Nurses’ Shift Length andIts Efficacy of Nursing Care

A Research Paper Presented to

The Faculty of the College of Nursing

Filamer Christian University

Roxas City, Capiz

In Partial Fulfilment

of the Requirements for the Course

Nursing Research 2

BSN 4 - Julita Sotejo Group 3

October 2018
 CONTENT

Abstract………………………………………………………………………………i

Acknowledgement………………………………………………………………….ii-v

CHAPTER

1 INTRODUCTION

Background of the Study……………………………………………1-6

Objectives of the Study……………………………………………..6-7

Significance of the Study……………………………………………7-8

Theoretical Framework……………………………………………...8-11

Definition of Terms………………………………………………….10-13

Scope and Limitation of the Study………………………………….13-14

2 REVIEW OF RELATED LITERATURE

Related Literature…………………………………………………….15-23

Related Studies……………………………………………………….23-27

Synthesis……………………………………………………………..27

3 METHODOLOGY

Research Design……………………………………………………..28-29

Methods

Area and participants………………………………………………..29

Sampling Procedure…………………………………………………29-30

Research Instrument………………………………………………..31

Scoring of Variables…………………………………………….…..31

Validity and Reliability………………………………………….….32

 Data Gathering Procedure………………………………………….32-33

Data Analysis Procedure…………………………………………..33

4 RESULTS AND DISCUSSION……………………………………35-52

Creative Synthesis………………………………………………….51-52

5 SUMMARY, CONCLUSION AND RECOMMENDATIONS

Findings…………………………………………………………….53-54

Conclusion…………………………………………………………54-55

Recommendation…………………………………………………..55-56
 ACKNOWLEDGEMENT

We would like to acknowledge the efforts and contribution of the following

individuals who have helped us from the very start of this study up to the development of

the hard copy of this research study. Our heartfelt gratitude goes to following,

Hospital Administrators and Nursing Service personnel who cooperated with us

and help us in the data gathering process. Your superb facilitation made this research

study data gathering process easier.

Our beloved research preceptor and dean, Dr. Nelly M. Guillen, for her unfailing

guidance, patience, and brilliant thoughts which honed us as researchers.

The research panel members namely Mrs. Agnes June L. Custodio, Mrs. Arlene

D. Upano, Mrs. Ermofe Garbosa and Mrs. Caroline Yoro for their suggestions that help

improved the study.

Dr. Felimon Pimentel and Dr. Ma. Lida Solano for helping us with the statistical

data.

Our parents who have supported us financially, emotionally and spiritually, thank

you for always staying by our side and for untiringly understanding us.

And mostly to our almighty God for all the blessings unselfishly showered upon

usand the heavenly wisdom bestowed upon us which helped us finish this hard task.

BSN 4 –Julita Sotejo Group 3

 ABSTRACT

Practicing prolonged working hours is trending at this millennial age due to

understaffing, a higher nurse – patient ratio, and a growing number of patients confined

in hospitals but little is known about how such extended hours affect the care that patients

receive or the well-being of nurses. This study aimed to determine the nurses’ shift length

and its efficacy of nursing care. This is a descriptive quantitative study among ward

assigned staff nurses of selective private hospitals in Roxas City, Capiz who were

purposively selected for having practiced more than 8 hours duty shifts for a minimum of

10 extended shifts a month. The study explained mixed method of gathering data. The

respondents were 95 nurses, 14 patients and 12 hospital administrators composed of

Human Resource director, Chief Nurse, Nurse Supervisors, Head Nurses and hospital

administrators or the Chief of the hospital themselves. Researcher – made questionnaire

were employed and was counter validated through an in-depth interview. Statistical

analyses were by frequency distribution, mean and Gamma tests. Ethical considerations

were properly observed. Most nurses were young adults, single, with short tenure,

coming from an average family size of middle – income bracket. Their average shift is 12

hours. Their nursing care was effective in terms of personal, hospital and patient efficacy.

No relationship was found between their profile and efficacy of nursing care. There was

also no relationship between the nurses’ shift length and efficacy in terms of personal,

hospital and patient care. Regardless of their profile and long working hours, the nurses

in the study were able to effectively discharge of their duties and responsibilities in

nursing care. Implications on hospital and nursing service administrative support for the
nurses on long work shifts to ensure their welfare and wellbeing. Recognition of their

good performance, as well as monitoring of their wellbeing will assist them to remain

effective in the discharge of their duties.

 CHAPTER I

INTRODUCTION

This chapter discusses the background of the problem, the purpose of the study,

the framework and objectives. It also presents significance, scope and limitations of the

study as well as the definition of terms.

Background of the Study

In many hospitals, staffing guidelines routinely offer 12-hour shifts as the norm,

with some nurses filling in shortfalls and working 16 hours or more. And for decades,

nurses have worked long hours many of them never giving a second thought to their own

fatigue. Is it time to reconsider whether 12-hour shifts are ideal for ensuring safe patient

care? Is patient safety the trade-off for helping nurses achieving a life-work balance?

After 20+ years of widespread use of 12-hour shifts, nurses are asking these questions,

and the answers have sparked great debate.

Longer shifts also increase nurse burnout and job dissatisfaction. A 2012 study

found that the percentage of nurses reporting burnout and an intent to leave their jobs rose

as shift length increased. Nurses working shifts of 10 hours or more were up to 2.5 times

more likely than those working shorter shifts to experience burnout and job

dissatisfaction and to intend to leave their jobs. The same study showed patient

satisfaction declined as the proportion of nurses working more than 13 hours increased.

