Impacts of Anti-social Working Hours on Nursing Staff

Impacts of Anti-social Working Hours on Nursing Staff Abstract The aim of this research proposal is to outline a research study that is designed to determine the effects, and impacts, of anti-social working hours on nursing staff, with a view to assessing the validity of three main hypotheses: H1: The greater the number of anti-social hours worked, the more serious will be the negative effects on the professional and personal lives of nursing staff; H2: Nursing staff who have high levels of workplace support are less likely to be affected by anti-social working hours; and H3: Nursing staff who receive adequate monetary compensation for the anti-social hours they work are less likely to be adversely affected, in terms of their professional lives, by these anti-social hours. It is proposed that these hypotheses be tested through sampling twenty nursing staff, gathering both qualitative and quantitative data through the use of the Work Ability Index, a questionnaire and a logbook containing various questions the participants will be asked to comple te each working day for one month. Introduction A previous review of the relevant literature showed that there are many facets to the effects of anti-social working hours on nursing staff that are not understood. The critical literature review revealed that there were many and various effects of anti-social hours on the professional lives of nursing staff, including negative effects on performance at work, an increase in the number of mistakes made, a decrease in the patience nursing staff had towards patients, a decrease in the levels of holistic care provided and that anti-social working hours could lead to strains being placed on the relationships nursing staff have with their colleagues, their patients and the families of their patients. In addition, it was shown that anti-social working hours had negative effects on the personal lives of nursing staff, including on their home life, their personal safety and their overall health and stress levels. Research questions and objectives As a result of the findings of this critical literature review, this research proposal suggests a dual quantitative and qualitative approach to assessing the actual effects of anti-social working hours and their impacts on nursing staff, with three main hypotheses to be explored: H1: The greater the number of anti-social hours worked, the more serious will be the negative effects on the professional and personal lives of nursing staff H2: Nursing staff who have high levels of workplace support are less likely to be affected by anti-social working hours H3: Nursing staff who receive adequate monetary compensation for the anti-social hours they work are less likely to be adversely affected, in terms of their professional lives, by these anti-social hours Perspective and methodology The methodology to be utilised is both qualitative and quantitative, incorporating two quantitative methods (the Work Ability Index and a logbook) and a qualitative method (a questionnaire). In order to test the effects of anti-social hours on nursing staff, it will be necessary to sample a number of nursing staff each of whom work different types/number of hours. Twenty nursing staff will be sampled in total, five who work only during the day, five who work only during the night, five who work shifts without committing to night shifts and five who work shifts and who do commit to working night shifts. Sampling such a diverse set of nursing staff, in terms of the number/type of hours worked will allow the effects of anti-social hours on different types of nursing staff to be assessed, It is proposed that the Work Ability Index (Ilmarinen, 2007) be used to assess how anti-social hours are impacting nursing staff, in terms of their ability to do their jobs, and their own health. The Work Ability Index (Ilmarinen, 2007) is basically a series of questions which take in to account the demands of the work, the workers health status and the resources available for work, and is a summary of the responses to seven items, including: 1) Current work ability compared with the lifetime best; 2) Work ability in relation to the demands of the job; 3) Number of current diseases diagnosed by a physician; 4) Estimated work impairment due to these diseases; 5) Sick leave during the past twelve months; 6) Own prognosis of work ability two years from now; and 7) Mental resources. In addition to the Work Ability Index, several supplementary questions will be asked of the sample of nursing staff, in the form of a questionnaire, in order to gauge their attitudes to work and their overall satisfaction with their work and pay, their motivation and their opinions regarding the support that is available in their workplace. In addition to the Work Ability Index, and the supplementary questionnaire, which will be used to assess how the sampled nursing staff are being impacted, in terms of the anti-social hours, the sampled nursing staff will be asked to keep a logbook of their activities over one month of work, in which they will be asked to record: their scheduled working hours; their actual working hours; how many of their overtime hours were paid; the amount of sleep they have; a rating of the quality of this sleep; whether they use any sleep aids, and what these are; a rating of their sleepiness levels; a rating of the fatigue they feel each day; a rating of their