INTRODUCTION
Statement of the problem
The issue of long shifts and working in the overtime attracted the attention of many healthcare policy-makers, stakeholders, and professions. Nurses have a set of resident duty hours developed by the Accreditation Council for Graduate Medical Education with the aim of improving the quality of care and ensuring high performance of health care professionals at all times (Accreditation Council for Graduate Medical Education, 2013). Engaging nurses in long shift hours and making them work overtime interferes with the health care outcome. There is an urgent need to come up with a research study to investigate its potential impact.
Hypotheses
Hypotheses H1: Increasing working hours and working overtime in an individual nurse practitioner reduces health productivity and patient health outcome
Independent variables
Long shift hours
Working overtime
Dependent variables
The performance of the nurse practitioner
Quality of health care
Extraneous variables
Nurse practitioner’s level of tiredness
Job satisfaction
Existing nurse practitioner’s task performance level
Operational definitions
Nurse Practitioner: An advanced practice registered nurse trained to offer and maintain the quality of health through diagnosis and treatments of both chronic and acute diseases.
Overtime: Working above normal working ours
Long shifts: Working for long hours without replacement
Purpose of the research
The study aims at investigating the potential impact of long working shift and overtime on the performance of an individual nurse practitioner. The specific objectives are:
Research question
The research will be guided by the following question:
What are the potential impacts of engaging a nurse practitioner in long working hours and overtime on the individual clinical performance and patient outcome?
Significance of the study
The following study will have a lot of significant in the field of nursing because it aims at determining how long shifts and overtime influence the performance of nurse practitioners and the quality of health. The outcome of the research will be used by the healthcare sector to come up with strategies for ensuring health care employees work within the acceptable time. Additionally, the outcome of the study will help health care organizations plan for overtime in a manner that does not interfere with the nurse practitioner’s ability to work the following day. The study will also have an impact on other health care professionals such as physicians and registered nurses by helping them understand the importance of having enough rest while in the professional of nursing.
THEORETICAL FRAMEWORK
The following project determines the effect of nurse practitioner’s interaction with the environment. The most appropriate theoretical framework to investigate the above relationship is the Conceptual Model for Healthy Work Environment for Nurses (HWEN). HWEN was suggested by the Registered Nurses Association of Ontario (RNAO) with the primary aim of promoting a healthy workplace for health professionals and ensure better patient outcomes and safety. Every nurse is entitled to work in a healthy work environment. RNAO defined a healthy work environment as a health care setting that ensures nurses achieve the highest level of satisfaction while giving care, promotes quality patient outcome, providing high organizational performance and excellent societal outcomes. The main healthy work environment best practices addressed by the framework are collaborative among nurses; establishing and sustaining an effective staffing program and workload practices; having sustainable nursing leadership; and ensuring the health, safety and well-being of individual nurses (Registered Nurses Association of Ontario (RNAO), 2008). The project focuses on establishing the influence of long shifts and overtime working on NP’s performance and patient outcome.
RNAO created HWEN with the aim of transforming a change in the practice of nursing upon the realization that different studies revealed strong relationships between nurses’ well-being and performance, patient outcome, and society demands. The HWEN theoretical framework will play a significant role in this study by demonstrating the relationship between the nurse’s output (determined by shift period and duration of overtime) and the healthy work environment (measured by performance and patient outcome). The principal dimensions illustrating the interaction between the nurse and the environment are cognitive/cultural/psycho-social, physical/structural, and occupational/professional (see fig.1).
Figure 1: The HWEN theoretical framework (Source: RNAO, 2008)
The following study will only utilize the micro level of the model to carry out the investigation. The level includes physical work demands and individual NP factors. Long working shifts represent the physical work demands while working overtime represents individual nurse.
LITERATURE REVIEW
The literature review plays a significant role in analyzing previous studies related to the research topic to come up with the research gaps. The main ideas looked at from past studies are the approaches used regarding data collection and analysis, the type of sampling used, interpretation of the results, and the outcome of the study. The search for literature will involve looking at the most recent journals, articles, and research studies that investigated the relationship between healthcare provider’s performance with workplace conditions like working hours and overtime. The keywords used in the search for the literature review are: Nurse Practice, shift length, over time, quality of care, and nurse practitioner performance. Examples of literature that will be reviewed are described below.