Working extended hours can lead to musculoskeletal injuries from prolonged exposure to

physical and postural risk factors and insufficient recovery time. What’s more, the risk of

blood borne-pathogen exposure for workers increases during the last 2 hours of a 12-hour
shift. One study showed needle stick injuries increased significantly in nurses working

12-hour shifts compared to those working 8-hour shifts.(Townsend and Anderson, 2013)

Strong physical and mental health is important for all employees irrespective of

level of management. From top level management to low level management, people wish

to have both strong physical and mental health in order to enjoy family as well as work

life happily and satisfactorily. Nominal working hours i.e., 8 hours or 6 hours working

will make employees productive and make them to concentrate balancing both family and

work life by devoting adequate time for family and social life. But, when working hours

is longer it will not only make the employees dissatisfied with work but also make

employees less productive and deteriorate their physical and them to quit the job. A

growing body of research shows that nurses working 12-hour shifts are more fatigued and

at greater risk for making errors. Roughly half of the shifts were scheduled for 12 hours

or more, and two-thirds of these shifts exceeded 12 consecutive hours. Long working

hours will distract their attention which will further affect safety of the patients. Hence,

long working hours not only affect physical, mental health, family and social life of

employees but also affect patients’ safety and organization reputation. The risk of making

an error or a “near error” increased with longer shifts, and longer shifts were also

associated with a decrease in vigilance. Specifically, critical care nurses working 12.5

consecutive hours or longer had nearly double the risk of making an error. (Baxter, 2014)

The fact that nurses often have to work irregular hours, nights and weekends takes

a real toll on their social lives and activities outside of work that are related to

interactions with family and friends. Being commonly unavailable for social functions

during the weekends and even on holidays can seriously compromise any worker’s ability
to maintain a normal and healthy social life outside of the office. Besides being

overworked, this lack of balance between work and social activities is one of the main

reasons why nurses tend to be so unhappy and why the turnover rate in hospitals is

constantly on the rise. (Brewer, 2001)

Patients who have experience with nurses working more than 13 hours are not

only unlikely to ever return to that hospital, they are also very likely to dissuade friends

and family from getting treated there. There are also studies that have been conducted

that confirmed that healthcare institutions operating in states that restrict mandatory

overtime show an increase in job satisfaction and better retention. The study conducted in

2010 showed that restricting, or at least limiting overtime, improves nurse safety and job

satisfaction. (Hoffman & Scott, 2003)

A total of 393 hospital staff nurses in Philadelphia revealed approximately 40% of

5,317 shifts worked exceeded 12 hours. It is important to note that approximately 30% of

originally scheduled shifts were 12 or more hours in duration, compared to the 40% that

were actually worked. In addition, long shifts exceeding 12 hours increased the likelihood

of errors or near errors, which could compromise patient safety. It is estimated that 20%

to 25% of the general population work outside typical business hours. A variety of shifts

exist to satisfy hospital nurse staffing, which often consist of 8, 10 and 12 hour shifts

throughout various times of day. There is widespread belief that longer shifts, such as 12

hours, may provide improved 16 communications and less time spent at change of shift

when handoffs occur. (Roger et al, 2004)

Extended shift work has crucial impact on employee health and sleep patterns. It

is known that shift work alters the body’s normal circadian rhythms and is thought to
alter several body systems. Temperature, blood pressure, mental alertness, and the

synthesis and secretion of hormones are affected. Job-related stress, including shift work,

is believed to be linked to health repercussions including cardiovascular, mental and

reproductive health. Job related stress is also higher in nurses working in rotating shift

patterns than nurses who work fixed day, afternoon or night shifts. These nurses reported

higher burnout, lower work satisfaction and expressed a greater willingness to leave the

workplace than fixed shift nurses. (Kilpatrick & Lavoie-Tremblay, 2006)

Extended work shifts of twelve hours or longer are common and even popular

with hospital staff nurses, but little is known about how such extended hours affect the

care that patients receive or the well-being of nurses. Survey data from nurses in four

states showed that more than 80 percent of the nurses were satisfied with scheduling

practices at their hospital. However, as the proportion of hospital nurses working shifts of

more than thirteen hours increased, patients’ dissatisfaction with care increased.

Furthermore, nurses working shifts of ten hours or longer were up to two and a half times

more likely than nurses working shorter shifts to experience burnout and job

dissatisfaction and to intend to leave the job. Extended shifts undermine nurses’ well-

being, may result in expensive job turnover, and can negatively affect patient care.

Policies regulating work hours for nurses, similar to those set for resident physicians, may

be warranted. Nursing leaders should also encourage workplace cultures that respect

nurses’ days off and vacation time, promote nurses’ prompt departure at the end of a

shift, and allow nurses to refuse to work overtime without retribution. (Patton et al.,

2010)
 Based on statistics, 30% of nurses would prefer to work in 8 hours shift while the

remaining 70% of them would go to 12 hours and above shift for they believe that

patients in the hospitals and nursing care facilities need round- the- clock care, nurses in

these settings usually work in rotating shifts, covering all 24 hours. So they work in

nights, weekends and holidays. They may also be on call. In terms of negligence there are

20% of errors and 50% of near errors happens in 8 hour shift, 30%of errors and 40% of

near errors in greater than 8 hours shift but less than 12 hours shift and 40% of errors and

70% of near errors occur in greater than 12 hours shift. (Ball, 2015)

The government has implemented the normal hours of work of any employee

shall not exceed eight (8) hours a day. Health personnel in cities and municipalities with a

population of at least one million (1,000,000) or in hospitals and clinics with a bed

capacity of at least one hundred (100) shall hold regular office hours for eight (8) hours a

day, for five (5) days a week, exclusive of time for meals, except where the exigencies of

the service require that such personnel work for six (6) days or forty-eight (48) hours, in

which case, they shall be entitled to an additional compensation of at least thirty percent

(30%) of their regular wage for work on the sixth day. Hours worked shall include (a) all

time during which an employee is required to be on duty or to be at a prescribed

workplace; and (b) all time during which an employee is suffered or permitted to work.

Rest periods of short duration during working hours shall be counted as hours worked.

Work may be performed beyond eight (8) hours a day provided that the employee

is paid for the overtime work, an additional compensation equivalent to his regular wage

plus at least twenty-five percent (25%) thereof. Work performed beyond eight hours on a

holiday or rest day shall be paid an additional compensation equivalent to the rate of the
first eight hours on a holiday or rest day plus at least thirty percent (30%) thereof. And

under time not offset by overtime. Under time work on any particular day shall not be

offset by overtime work on any other day. Permission given to the employee to go on

leave on some other day of the week shall not exempt the employer from paying the

additional compensation. (Harrington, 2001)

The study area, Capiz has grown significantly in the past few years in field of

health care. Many hospitals and pharmaceuticals have been established recently. But, still

in many hospitals and diagnostic centers twelve hours working with two shift working

system is practice. Low salary, incentives, unfair increment, promotion, discrimination on

the basis of caste, religion and locality, poor welfare facilities and absence of training and

development programs are apparently seen in most of the hospitals. When twelve hours

working pattern which affect health, family life and social life, join with these weak

human resource management system, it will definitely affect health of the employees

severely.