stress levels each day; a note of any errors they made whilst at work; a note of the type of error made; a note of any potential errors they would have made had another member of staff not intercepted them; and a note of any errors observed in other colleagues. Methods Sampling The target for this research is nursing staff, in the hospital in which the researcher is employed. Due to time restrictions with the research project, which needs to be completed in two semesters, the number of participants in this study will need to be kept low, so that their responses to the Work Ability Index, the questionnaire and their records in their logbooks will be manageable, in terms of the amount of data that will result. It is therefore suggested that twenty participants are selected for the study, divided in to nursing staff covering a variety of shifts and working hours: five who work full-time, only day shifts; five who work full-time, only night shifts; five who work shifts, with no night shifts, only day shifts; and five who work shifts but who can work night shifts. Sampling the nursing staff in this way will allow an assessment of the effects of the type of extra working hours has on nursing staff, for example whether working anti-social hours at night has a grea ter negative effect on nursing staff than working anti-social (i..e, longer) hours during the day, for example. Data collection As has been discussed, the objectives of this research, and the associated hypotheses, will be tested through a combination of qualitative and quantitative research methods. The Work Ability Index will be utilised in order to gain an overall picture of the effect the work is having on the participants and the views the participants hold regarding their ability to do their jobs, and their own health (Ilmarinen, 2007). The Work Ability Index, as it requires participants to provide a numerical assessment of their responses to the various questions, will provide a quantitative assessment of the participants attitudes towards their work, their ability to do their work and their own health, as a function of the work they are required to do. The questionnaire that will be handed out to the participants aims to provide a snapshot of the participants’ attitudes to work and their overall satisfaction with their work and pay, their motivation and their opinions regarding the support that is available in their workplace. The responses to this questionnaire are intended to be open-ended and, as such, will constitute a qualitative approach to data gathering, with participants being free to respond, at will, to the questions asked. This qualitative approach will allow the participants to outline any concerns they have and to expand upon their feelings with regards to the impact of their working hours on their ability to do their work, on their professional lives, on their personal lives and on their health, amongst other factors. The logbook will, through the various questions it contains, allow both a qualitative and a quantitative approach to data gathering. Some of the questions will ask the participants to rate various things, with the responses being quantitative in nature, such as the quality of their sleep, the number of hours (scheduled and non-scheduled) that they worked, or their stress levels, for example. Other questions will allow for more open-ended responses, qualitative in nature, such as whether they use any sleep aids, and what these are, or whether any errors were made, with the opportunity to describe these errors. Analytical processes As the data that will be collected is both quantitative and qualitative in nature, various analyses will be necessary. For the quantitative data gathered, for example the responses to the Work Ability Index and the quantitative questions in the logbook, the data will be analysed with regards to determining any correlations between the responses, for example, whether longer hours, as recorded in the log book, correlates with lower satisfaction with their work, as recorded by the Work Ability Index. Such correlations can be performed using various statistical tests, via a statistical analysis software package, and will provide firm conclusions as to the relationships between the various variables being measured. The qualitative data that is collected will be voluminous in nature with a great deal of responses to view and analyse (Polit et al., 2007). As Thorne (2000) suggests, the analysis of qualitative data relies on some form of deductive reasoning in order to interpret and structure the meanings that can be derived from the data collected, within the framework of the objectives of the research and the hypotheses that are being tested. It is suggested that the data be analysed using content analysis (Pope et al., 2000; Miles and Huberman, 1984). Content analysis will allow the data to be analysed and to find emergent meanings from this data in order to find inferences from what has been said by the participants and to relate these inferences to the quantitative data that will be collected (Neuendorf, 2002). Analytical induction will be used to test and re-test the intuitive ideas the researcher has regarding the content of the responses, with regard to the objectives of the research and h ypotheses being addressed (Pope et al, 2000; Holloway, 1997). It is expected that the correlations found within the quantitative data will be supported by the qualitative data collected, and