients. This had resulted in cases of casualties within an
acute care set up and often endangers reputation of the hospital. As per reports and evidence,
several states such as California and Maryland have restricted longer work hours for the nurses

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(Jamieson, Kirk, Wright & Andrew, 2013). However, no restrictions are imposed upon the
voluntary overtime by the staffs of the hospital. Further research has highlighted two major
contributing factors for wilful overtime by the nurses. These conditions could be summarised as
shortage of nurses leading to more pressure on individual staffs along with weaker economy.
However, such restriction of timings is yet to develop for the nurses. Reports and
evidence have suggested that the normal accepted length of duty hours was put at 12 hours for
most hospital set up on a larger scale. As argued by Lesuffleur, Chastang, Sandret &
Niedhammer (2014), most of the nurses have been found to be satisfied with long duty hours and
would never complain. The reason was thought to be low salary being paid to the nurses; where
a hike in the work hours would also mean a hike in the last drawn salary.
Working on consecutive extended shifts can also increase the risk of workplace accidents
(Sorenson, Bolick, Wright & Hamilton, 2016). These accidents are often misinterpreted as
carelessness by the staff. However, such carelessness often results due to excessive amount of
fatigue present in the workers. Thus, the ergonomics or the workplace infrastructure are some
other contributing factors and needs to be worked upon. As commented by Hassard et al. (2014),
providing the staff with proper resting areas can help them to relax and unwind. Additionally,
some of the other factors are provision of adequate facilities such as clean drinking water,
changing rooms.
Reports and evidence have suggested that providing the nursing professionals with
suitable ergonomics can also help in reducing the grievances faced by them (Cheng & Cheng,
2017). As commented by Harris, Sims, Parr & Davies (2015), sufficient counselling and training
could help the nursing professionals in coping up with increasing tension and work pressure. The

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training has also been seen to generate sufficient motivation in the staffs (Munabi, Buwembo,
Kitara, Ochieng & Mwaka, 2014). In this respect, providing the staff with performance bonus
and incentives has also been seen to generate sufficient motivation within the staffs.
Feasibility of the research
In order to conduct a research successfully the feasibility options for conducting the
research successfully have to be taken into consideration. In the current study, we have used both
survey and questionnaire for the collection of relevant data regarding the increased absence of
nursing staff from their place of work. Some of the feasibility issues which were faced by the
researcher in conducting the survey and the interview were getting proper support from the
management and the nursing staffs. Additionally, being at an arm's length from the hospices also
affected the data collection procedure. The remote locations of some of the hospitals also
resulted in accessibility issues, which further affected the authenticity of the results.
Time
The timing is a very important factor in ensuring the rate of success of a research project.
In this respect, the limited time allotted for conducting the research study limited the scope of the
research. Since the research had to be conducted within the hospital premises; therefore prior
consent had to be taken from the respondents of the survey and interview process. Otherwise,
any interruption within a busy hospital setting would have been considered as a violation of the
research ethics and practices (Byrne & Martin, 2014).

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Cost
The budget allocation and costs associated with conducting a research project also have
significant impact on the success rate of the project. The allocation of the budget could be done
based upon the set of activities which are to be performed for the process of data collection and
evaluation. A data plan entailing the amount spent upon each component of the research has been
provided below.
Activities Figures (in singapore dollars)
Advertising (online promotion, designing
posters, templates)
S$ 0.2 million
On –field expenses (organizing surveys) S$ 0.3 million
Research (collection of primary and secondary
data about the issues faced by theworking
professionals in healthcare)
S$ 0.2 million
Fundraising activities (inviting tenders,
expression of interest)
S$ 0.5 million
Table 1: budget allocation
(Source: author)
Adverse events
The adverse events in the context of healthcare could be described as any untoward
incident that may occur during the process of care delivery by the nursing professionals. Some of
the common phenomena which could be described over here are overdosing of patients by the
fatigues or tired nursing staffs. The reporting of the adverse events can help in the identification

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of organizational, systematic and environmental problems (Ganster & Rosen, 2013). There are a
number of methods of reporting the adverse events including document review and surveillance
of the clinical data. Therefore, the detailed analysis of the clinical data would help in analysing
the factors which contributes towards increased rate of absentees among the nursing staffs.
Database: NCBI, Pubmed, Cochrane library, MEDLINE.
Is lack of sleep the cause behind increased rate of sickness absences in nursing staffs?
Search topic Number of hits generated
Workplace stress 52
Effect of stress on the
physical and mental health of
nursing staffs
65
Stress on absenteeism in
workplace
50
Work life balance in
improving health of the
nursing staff
42
Systematic reviewed journals
only
40
Limit the journals to last ten
years only
35