Long shifts for RNs can lead to patient dissatisfaction


Longer shifts make nurses more likely to experience burnout and job dissatisfaction and also make patients more likely to be dissatisfied with care, according to a study.

In what was described as the first study to examine the relationship between nurse shift length and patients’ assessment of care, researchers from the University of Pennsylvania School of Nursing reported that nurses working shifts of 10 hours or longer were up to 2.5 times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction.

When shifts of 12 hours or longer "are combined with overtime, shifts that rotate between day and night duty and consecutive shifts, nurses are at risk for fatigue and burnout, which may compromise patient care," Amy Witkoski Stimpfel, RN, PhD, a post-doctoral fellow at Penn Nursing’s Center for Health Outcomes and Policy Research, said in a news release.

Nearly 23,000 RNs took part in the study over a three-year period in California, Florida, New Jersey and Pennsylvania, states that represent about 25% population and 20% of annual hospitalizations in the U.S.

Survey data showed more than 80% of the nurses were satisfied with scheduling practices at their hospitals. However, as the proportion of hospital nurses working shifts of more than 13 hours increased, patients’ dissatisfaction with care increased.

The percentages of nurses who reported burnout and intention to leave their job increased incrementally as shift length increased, the researchers wrote. In hospitals with higher proportions of nurses working longer shifts, higher percentages of patients reported that nurses sometimes or never communicated well, pain was sometimes or never well controlled, and they sometimes or never received help as soon as they wanted.

Witkoski Stimpfel and co-authors recommend restricting the number of consecutive hours worked. They also said state boards of nursing should consider whether restrictions on nurse shift length and voluntary overtime are advisable, and nurse management should monitor nurses’ hours worked, including second jobs.

"Nursing leadership should also encourage a workplace culture that respects nurses’ days off and vacation time, promotes nurses’ prompt departure at the end of a scheduled shift and allows nurses to refuse to work overtime without retribution," Witkoski Stimpfel said. "These types of policies that facilitate manageable work hours can contribute to the development of a healthier nursing workforce [that is] prepared to manage the complex care needs of patients and their families."



 

CDC to bring HIV testing to pharmacies, retail clinics


The U.S. Centers for Disease Control and Prevention has announced a pilot project to train pharmacists and retail store clinic staff at 24 rural and urban sites to deliver confidential and rapid HIV testing.

The goal of the initiative is to extend HIV testing and counseling into the standard, everyday services offered by pharmacies and retail clinics. The CDC will use the results of the pilot effort to develop a model for implementation of HIV testing in these settings across the country.

The project is part of the CDC’s efforts to support its 2006 testing recommendations, which call for all adults and adolescents to be tested for HIV at least once as part of routine healthcare. It coincides with this year’s National HIV Testing Day, which has taken place every June 27 since 1995.

"We know that getting people tested, diagnosed and linked to care are critical steps in reducing new HIV infections," Kevin Fenton, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said in a news release. "By bringing HIV testing into pharmacies, we believe we can reach more people by making testing more accessible and also reduce the stigma associated with HIV."

The CDC estimates that 1.1 million people are living with HIV in the United States, yet nearly one in five remains unaware of the infection. In addition, a third of those with HIV are diagnosed so late in the course of their infection that they develop AIDS within a year, missing ample time in which they could have received life-extending medical care and treatment, and potentially reduced transmission to partners.

Community pharmacies and retail clinics, with their convenience and easy accessibility, can play a critical role in ensuring more Americans have access to an HIV test, the CDC said. Millions of Americans enter pharmacies every week, according to estimates, and an estimated 30% of the U.S. population lives within a 10-minute drive of a retail clinic. Compared to healthcare settings and conventional HIV testing sites, these locations may provide a more accessible environment for people who may be anxious about seeking an HIV test.

"Our goal is to make HIV testing as routine as a blood pressure check," said Jonathan Mermin, MD, director of the CDC’s Division of HIV/AIDS Prevention. "This initiative is one example of how we can make testing routine and help identify the hundreds of thousands of Americans who are unaware that they are infected."

Throughout the two-year initiative, the CDC will provide training for staff in community pharmacies and retail clinics in 12 urban areas and 12 rural areas with high HIV prevalence or significant, unmet HIV testing needs. Training will focus on how to deliver rapid HIV testing and counseling and link those who are diagnosed with the virus to care and treatment.

The CDC will use the pilot project to develop a comprehensive toolkit for pharmacists and retail clinic staff around the country to use in implementing HIV testing.