We are now living in a fast pace society. Number of population increases but low

demand for jobs, and products now are more expensive. Therefore people tend to work

for longer hours, at day time they work under the heat of the sun and as night time instead

of resting to regain strength for tomorrow’s activity they are still working what they

called “side-lines” to meet their financial needs.

As a student nurse, we are triggered about this clinical issue, therefore we

conducted this study to probe the efficacy of nursing care of nurses who go for extended

working hours in private hospital.

 Theoretical and Conceptual Framework

This study was anchored on the theory of self-efficacy by Albert Bandura. Self-

efficacy is the belief that one has the power to produce that effect by completing a given

task or activity related to that competency. Self-efficacy relates to a person perception of

their ability to reach a goal. It is the belief that one is capable of performing in a certain

manner to attain certain goals. It is the expectation that one can master a situation, and

produce a positive outcome. In relevance to work performance, self-efficacy theory has

been embraced by management scholars and practitioners because of its applicability in

the workplace. Self-efficacy is positively and strongly related to work-related

performance. The theory was based on the principle assumption that psychological

procedures, whatever their form, serve as a means of creating and strengthening

expectations of personal efficacy. The theory distinguishes between expectations of

efficacy and response-outcome expectancies. An efficacy expectation is the conviction

that one can successfully execute the behaviour required to produce the outcomes.

Although a person may expect a certain activity to lead to a particular outcome, they may

lack the motivation to perform the action, doubting their ability to do so.

Self-efficacy typically comes into play when there is an actual or perceived threat

to one’s personal safety, or one’s ability to deal with potentially aversive events

(Bandura, 1983). Increasing a person’s self-efficacy increases their ability to deal with a

potentially averse situation. Bandura defined self-efficacy as people’s beliefs about their

capabilities to produce designated levels of performance that exercise influence over

events that affect their lives.

 Expectation alone will not produce desired performance if the component

capabilities are lacking. Moreover, there are many things that people can do with

certainty of success that they do not perform because they have no incentives to do so.

Given appropriate skills and adequate incentives, however, efficacy expectations are a

major determinant of people’s choice of activities, how much effort they will expend, and

of how long they will sustain effort in dealing with stressful situations.

Conceptual Framework

In this study, it is assumed that younger nurses can perform better in extended

hours than their older counterparts due to the reason that ageing is associated with

recognized physical and mental changes including reductions in aerobic power, muscular

strength and endurance, reaction speed and acuity of special senses. Back pain, other

musculo-skeletal disorders and stress-related mood disorders are common health and

injury problems with older health workers, which can affect the care given to the patient.

On the other hand, older nurses can give better care towards the patient due to their years

of experience. Nurses who were the breadwinner of their larger family prefer working for

longer hours to meet the demands of their family. In terms of marital status, it is assumed

that nurses who were single prefer to work for extended hours in a shift than those nurses

who were married since they have lesser responsibilities at home. Their energy and

concentration is much higher thus work performance is more guaranteed. It is assumed

that committing errors in the workplace is minimal. Nurse’s work in extended hours to

increase their salary thus making good in their outcome that they will be preferred over

others. It is assumed that nurses who work in extended hours tend to have more burnouts
and that patients were unsatisfied with the care provided. They are more prone to commit

errors thus putting themselves, their patients and the hospital at stake.

Antecedent Variable Independent Variable Dependent Variable

Profile of Nurses
 Age
 Household
Size Nurse’s shift length Efficacy of Nursing
 Marital Status Care
 Years of
Experience

Figure 1.Showing the assumed relationship of variables in the study.

Objectives of the Study

This study aimed to find out the efficacy or outcomes of nurses working in an

extended shift length hospital duty. Specifically, it aimed to:

1. Determine the profile of nurses in terms of age, household size, marital status,

years of experience and salary.

2. Determine the number of shift length of the nurses who work in the hospital.

3. Determine the efficacy of nurses working in extended shift length in terms of

personal, hospital and patient outcomes.

4. Determine if there is relationship between the nurses’ profile and shift length.

5. Determine if there is relationship between shift length of nurses and their

efficacy.
 Hypothesis of the study

1. There is no significant relationship between the nurse’s profile and shift

length.

2. There is no significant relationship between nurse’s shift length and its

efficacy.

Significance of the Study

The results of this study may be beneficial to the Hospital Administrators,

Department of Labor and Employment, Department of Health, nurses, patients and future

researchers:

Hospital Administrators. The result of this study could give information as to the

outcomes of extended working hours to the nurses, patients and the administration.

Through the result, the administrators could have basic information which could serve as

basis of decision making, bench marking and creating measures that could safeguard the

givers and receivers of hospital services.

Department of Labor and Employment. A policy coordinating arm of the

executive branch in the field of labor and employment that is mandated to formulate

policies, implement programs, services and enforcement of the provision of the labor

code. Findings of the study could provide information to this agency that monitoring and

implementing labor practices be uphold and synthesized by health institutions and

agencies.

Department of Health. A department that is responsible for ensuring the access,

services and quality of care to reach all Filipino who are in need. The result of the study
could help the department to identify the factors in the provision of quality care to the

clients and will help them to develop a plan of action in regulating health care services of

health care agencies.

Nurses. Through this study nurses will be able to share their experiences and

insights of hospital work and the pros and cons of working over long periods that could

serve as primary source of information to this practice. The result could give information

and serve as basis of decision for themselves, their patients and the hospital.

Patients. The patients are the recipients of care. Through the findings of the study,

patients’ welfare, safety, and rights may be uphold to the fullest.

Definition of Terms

The following terms used in this study were conceptually and operationally

defined to enhance better understanding.

Age – as defined by Gerontology and the Concept of Aging (2018) refers to the

physical changes that “slow us down” as we get into our middle and older years.

In this study, age is classified as young when it falls between 30 years old and

below and old when it falls between 31 years old and above. It is obtained by answering

the profile in the questionnaire.

Household size- as defined by Immihelp (2017) is essentially the number of

persons for whom you are financially responsible. Some of these persons may not be

residing with you.

 In this study, household size is classified as small size if they have 1-2 family

members, medium size if they have 3-5 family members and big size if they have 6 and

more family members. It is obtained by answering the profile in the questionnaire.

Marital Status- as defined by Philippine Statistics (2017) is a status of an

individual in relation to marriage.

In this study, marital status is classified as the single, married, widowed or

separated. It is obtained by answering the profile in the questionnaire.

Years of Experience-as defined by Workplace (2014) implication of the

candidates with that amount of experience would be a good fit for the position. In reality

(and certainly in the current technology hiring climate), it's really your skills that count.

