Changes in nurses' decision making during a 12-h day shift

Area of Science:

• Healthcare Management
• Nursing Practice
• Human Factors in Medicine

Background:

• Shift work is prevalent in healthcare settings.
• Research indicates potential negative impacts of shift work on healthcare provider performance.
• Understanding these effects is crucial for patient safety and provider well-being.

Purpose of the Study:

• To investigate changes in registered nurses' decision-making during a 12-hour day shift.
• To assess the relationship between shift duration and clinical judgment.
• To evaluate nurses' self-reported alertness and stress levels across the shift.

Main Methods:

• A cohort of registered nurses working a 12-hour day shift participated.
• A policy-capturing questionnaire assessed physician call decision-making at shift start and end.
• Self-report surveys measured alertness, stress, and sleepiness.

Main Results:

• Sixty-five nurses completed the study (41% response rate).
• Significant changes in decision-making policies were observed from the beginning to the end of the shift.
• Nurses reported decreased alertness and increased stress, with no correlation to decision-making changes.

Conclusions:

• Medical judgment in registered nurses is altered by the end of a 12-hour day shift.
• The Controlled Attention Model may explain changes in attention and decision-making.
• These findings underscore the multifaceted negative outcomes associated with shift work in healthcare.