that the qualitative data will provide more of an in-depth understanding of the actual effects and impacts of anti-social working hours on nursing staff. This combination of quantitative and qualitative data is therefore expected to be a powerful tool in terms of gaining a full understanding of the impacts of anti-social working hours on nursing staff, in terms of the effects on both their professional and private lives, with regards to fulfilling the objectives of the research and determining the validity of the hypotheses being tested. Strategies to promote methodological rigour There is a risk, in this study, that the nature of the study, and implied pressure from managers and colleagues, may lead to bias in the results gained, in that nursing staff may not feel able to reveal their true feelings about these issues for fear of retribution. In order to minimise the chances of this happening, as has been seen, anonymity will be ensured at all times, minimising the chances of bias entering in to the data and maintaining methodological rigour. Access and Ethical issues In order to recruit twenty nursing staff, and to allow the research to be conducted, the Manager of the nursing staff will contacted and permission will be requested to contact the nursing staff to be able to recruit participants. As this research topic touches on a delicate subject, in that managers might be wary of addressing this subject with their staff, and because making recordings in the logbook will take time out of the working day of the nursing staff, the Manager will need to be approached with care. Appendix 1 provides a copy of the suggested letter, that will be sent to the Manager of the nursing staff, in order to recruit possible subjects for the research. All nursing staff on one floor of the hospital will be sent an introductory letter, given in Appendix 2, which will explain the purpose of the study, outline the aims and objectives of the study and outline what will be expected of participants, and which asks for any interested parties to come forward to volunteer themselves for the study. Participants will be selected on the basis of them being independent (i.e., not known to the researcher or any supervisors of the researcher) and will be contacted, within a few days of volunteering themselves and being selected, in order to sign a Consent Form (given in Appendix 3). Following the signing of the consent form, the study will be explained in more detail to the selected participants, with the letter in Appendix 2 being sent out to selected participants, with the various components, and how they will be presented to the participants, being explained within this letter. Following this, the questionnaire will be given to the participants and they will be asked to fill this in and to return it to the researcher within a week of it being sent to them. The Work Ability Index will also be passed to the participants, at the same time as the questionnaire, and the participants will be asked to complete this, within a week, and return the completed questionnaire with the completed Work Ability Index. At the same time, the logbook will be explained in detail, and passed out to each participant, for them to start recording their responses to the questions within this, every working day for one month. The actual Work Ability Index, questionnaire and logbook that will be sent out to participants are given in Appendix 4, 5 and 6, respectively. It is fundamental, at every stage of this process, that the responses of the participants are kept confidential, with only the researcher knowing which responses come from which person. This will be handled by allocating each participant a number and with the questionnaires, Work Ability Index and logbook being passed out, completed and returned, with only this number, not any names. This will ensure that only the researcher knows which participant provided which responses, ensuring that all responses will remain anonymous. Anonymity is fundamentally important in this study, given its delicate nature, dealing as it is with topics that are inflammatory within the workplace of nursing staff, and which could cause problems between nursing staff and their managers. In addition to the numbering system that will be used to protect the anonymity of participants, no personal data will be collected, other than the responses to the three tools, and the storage of all of the responses collected will be carried out in compliance with relevant data storage regulations, such as the Data Protection Act 1998. The data collected will be collected on the basis of anonymity being maintained, but, due to the nature of the study, in that the results are expected to be disseminated as widely as possible, although anonymity will be maintained, confidentiality of responses cannot be guaranteed, as it is these responses that will form the basis of the results, and conclusions of this research, which will be disseminated. The researcher could be affected by the conducting of this study, because, as has been stated, the research topic touches on sensitive matters that are often the cause of conflict within the workplace between managers and nursing staff. The very fact of conducting this study within the workplace may put the researcher at risk of reprisals of some sort, although it should be noted that the study will be introduced to the Head of Department and to managers as a research study, and that, as such, the