In this study, experience is classified as short experience if it is 2-5 years and long

experience if it is 6 years and above. It is obtained by answering the profile in the

questionnaire.

Salary- as defined by Payroll Definitions (2017) a specified amount of money that

changes hands between an employer and an employee in exchange for services rendered.

In this study, salary is classified as below 10,000, 11,000- 20,000 and 21,000 and

above.

Shift length- defined by Balance Careers (2018) a 24 hour a day and occasionally

7 days a week to keep an organization operating without a hitch and optimize work

output and productivity.

In this study, extend shift length refers to the clinical duty of nurses who extend

more than the traditional 8 hours shift. It is classified as long for 10 to 14 hours a day and

extensive for 16 or more hours of work a day.

 Efficacy – as defined by Research Gate (2018) as the ability to achieve result

intended.

In this study, efficacy is the outcomes and results of work of nurses affecting

herself, her patient as the recipient of her care and the hospital as the institution where in

he/she works or performs. It will be measured through a three category questionnaire.

The personal efficacy, patient efficacy and hospital efficacy.

Personal Efficacy - as defined by Positive Psychology Program (2018) personal-

efficacy is the belief we have in our own abilities, specifically our ability to meet the

challenges ahead of us and complete a task successfully.

In this study, personal efficacy is the effect of extended working hours on

their personal, social, family and professional life. It is measured by a 10 item questions

categorized as strongly disagree, disagree, neither/ nor agree, agree and strongly agree.

Validated by an interview using the interview guide questions.

Patient Efficacy – as defined by Science direct (2018) it is the capacity for

beneficial change (or therapeutic effect) of a given intervention (for example: a drug,

medical device, surgical procedure or a public health intervention.)

In this study, patient efficacy is the effect of extended working hours to the quality

of care they receive. It is the outcome of an in depth interview with patients who were

admitted more than 3 days in the hospital.

Hospital Efficacy – as defined by Science direct (2014) it is a level of value

provided by any health care resource, as determined by some measurement.

In this study, hospital efficacy is the outcome of the extended work hours of nurses

affecting the hospital in general. It is the outcome of in depth interview using the
interview guide questions among the hospital administrators, nursing service director,

nurse supervisors, head nurses, human resource director and hospital finance in charge.

Scope and Limitation of the Study

The respondents of the study was only be limited to staff nurses who have worked

more than the average working hours in a shift among private hospitals. The study were

confined only to hospital departments with admitted patients in a 24 hours rotation basis.

Respondents are staff nurses with at least a year experience working in the hospital. For

patient’s respondents, they are admitted at least 3 days in the hospital to give accurate

accounts of the care they received from nurses on extended duty shift. They must be sane,

conscious, oriented, coherent aging 18 to 70 years old. For hospital administration,

respondents are those personnel who have knowledge about the nurses’ shift, its

advantages and disadvantages.

The study is also limited to private hospitals who practices more than 8 hours duty

a day among their nurses.

 CHAPTER II

LITERATURE REVIEW

This chapter presents related literature and studies of the study being conducted.

Nurses’ shift length was calculated as the difference between the start and end

time of the most recent shift that the nurse worked. Shift length was grouped into four

categories: 8–9 hours, 10–11 hours, 12–13 hours, and more than 13 hours. These ranges

were used to account for changes in planned shifts. For example, shifts in the category of

10–11 hours might have involved overtime after an 8-hour shift. Scheduled shifts are

typically eight or twelve hours in length. For our analyses of patient outcomes, including

patient satisfaction, we used the hospital-level proportion of nurses working each of the

four shift-length categories.

Patient outcomes data were available only at the hospital level. In our analyses,

we estimated the effects of the four different shift category proportions—that is, the

proportion of nurses working each shift category—on each patient outcome. Across the

four shift length categories, more than 80 percent of the nurses reported being satisfied

with scheduling practices at their hospital. The percentages of nurses reporting burnout

and an intention to leave the job increased incrementally as shift length increased. The

percentage of nurses who were dissatisfied with the job was similar for nurses working

the most common shift lengths, 8–9 hours and 12–13 hours, but it was higher for nurses

working shifts of 10–11 hours and more than 13 hours. Large studies from Europe, the

UK and the US report that when nurses work shifts of 12 hours or longer, they are more
likely to report poor quality nursing care and reduced patient safety (Griffiths et al, 2014;

Stimpfel and Aiken, 2013; Stimpfel et al, 2013).

There is evidence that 12-hour shifts are associated with increased error rates

(Clendon and Gibbons, 2015) and increased levels of omitted nursing care (Griffiths et al,

2014), so any direct cost savings from a two-shift system could be offset by a loss of

productivity and adverse outcomes. Studies correlating long shifts with increased fatigue

and decreased alertness come from a wide range of industries (Dall’Ora et al, 2016).

While performance deficits have been associated with all shifts longer than eight hours, it

is not clear that there is a consistent linear decline (Griffiths et al, 2014). The effects of

shift length may be job-specific (Dall’Ora et al, 2016). Some nurses prefer 12-hour shifts

because they benefit from more days off and increased flexibility (Stone et al, 2006).

However, studies give a mixed picture: some have shown increased job

satisfaction with longer shifts (Stone et al, 2006), but larger and more recent studies show

lower job satisfaction, increased burnout and intention to leave the job (Dall’Ora et al,

2015; Stimpfel et al, 2012). Some nurses may be prepared to sacrifice job satisfaction for

personal benefits (Dall’Ora et al, 2015). None of the reviews cited recent, good-quality

evidence on actual turnover or sickness rates. Limited and dated evidence suggests that

educational opportunities may be reduced under 12-hour shifts for both student nurses

(Reid et al, 1991) and staff (McGettrick and O’Neill, 2006).

While there is clear evidence of risks associated with longer shifts, 12-hour shifts

in particular, few studies considered multiple shift work factors concurrently. This means

that results may be confounded or that factors not considered might mitigate adverse

effects.
 In the fully adjusted linear regression models, we found that seven of the ten

outcomes were significantly and adversely affected by the proportion of nurses in the

hospital working shifts of more than thirteen hours, including both of the global

assessments of care—patients’ rating of the hospital overall, and whether patients would

recommend the hospital. That is, increases in the proportion of nurses working shifts of

more than thirteen hours were associated with increases in patient dissatisfaction.

