Risks posed by nurses' working hours in the intensive care unit: a systematic review

Nurses in intensive care units often work long shifts, leading to significant physical and mental strain. This strain can negatively impact their well-being and the quality of care they provide to patients.

To evaluate the associations between nurses' working hours in intensive care units and outcomes related to risk identification, nurse well-being, patient safety, and institutional performance.

This systematic review was conducted under the methodological guidance of the Joanna Briggs Institute, grounded in a theoretical framework based on the Donabedian Model, and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Literature searches were conducted from 2014 to 2024, with the assistance of an expert librarian, across the databases of Scopus, Medline/PubMed, CINAHL, Web of Science, Cochrane Library, and Google Scholar. Peer-reviewed empirical or primary studies, published in English or Turkish, focused on nurses working in adult intensive care units, addressed risks related to working hours, utilized experimental, quasi-experimental, cross-sectional, or longitudinal designs, and regression analysis methods to explore associations and predictive outcomes were included. Publications not in English or Turkish, lack of full-text access, grey literature, studies on official sections of the intensive care units, and studies not focusing on the risks of growth along with the working hours of officials in the intensive care units were excluded.

A total of 902 articles were identified, and 16 studies met the inclusion criteria. The analysis suggests that extended working hours in intensive care units pose significant risks, particularly related to sleep disturbances, increased burnout, and medication errors. These risks affect nurses, patients, and institutions alike.

The review highlights the importance of addressing the risks associated with long working hours in intensive care units. The primary risks identified include nurse-focused issues such as the development of sleep disturbances and increased burnout, as well as patient-focused risks like medication errors. These risks, along with their frequency and impact, underscore the need for improved scheduling and working conditions to ensure patient safety and nurse well-being.

This systematic review was registered with the Open Science Framework proposed by the Joanna Briggs Institute Collaboration on August 10, 2024 and is available at https://doi.org/10.17605/OSF.IO/FTQBK.

Healthcare organizations can use these findings as a resource in creating evidence-based programs to create a healthy work environment and ensure patient safety, and to minimize existing risks in institutions.