Perceptions and observations of off-shift nursing

The purpose of this paper is to qualitatively explore registered nurse perceptions of off-shift (e.g. nights and weekends) nursing care and quality compared with regular hours.

Patients admitted to hospitals on off-shifts have worse outcomes than patients admitted on more regular hours. The underlying mechanism for this association is not well understood.

In-depth semi-structured interviews of 23 registered nurses and four observer-as-participant observations were conducted on both medical-surgical and intensive care units in two large (>850 beds) tertiary hospitals. Content analysis was used to identify themes.

Six themes emerged: (1) collaboration among self-reliant night nurses; (2) completing tasks; (3) taking a breather on weekend day shift; (4) new nurse requirement to work at night; (5) mixture of registered nurse personnel; and (6) night nurse perception of under-appreciation.

Although nurses collaborate, complete more tasks and work with other types of registered nurses, the decreased resources available on off-shifts may affect quality care delivered in hospitals.

These findings support the importance of management to provide sufficient resources in terms of ancillary personnel and balance less experienced staff. Facilitating communication between night and day nurses may help allay night nurses' feelings of under-appreciation.