Although only 5 percent of the nurses in our sample worked shifts of more than thirteen

hours, the hospitals in the sample varied considerably in terms of the percentages of their

nurses working those shifts, from 0 percent to nearly 40 percent.

A change from 0 percent to 40 percent of nurses working those shifts would result

in nearly a five-percentage-point increase in the patients who gave the hospital a low

rating. We found a number of significant relationships between the other shift length

categories and patient satisfaction. Notably, having higher proportions of nurses working

shorter shifts—8–9 hours or 10–11 hours—resulted in decreases in patient dissatisfaction.

Although not all of the coefficients in are significant, it is note-worthy that all of the

significant ones associated with shifts of 12–13 hours and of more than 13 hours are

positive (that is, they indicate more dissatisfaction), while all of the significant

coefficients associated with shifts of 10–11 hours and 8–9 hours are negative (indicating

less dissatisfaction).Many hospitals and nursing homes are endangering patients by

allowing or requiring nurses to work more than 12 hours a day, according to a report

commissioned by the US government. Long hours cause fatigue, reduce productivity, and

increase the risk that the nurses will make mistakes that harm patients, says the report,

conducted by the Institute of Medicine. The report said many nurses and nursing
assistants worked more than 12 consecutive hours, with some working double shifts of 16

hours.

To reduce "error-producing fatigue," the report said, state officials should prohibit

nurses from working more than 12 hours in any 24 hour period or more than 60 hours a

week. The report said, "Long work hours pose one of the most serious threats to patient

safety, because fatigue slows reaction time, decreases energy, diminishes attention to

detail, and otherwise contributes to errors." Many hospitals and nursing homes have too

few nurses to take proper care of patients, it said. Intensive care units at hospitals should

have one licensed nurse on duty for every two patients, the report said. Nursing homes, it

said, should have one registered nurse for every 32 patients and one nursing assistant for

every 8.5 patients. So far, the federal government has not sought to set minimum staffing

levels for nursing homes, in part because such requirements would generate billions of

dollars in additional costs for Medicaid, Medicare, and nursing homes. The academy said

it found overwhelming evidence that as levels of nurse staffing rose the quality of care

improved, because nurses had more time to monitor patients and could more readily

detect changes in their conditions.

The odds of burnout and job dissatisfaction were up to two and a half times higher

for nurses who worked longer shifts than for nurses who worked shifts of 8–9 hours.Even

after we adjusted for potential confounding factors, the significant relationship between

longer shift lengths and nurse reports of burnout and job dissatisfaction persisted.

Compared to nurses who worked shifts of 8–9 hours, nurses who worked shifts of 10–11

hours had a greater likelihood of being burned out, being dissatisfied with the job, and

intending to leave the job. So did nurses who worked shifts of 12–13 hours, although the
impact of shift length was smaller for them than for nurses in the shift category of 10–11

hours.

The odds of these unfavorable outcomes were highest for nurses who worked

shifts of more than 13 hours. Job satisfaction was assessed using a four-point Likert

scale–type question, “How satisfied are you with your job?” Responses, which ranged

from very satisfied to very dissatisfied, were dichotomized to contrast satisfied and

dissatisfied respondents. Burnout was measured using the nine-item emotional exhaustion

subscale of the Maslach Burnout Inventory, a reliable and valid instrument for assessing

burnout in human service professions. Scores totalling twenty-seven or more are

considered an indication of high emotional exhaustion, and our analysis contrasted nurses

with burnout scores of twenty-seven and above and those with scores below that point.

Nurses’ intent to leave their employer within the next year was assessed using a single

yes/no item. Nurses reported leaving work at the end of their scheduled shift less than

20percent of the time during the study period.

In the study of “The Working Hours of Hospital Nurses and Patient Safety”

several trends in hospital use and staffing patterns have converged to create potentially

hazardous conditions for patient safety. High patient acuity levels, coupled with rapid

admission and discharge cycles and a short-age of nurses, pose serious challenges for the

delivery of safe and effective nursing care for hospitalized patients. While systematic

national data on trends in the number of hours worked per day by nurses are lacking,

anecdotal reports suggest that hospital staff nurses are working longer hours with few

breaks and often little time for recovery between shifts (Rogers, 2014). This is important

for the health care industry to consider as the nursing workforce ages and there is a need
to retain them through improved job attributes (D. Martin, 2009). Decades of research

and studies have shown that there is a real and palpable connection between job

satisfaction and a nurse’s ability to provide proper care for his or her patients. If you ask

any nurse why he or she puts up with the long hours and everything else that makes the

job so hard, most will probably tell you that it’s because they love helping people and

they love the feeling that helping people to get health gives them. A variety of shifts exist

to satisfy hospital nurse staffing, which often consist of 8, 10 and 12 hour shifts

throughout various times of day.

In “Nurses’ Shift Length and Overtime working in 12 European Countries” study,

traditionally, shift work was organized by dividing the day into three 8-hour shifts. This

pattern was the norm in nursing for many years. In common with other industries, there is

now a trend for some health care employers to adopt longer shifts, typically 2 shifts per

day each lasting 12–13 hours. Employees work fewer shifts each week. Changes are

driven by perceived efficiencies for the employer, and improved work life balance for

employees because they work fewer days per week. However, persistent concerns have

been raised about negative impacts on the quality of care associated with working longer

hours. From an employer’s perspective, a move from 3 to 2 shifts per day reduces periods

of shift overlap and the number of handovers, thus reducing costs by reducing total

workforce requirements. Because handovers and overlaps between shifts are regarded as

unproductive, the aim is to improve efficiency with no detrimental effect on quality.

Indeed a reduced number of handovers might have beneficial effects as handovers are

associated with discontinuity and errors. From an employee perspective, there are reports
that many nurses prefer the compressed working week that results from working fewer

shifts.

Nonetheless, the introduction of 12-hour shifts has raised concerns. Long working

hours are correlated with fatigue and decreased levels of alertness, potentially resulting in

more adverse events. However, the point at which longer shifts adversely affect

performance is likely to be industry, context, and task specific, and studies in health care

have given mixed results. A recent study based on a survey of 22,275 registered nurses

(RN) in 4 US states found that nurses who worked shifts of ≥12 hours were significantly

more likely to report poor quality of care and poor patient safety when compared with

nurses working 8- to 9-hour shifts. Patients in hospitals where a higher proportion of

nurses worked longer shifts also reported lower satisfaction. However, the odds of

adverse reports of quality and safety were greater for nurses working 10–11 hours than

for those working ≥12, which is inconsistent with a simple effect from longer hours

worked on the shift. Analysis of a subsample of 3710 pediatric nurses found that reports

of poor quality and safety were substantially elevated only among nurses working >13

hours (Griffiths, 2014). This can affect the nurses’ performances in caring for patients

and this was strongly supported in the research of “Negative Impacts of Shift work and

Long Work Hours” according to them, without adequate sleep, people feel sleepy, are

less alert, and can fall asleep involuntarily. Sleep deprivation increases pressure for the

brain to fall asleep.

