The Impact of Overworked Nurses on Patient Mortality

It may be wise for hospital officials to more carefully scrutinize the hours worked by nurses.

A new study examining nurses' schedules and patient outcomes finds that patients run a higher risk of mortality in hospitals where nurses report working longer hours and not having much time off.

Although nurse staffing has been found to be related to patient mortality in previous studies, and the same authors have linked working long shifts to health problems and sleep deprivation in nurses, clinical evidence of the independent effect of work schedules on patient care outcomes has been limited to this point.

In a report published in Nursing Research, Alison M. Trinkoff and colleagues from the University of Maryland School of Nursing conducted a study using data from a 2004 survey of 633 nurses working in 71 acute hospitals in North Carolina and Illinois to determine if, in hospitals where nurses report more adverse work schedules, there would be increased patient mortality, controlling for staffing.

The researchers used the risk-adjusted Agency for Healthcare Research and Quality Inpatient Quality Indicators for mortality measures, and utilized staffing data from the American Hospital Association Annual Survey of hospitals. Principal components analysis was conducted on the 12 work schedule items to create eight independent components, and generalized estimating equations were used to examine the study hypothesis.

Trinkoff and colleagues found that work schedule was significantly related to mortality when staffing levels and hospital characteristics were controlled. Pneumonia deaths were substantially more likely to occur in hospitals where nurses reported schedules with long work hours and a lack of time away from work.

They also found that abdominal aortic aneurysm was also associated significantly with the lack of time away. For patients with congestive heart failure, mortality was linked to working while sick, whereas acute myocardial infarction was associated significantly with weekly burden (hours per week; days in a row) for nurses.

The researchers concluded that “in addition to staffing, nurses’ work schedules are associated with patient mortality. This suggests that work schedule has an independent effect on patient outcomes.”

To read the study, click here.

For more:

• Hospital Staff Nurses' Work Hours, Meal Periods, and Rest Breaks (American Association of Occupational Health Nurses Journal)
• Strategies for Nurses to Prevent Sleep-related Injuries and Errors (Rehabilitation Nursing)
• Is It Time to Pull the Plug on 12-hour Shifts? (Journal of Nursing Administration)