The article by the National Association of Neonatal Nurses will be of great assistance in the study. The article studied the impact of advanced nurse practice nurse’s shift length and fatigue on patient safety. It focused on how working for long hours and fatigue from work-related duties affect the outcome of individual advanced nurse practitioners (National Association of Neonatal Nurses, 2014). The findings from the article will influence the current study by linking fatigue to the nurse's performance. Additionally, the article provides some recommendations that will be used to make the study more reliable and valid.
The study by Dembe, Erickson, and Banks (2015) will also be reviewed in the study. The research investigated the impact of overtime and long working hours on occupational injuries and illnesses in the United States. First, the outcomes of the research will be used in the comparative analysis of the results of the proposed study to test their relevance since the study will also be conducted in the United States. Additionally, the research will be used to determine research gaps based on the methodology used. The new study will use a different methodology approach to determine whether same results will be achieved.
Finally, the study will review the work of Amy Witkoski Stimpfel and Aiken, Linda on the relationship between hospital staff nurses’ shift length and safety, quality of care. According to Stimpfel and Aiken (2012), long shift lengths are associated with poor quality and safety in healthcare organizations. Findings from Stimpfel and Aiken's study will be used to determine how a combination of two variable, shift length and over time influences the Nurse Practitioner's outcome; hence, defining the research gap.
METHODS
Design
The study will use the non-experimental, descriptive research design. Non-experimental descriptive research design will be the most appropriate for this study because it only relies on interactions, interpretations, and observations. Additionally, it gives the researcher a chance to use case studies, surveys, and correlations to correct data. Studies on health care are very broad, and their outcomes impact a big population. The non-experimental research design has a high level of external validity; hence, easier to generalize to a larger population (Cottrell & McKenzie, 2011).
Sample
The research will investigate Nurse Practitioners from 3 hospitals located at Chicago City, Illinois. The population will be recruited at their specific health care centers. Stratified sampling technique will be used.
Instrumentation
The data will be collected using surveys, open-ended questionnaires to capture professional and personal information, interviews, and health care data to determine the performance of the NP.
Setting
The study will be conducted in 3 selected health care organizations in Chicago.
Procedure
Surveys: Conducted through telephone calls, online means, or by emails.
Questionnaires: resented to individual participants and corrected at the end of the day.
Data on performance: Acquired through the one-on-one interview with managements at the selected health care organizations.
Ethical considerations
Human subject reviews
The approval to conduct the study will be acquired from the Research Ethics Board of the University. The permission to collect data from Nurse Practitioners in the selected health organizations was obtained from the organizational directors. Moreover, organizational heads will be requested to make information about NP’s performance to researchers through a letter.
Consent information
All participants were assured of privacy and confidentiality of information they will give and an informed consent signed towards the same. No response would bear the participant’s name but they will be identified with anonymous names.
References
Accreditation Council for Graduate Medical Education. (201, April 24). Implementing
Milestones and Clinical Competency Committees. Accreditation Council for Graduate Medical Education.
Cottrell, R. R., & McKenzie, J. F. (2011). Health promotion and education research methods:
Using the five-chapter thesis/dissertation model. Sudbury, Mass: Jones and Bartlett Publishers.
Dembe, A. E., Erickson, J. B., and Banks, S. M. (2015). The impact of overtime and long work
hours on occupation injuries and illnesses: new evidence from the United States. Occupation and Environmental Medicine, 62, 588-597.
National Association of Neonatal Nurses. (2014, December). The Impact of Advanced Practice
Nurses’ Shift Length and Fatigue on Patient Safety. NANNP Council.
Registered Nurses’ Association of Ontario (2008). Workplace Health, Safety and Well-being of
the Nurse. Toronto, Canada: Registered Nurses’ Association of Ontario
Stimpfel, A. W., and Aiken, L. H. (2012). Hospital staff nurses' shift length associated with
safety and quality of care. Journal of Nurse Care Quality.