The transition from wakefulness to sleep is abrupt and rapid and occurs in an on-

off-type switch in the brain stem (Schwartz & Roth, 2008). This can lead to dangerous

situations if the brain is under high pressure for sleep and the person falls asleep
involuntarily during critical times, such as when driving or providing patient care.

(Caruso, 2013). The results can be summarized as follows: (I) working night shifts does

not have a significant effect on the conflict in balancing work and child care. Also

findings show that three‐shift duty is more likely to increase the conflict. (II) When

supportiveness about child care responsibilities with small children is absent at work, the

conflict is likely to increase. (III) For mothers working night shifts, the reduction of the

duties are likely to reduce the conflict. These results highlight the importance of

establishing a system in which nurses can select the work hours flexibly and to promote

awareness at work regarding the importance of child care support to strike balance

between the nursing work and child‐raising. The difficulty in balancing work and child

care is one of the main factors that prevent inactive nurses from returning to work. Also,

enrichment of child care support is important to reemploying inactive nurses.

Nursing is a rapidly aging, and female‐dominated workforce. However, despite

the ageing of the nursing workforce, little is known about the needs and health concerns

of older nurses. A feminist perspective was used and 12 female Registered Nurses aged

40–60 years, employed in various acute hospital and community health settings in

Australia took part in qualitative interviews in late 2004. Narratives were audio taped,

transcribed and analyzed thematically. Further research is needed to explore the need for

protective work practices and promoting healthy lifestyle practices for ageing nurses.

Managers need to recognize the changing health needs of older clinical nurses and offer,

for example, flexible roistering and tailored exercise programs to promote their health.

Changes of alertness and cognitive efficiency has been suggested in people whose

circadian rhythms are disrupted, e.g. night or shift-workers. Data from field and
laboratory studies have demonstrated short-term cognitive disturbances related to

circadian rhythm disruption. By contrast, little is known about the long-term

consequences of chronic sleep deprivation, as can be observed with shift-work, on

cognitive abilities. The present paper is aimed at evaluating, on a large cross-sectional

sample of workers, the long-term influence of shift-work on verbal memory and speed

performances. Participants were 3237 workers aged 32, 42, 52, and 62 years of various

occupational statuses included in the VISAT (Aging, Health and Work) cohort. Data

collected by questionnaires included items on working hours and shift-work and sleep

disorders.

Cognitive abilities were assessed using neuropsychological tests. Current male

shift-workers had lower cognitive performance than never exposed workers. In the same

population, memory performance tended to decrease with increasing shift-work duration.

Among former shift-workers, the cognitive performance of the participant having stopped

shift work more than 4 years ago seemed to be increased, suggesting a possible

reversibility of effects. In conclusion, this study demonstrated that cognitive functioning

tends to be impaired by a long-term exposure to SW.

As found by other authors, neuropsychological performance tends to decrease

with the increases in the duration of exposure to SW. This study was conducted between

June 1 and July 31, 2015 on 244 male manual workers aged 20–39 years old at a display

manufacturing company and investigated age, marital status, education level, alcohol

consumption habit, smoking habit, regular exercise habit, sleep duration, sleep debt, sleep

insufficiency, past medical history, current and past shift work experience, duration of
shift work, and weekly work hours through face-to-face interviews using structured

questionnaires and performed blood tests.

Study participants were divided into daytime, former shift, and current shift

workers based on the work schedule. Chi-square tests and one-way analyses of variance

were performed to compare inflammatory markers and cardiovascular disease risk

factors, and analyses of covariance were conducted after adjusting for variables

potentially affecting inflammatory markers.

Workers who engage in shift work or who work long hours can experience

considerable disruption of family and social activities as many of these rhythms of the

general population are oriented around the day. Saturday and Sunday work, for example,

can preclude involvement in sporting events or religious activities. Shift work can thus

lead to social marginalisation.Family and marital responsibilities can be severely

disrupted by shift work or long hours. Childcare, housework, shopping, and leaving a

partner alone at night can all lead to marital strain and family dysfunction. On the

positive side, for those shift workers who like relatively solitary leisure pursuits or who

abhor the crowds often find that shift scheduling provides them with greater opportunities

to do what they want to do in their non-working time. Work is an important part of

everyone’s life. Satisfaction with work is an important part of everyone’s life as it can

affect a number of basic human needs such as nurturing the mind and body, social

relationship, creation of sense of worth, self-confidence and competency.

Also it may be the main source of dissatisfaction (Peiman Pak et al., 2012).The

entrance of people to work world due to nature of some jobs such as nursing has caused

the confrontation of them with some phenomena named workplace conflict, family
conflict and work–family conflict. In these conflicts, Job commitments and family

commitments interact with each other and affect the quality of life of people; and

consequently lead to occurrence of problems such as marital dissatisfaction (Rajabi et al.,

2013).

Successful marriage causes satisfy the physical and psychological needs in people

and in the cases of unsuccessful marriage, the couples and their children encounter with

severe psychological trauma. Therefore; the survey of marital satisfaction and the factors

that can affect of durability of marital life, is very important (Padash et al., 2012).

Marital satisfaction is one of the most important determinative factors of healthy

function in family (Greef et al., 2000). Kaplan and Maddux (2002) stated that the marital

satisfaction is a personal experience in marriage and it can be assessed only by the

couples. This occurs through their response to satisfaction rate from marital relationship.

They believed that the marital satisfaction is dependent to individuals’ expectations and

beliefs (Kaplan & Maddux, 2002). Marital satisfaction consisted of four domains such as

physical and sex appeal, understanding, attitude and investing (Mobarak Abadi et al.,

2014).The mentioned satisfaction was not easily accessed (Myers, 2004). From the

beginning of marriage, differences and disagreements between man and woman in

majority issues and unsolved problems can face them with threats in marital satisfaction

and stability (Tallman & Hsiao, 2004).Overall, quality of life increases marital

satisfaction and mental health (Kazemi et al., 2011). Quality of life is a sense of

wellbeing that is arises from the satisfaction or dissatisfaction in various important

aspects of life (Sammarco, 2001). For each person, quality of life is dependent on his
unique perception from life and life satisfaction; in spite of the relationship with family,

friends and community.

