Determinants of Night-Shift Scheduling Quality for Nurses in Korea: A Multilevel Approach

Night-shift work burdens nurses and increases the likelihood of medical errors. This study aims to identify the factors that influence the quality of night-shift scheduling.

This study is framed as a secondary data analysis. Original data are drawn from nurses' roster schedules and questionnaires completed by unit managers. The dataset had a nested structure comprising 1566 nurses within 81 wards. Multilevel analysis was conducted to examine factors influencing the quality of night-shift scheduling at both the individual and organizational levels.

The majority of participants were female (95.7%, n = 1498). The night-duty RN-to-patient ratio was 8.83 (SD = 2.34). The mean overall quality of night-shift scheduling among participants was 2.90 (SD = 0.35). In Model 2, which included both individual- and organizational-level variables, the only statistically significant individual-level predictor of the quality of night-shift scheduling was gender (β = - 0.88, p = 0.032). At the organizational level, the number of night-shift-only RNs (β = 0.24, p = 0.001), ward type (β = 0.12, p = 0.026), and the night-duty RN-to-patient ratio (β = 0.25, p = 0.002) were significant.

The quality of night-shift scheduling was greater for female nurses, Comprehensive Nursing and Care Service (CNCS) wards supported by governmental policy, wards with an RN-to-patient ratio of more than 8 during night shifts, and wards with more night-shift-only RNs. Therefore, these results indicate that the composition and number of nursing staff in a ward contribute to improving the working conditions and environments of nurses' shift work.

The higher quality of night-shift scheduling observed in CNCS wards and wards run on the basis of the policy of night-shift-only RNs suggests that governmental support positively influences individual nurses' shift work environments. These findings support the need for policy-level interventions to improve the quality of shift work.