researcher should be respected, without facing reprisals, and the research allowed to continue without problems. Timetable It is suggested that the work be conducted over the course of four months, January to April 2009. The nursing staff will be contacted, initially, and once the twenty nursing staff have been selected, the Work Ability Index and the questionnaire will be completed. Following this, the logbook will be handed out and the nursing staff will record their responses to the questions within that each working day for one month. Once the logbooks have been completed, all of the primary data will be collated and analysed, with the expectation that this process will require a further month. Once the results and conclusions have been gathered from the data, two further months will be required to write up this data in the form of the dissertation. The work would be more vigorous if a larger sample of nursing staff could be included, but this is not possible, unfortunately, given the time constraints, Budget and likely funding sources The researcher intends to apply for scholarships in order to cover the costs of the research materials needed, but, as the methodology is utilising reasonably priced materials, if a scholarship is not won, it is expected that the materials could be paid for out of the pocket of the researcher. The expected costs are as follows: Twenty notebooks (for the logbooks): 20 x  £1.50 = 30 Paper/pens/printer ink etc. for the questionnaire/Work Ability Index = 20 x  £1.00 =  £20 Small gift for each participant: 20 x  £2.00 =  £40 Binding of dissertation: 4 x  £10 =  £40 Total cost =  £130 Dissemination of results Given the intense interest in this subject in the nursing literature, it is intended that this study be written up for publication in a peer-reviewed nursing journal. In addition, the results of the study will be presented as nursing seminars and the abstract of the work will be sent out to various conferences, with a view to the work being presented at various nursing conferences. In addition, as with all dissertations completed at academic establishments, a copy of the dissertation will be deposited in the university library, so that the work is available for reference by other interested parties. References Holloway, I. (1997). Basic concepts for qualitative research. Blackwell Science. Ilmarinen, J. (2007). The Work Ability Index. Occupational Medicine 57(2), pp. 160. Miles, M. and Huberman, A. (1984). Qualitative data analysis. Sage. Neuendorf, K.A. (2002). The content analysis guidebook. Available from http://academic.csuohio.edu/kneuendorf/content/ [Accessed 27th November 2008]. Polit, D.F. et al. (2007). Nursing research: generating and assessing evidence for nursing practice. Wolters Kluwer Health. Pope, C. et al. (2000). Qualitative research in health care. BMJ 320, pp. 114-116. Thorne, S. (2000). Data analysis in qualitative research. Evidence-Based Nursing 3, pp. 68-70. Appendix 1: Access letter Address Date Dear XXXXX, Re: Msc dissertation An exploration of the impacts of anti-social working hours on nursing staff I am writing to ask permission for this research to be conducted within your section. As part of this request, I am asking for permission to be granted to make contact with staff under your management, and for these staff to be asked if they will participate in my research project. I hope to be able to select a total of twenty nursing staff to be able to participate in this research project. The research project consists of three separate sections: a survey of the participants using a Work Ability Index, a questionnaire of the participants and a logbook, which the participants will need to complete each working day for one month. I would like the opportunity to present the research project to all of the nursing staff under your management and to select twenty participants from the staff who volunteered their participation. The research project will require the participants to volunteer their own time and any and all research costs will be covered by myself. By the time of the study, the necessary ethical approval for the study will have been given by the relevant committee. I do hope you can consider my request for access to your staff and look forward to hearing from you. Yours sincerely, XXXXXX Appendix 2: Participant information sheet Address Date Dear XXXXX, Re: Msc dissertation An exploration of the impacts of anti-social working hours on nursing staff I am writing to you now to request your participation in a research study I am conducting, looking at the effects and impacts of anti-social working hours on nursing staff. A literature review I previously worked on showed that there are many facets to the effects of anti-social working hours on nursing staff that are not well understood and that, as anti-social working hours have many negative effects on nursing staff, in terms of their professional and personal lives, I am interested in looking in to this issue in further detail. The main aims of the research are to test three hypotheses: H1: The greater the number of anti-social hours worked, the more serious will be the negative effects on the professional and personal lives of nursing staff H2: Nursing staff who have high levels of workplace support are less likely to be affected by anti-social working hours H3: Nursing staff who receive adequate monetary compensation for the anti-social hours they work are less likely to