According to the importance of balance performance in family and prevention of

its disconnection, the recognition and assess the related factors with marital satisfaction

which is the foundation for a strong family, is very important.

Therefore, with attention to effective factors on marital satisfaction, it is expected

that with the increase of level of marital satisfaction, many psychological, emotional and

social problems would be decreased in family and in the community. Also; with the

improvement of the marital satisfaction level and Life satisfaction, the people carry out

their duties with greater confidence and peace of mind (Heidari & Eghbal, 2010).Due to

the unique nature of nursing profession and high stress conditions for nurses, the specific

problems have been created for them and with regard to the problems in nurses’ health

status due to satisfaction, it is important to survey the marital satisfaction of this stratum

of society.

Marriage life has the various aspects such as financial issues and emotional

relationship. Due to the increasing number of family roles, individuals’ duties and the

challenge concerning to the balancing between job and family roles, this study intent to

response to this question “Does the nurses’ quality of life affect on their marital

satisfaction?”Limited research have been examined the relationship between quality of

life and marital satisfaction. Vibha, Saddichha, and Akhtar (2010) compared the quality

of life and marital adjustment in patients with epilepsy and psychiatric patients. 60

patients (30 Epileptics and 30 bipolar patients) were studied.

 Results showed that there is no significant relationship between quality of life and

marital adjustment in two groups (Vibha et al., 2010). The results of Pereira et al study

(2011) in which quality of life, behavioral issues and marital adjustment were examined,

also demonstrated that there is significant positive relationship between high level of

quality of life and marital adjustment. Also; the findings of Gameiro et al. (2011) showed

that there is significant positive correlation between marital satisfaction and quality of life

and the promotion of quality of life causes the increase in all aspects of marital

satisfaction (Pereira et al., 2011; Gameiro et al., 2011).

Whisman et al in study on 744 American couples confirmed the existence of

relationship between anxiety and depression with marital satisfaction. In this study, they

realized the relationship between psychological health status and couples’ satisfaction

(Whisman et al., 2004).The study by Rostami et al. (2013) was conducted to determine

the effectiveness of quality of life based treatment on psychological well-being in

incompatible couples. Results demonstrated that this treatment causes the improvement

of psychological well-being and components of environmental skills, personal growth,

positive relationship with others and self-acceptance (Rostami et al., 2013). According to

above mentioned, the current study was conducted aimed to determine the relationship

between quality of life and marital satisfaction in nurses in Social Security hospital in

Zahedan.

Marital satisfaction is one of the most important determinative factors of healthy

function in family and can be affected by some factors. In this descriptive and

correlational study, the population was the all of the nurses in various wards in Social

Security hospital in Zahedan. The sample size was 103 and data collection was done
through quality of life questionnaire (War and Sherborn) and Enrich Marital Satisfaction

Scale. Data analysis was done through SPSS15 and using Pearsons’ correlation

coefficient and stepwise regression. The aspects of physical functioning, role limitations

due to physical health problems, role limitation due to emotional problems had a

significant positive correlation and the bodily pain had a significant reverse correlation

with aspects of marital satisfaction. The aspects of role limitations due to physical health

problems and bodily pain were predictors of marital satisfaction.

It has been proposed that almost one in five workers leave shift work because they

cannot tolerate it, about 10% positively enjoy it, and the rest tolerate it to a greater and

lesser extent. Personality may play a part in this as there is an association between

neurotic introversion and intolerance to shift work. It may be simplistic to view introvert-

extrovert personality types in this way but there is some physiological support for the

importance of personality if people are viewed as morning types and evening types.

People who are at their best in the morning face more difficulties in adjusting their

circadian rhythms to night work compared with those who feel better in the evening. By

contrast, evening types have greater problems with the early morning shift. Physical

factors may also play a part and are discussed later.Physical fitness does seem to be

important in helping workers to cope with shift work, so advice on exercise, diet, and

sleep management helps the person to manage his or her approach to shift work.Finally,

there is the much debated issue of health surveillance. The Working Time Directive calls

for health checks for night workers, although it is unclear what a health check might be!

Some suggestions for an effective, and to some extent, an evidence based approach has

been proposed by Costa et al. A sensible and measured stance has also been promulgated
in a guidance booklet published jointly by the Society of Occupational Medicine and the

Faculty of Occupational Medicine in the United Kingdom. A total of 12 hours per shift, 3

to 4 days a week, and P700 a day.

These figures sum up the reality for Albay native Faith Barcelon, a 24-year-old

nurse for a government hospital in Quezon City. Barcelon, like most nurses, does not

have the privilege of a fixed schedule. Their shifts are assigned each month and vary

every week – often at random. On one Monday, for example, she was assigned to take the

morning shift from 6 am to 6 pm. Her next shift on Thursday, meanwhile, starts at night.

On other days, she's on call, which means she has to be ready to report to work if the

need arises.Her income is never the same each month either. On busy months, she could

earn as much as P16, 000 – that's when she's called to report more often than usual. On

regular months, she gets to take home only around P10, 000. "I have to pay my rent,

groceries, provide for my transportation. Kulang na kulang [ang sweldo]. Minsan

nagpapadala nanay ko just to sustain me (My salary is really not enough. Sometimes my

mother sends money just to sustain me)," Barcelon said. While the law sets the minimum

pay for entry-level nurses at government hospitals at P19,000 a month (Salary Grade 11),

Barcelon works on a contractual basis, like most of her colleagues. This also means she

doesn't get benefits that regular employees enjoy. For social services, "you have to pay on

your own," she added. With her income, she can only pay for a PhilHealth membership.

There were increased levels of fatigue, as thirteen (54%) nursing staff reported

feeling tired during the 12-hour shifts, although this was also attributed to factors

including patient dependency, workload and personal issues. The findings in relation to

sickness absence however present a more mixed picture; levels of sporadic (or short term)
sickness dropped during the trial (1072 hours compared to 1911 hours the previous year),

whilst longterm sickness increased (2087 hours compared to 938 hours the previous

year). Using a cross-sectional design with data collected from a range of sources (survey,

administrative and patient records), Stone et al. (2006) compared levels of burnout

(Maslach Burnout Inventory) and job satisfaction with nurses’ shift patterns. Nurses

working 12-hour shifts were more satisfied with their jobs, experienced less fatigue, were

10 times more satisfied with their shift patterns than and twice as likely to perceive 12-

hour shifts as important.