be adversely affected, in terms of their professional lives, by these anti-social hours The research project will consist of three main tools, a Work Ability Index, a questionnaire and a logbook, to be filled in by participants every working day for one month. It is expected that the initial assessment, via the Work Ability Index and the questionnaire, would take around one hour of your time to complete, with the logbook taking around twenty minutes to complete each day. If you have any questions or concerns about your participation, please do not hesitate to contact me and I will address these. If you decide you would like to be part of this research project, I would be grateful if you could sign and return the attached consent form and return it to me in the attached stamped addressed envelope. Yours sincerely, XXXXX Appendix 3: Consent form Research title: An exploration of the impacts of anti-social working hours on nursing staff Name of researcher: XXXXXX Please tick the boxes I can confirm that I have read the participant information sheet and that I understand the aims and objectives of the proposed research _____ I have been given the opportunity to ask questions and to have these questions answered by the researcher ______ I understand that my participation in this research is voluntary and I have fully understood the amount of time my participation in this research will require ____ I understand that I will be able to withdraw from the research at any stage without any retribution  ­Ã‚ ­Ã‚ ­_____ I consent to my responses being used in the dissemination of the results of this research, under the proviso that my responses will remain anonymous at all times _____ I agree to keep the research study confidential in that I should not discuss this with my colleagues or managers ____ I agree to take part in the above study ____ Name of participant: Signature: Date: Name of Researcher: Signature: Date: Appendix 4: Work Ability Index The Work Ability Index (Ilmarinen, 2007) will be used to assess how anti-social hours are impacting nursing staff, in terms of their ability to do their jobs, and their own health. The Work Ability Index for each participant will be calculated as a summary of the responses to seven items, scored over a variety of ranges, giving a total possible maximum score of 49: Current work ability compared with the lifetime best (scored from 0-10) Work ability in relation to the demands of the job (scored from 2-10) Number of current diseases diagnosed by a physician (scored from 1-7) Estimated work impairment due to these diseases (scored from 1-6) Sick leave during the past twelve months (scored from 1-5) Own prognosis of work ability two years from now (scored from 1-7) Mental resources (scored from 1-4) As has been seen, in addition to the Work Ability Index, which will give a possible score out of 49, according to the status of the participants regarding their ability to work, several supplementary questions will be asked of the sample of nursing staff, in the form of a questionnaire, in order to gauge their attitudes to work and their overall satisfaction with their work and pay, their motivation and their opinions regarding the support that is available in their workplace. The actual questionnaire is given below: 1. What are your overall feelings towards your job? 2. What is your attitude towards your work? 3. How do you feel about your pay? 4. Do you work anti-social hours? 5. Are you compensated adequately for these anti-social hours? 6. Do you feel you are forced to work anti-social hours? 7. Do you feel motivated to do your work? 8. If not, please specify the reasons behind you lack of motivation 9. Do you feel you receive enough support in your workplace? 10. If not, what could be done to improve the support available to nursing staff in your workplace? 11. How satisfied are you, overall, with your work? 12. Have you ever considered giving up the nursing profession? 13. If yes, please expand upon your reasons behind this. 14. What do you feel could be done to make your job easier? 15. What do you think managers ought to be doing to minimise the impacts of anti-social hours on you and your colleagues? Appendix 6: Logbook The logbook is intended to be completed every working day for one month, and consists of the following questions, repeated every day: Date: Please note your scheduled working hours for today Please note your actual working hours for today Please note how many of your overtime hours will be paid Please note the amount of sleep you had last night Please provide a rating of the quality of the sleep you had last night (from 1 to 10, with 1 being the poorest quality) Please note whether you used any sleep aids If you used an aid to get to sleep, please note what the nature of this sleep aid Please provide a rating of their sleepiness levels (from 1 to 10 with 1 being very sleepy) Please provide a rating of the fatigue you feel today (from 1 to 10 with 1 being very fatigued) Please provide a rating of your stress levels today (from 1 to 10, with 1 being very stressed) Please make a note of any errors you made whilst at work Please make a note of the type of error made Please make a note of any potential errors you would have made had another member of staff not intercepted this error Please make a note of any errors observed in other colleagues Please make any other comments you would like to record here Appendix 7: Ethics form (NEEDS TO BE INCLUDED)