Synthesis

In summary of the literature review, it is shown that many personal and

contributing factors are affecting the decision of the nurses that why they go through an

extended shift length. Somehow going in an extended shift length has advantages and

disadvantages. The advantages shown were there are able to have longer time with the

patient which can be a help for the nurses to improve their skills and knowledge about the

disease proper and to the facilities of the hospital. While the disadvantages are there is an

increase in number of errors and near errors towards their care to the patient. Also it can

affect their selves as well. Their personal, social, mental, emotional and their health. Due

to extended shift length nurses reported higher burnout, fatigue, easy get sick, decrease

first line of defense, stress, lack of sleep, lack of organization and dissatisfaction of the

patient to the care they received from the nurses. And because of this, most nurses who

work in an extended working hours has lower work satisfaction and expressed a greater

willingness to leave their work place that cause them to become depress about their job,

self and everything and that is the ultimate reasons to the nursing shortage.
 CHAPTER III

METHODOLOGY

This chapter discusses the research design, study of area and population, research

instruments used, data gathering with ethical considerations and the statistical data

analysis.

Research Design

Based on the problem that was investigated, the research design employed was

descriptive and correlational in nature, using descriptive quantitative methods of data

collection.

Quantitative research is adopted as a research strategy for this study. Quantitative

research method was adopted because it allowed the researcher to get to the facts and not

abstract about the aim of study (Bryman and Bell, 2007). According to Matthews & Ross

(2010) quantitative research methods are basically applied to the collection of data that is

structured and which could be represented numerically.l

Methods

Area and Participants

This study was conducted among private hospitals who have given their consent

to participate in the study. The respondents are 95 nurses that are working for 12 to 16

hours of duty a day in the hospital. These nurses are assigned in wards that cater patients
for 24 hours. For patients respondents, inclusion criteria includes hospital admission of at

least 3 days, 18 to 60 years of age, conscious, coherent sane.

The participants of the study consisted of 95 staff nurses, 14 patients under their

care, hospital administrators, human resource officer, chief nurses, nurse supervisor, head

nurses and chief of hospital. The socio-demographic profile of the nurses includes the

age, household size, marital status, salary and years of experience.

This study utilized nurses and patients confined at the hospital. Nurses who cater

patients in general ward and are going on duty for more than 12 hours per day. An

inclusion criteria for nurses include those assigned permanently in general wards catering

admitted patients in a 24 hour rotation rendering at least 12 hours a day duty for at least

10 times within a month. All regular nurses were taken as respondents.

Inclusion criteria for patients include those admitted in general wards for at least 3

days and must be 18 to 70 years old. They must be conscious, oriented, awake and

coherent. For patient respondents, purposive sampling was utilized. Those who fit the

inclusion criteria were taken as patient respondents.

For hospital administration, the hospital administrators, chief nurses, nurses’

supervisors and accompants, the human resource personnel were interviewed in depth to

answer the objectives of the study. There were 12 total number of the hospital

administrator respondents. For nurses respondents for descriptive data a total of 16 nurses

were interviewed.

Sampling Procedure
 For quantitative data, total enumeration for nurse respondents who fits the

inclusion criteria was utilized. A total of 95 staff nurses among the two private hospitals

were taken.

For descriptive data, hospital administrators, a total of 12 hospital administrators

which includes the Chief Nurse, Nurse Supervisor, Head nurse, Human resource director

and Chief of Hospital were taken. For patient respondents, a total of 14 patients were

selected who fits the inclusion criteria.

To counter validate the response of the nurses, 16 staff nurses were interviewed

who were assigned in general wards who cater patients for 24 hours and who rendered

duty for 12 to 16 hours per shift for at least 10 times a month.

Research Instrument

Data were collected using researcher-made questionnaires which were developed

to answer the objectives of this study. It was subjected for validation by the adviser and

the research panel. Part I of the questionnaire focused on the profile of nurse respondents.

Part II of the questionnaire focused on the average hour per shift rendered by staff nurses.

Part III of the instrument focused on the efficacy of the nurses who worked for 12 to 16

hours per shift. It was divided into 3 sections, the personal, and patient and hospital

efficacy. It was composed of 10 questions for each category with a total of 30 items in all,

with positive and negative questions answered by a 5 points Likert scale and scored as

strongly disagree, disagree, neither agree nor disagree, agree and strongly agree. For

descriptive data, an interview guide was used.

Validity and Reliability of the Questionnaire

Validity

The researcher-made questionnaire was subjected to validation by the adviser and

the member of the panel which are considered experts of the field. Their corrections,

suggestions, comments will be incorporated to the final questionnaire.

Reliability

The properly validated questionnaires were pre-tested among thirty (30) nurses

who are not direct respondents of the study. Responses were computer generated. A score

of .75 and above was consider the questionnaire to be reliable.

Ethical Consideration

Confidentiality in this research study was observed through these measures.

Permission must be taken first from hospital administrators through channel and from the

respondents before giving them the questionnaire. They can refuse anytime along the

process and/or not to answer the questionnaire. There was an open venue to ask

questions. The researcher made questionnaire passed approval from the ethical Review

committee of the College of Nursing.

Data Gathering Procedure

Before conducting the study, a letter asking permission to conduct this study was

sent to the hospital administrators. The researchers explain in the letter the purpose of the

study. The researcher assumed the anonymity and confidentiality of the participants.

Upon approval, the researcher personally distributed and administered the questionnaire

among the participants who were given enough time to answer the questionnaires and the

same were collected immediately thereafter. Upon retrieval, the researcher reviewed the
completed forms to make sure that all data requirements have been obtained. To stimulate

the interviewee to reveal underlying opinions, attitudes and reasons for their behavior.

Other data were collected from the respondents using unstructured or unstandardized

interview. The interview was conducted at the convenient place for the participant. The

researchers gave enough time for the nurses to answer the questions given. Any vague or

inconsistent responses during data gathering were clarified immediately to obtain valid

answer from the respondents. Information were gathered through the use of audio

recorder and were transcribed for further processing. The in-depth interview was

conducted individually among the target respondents.

For quantitative data, responses were coded, tabulated and processed using SPSS.

For qualitative data, an in depth interview was done until data saturation was achieved.

Data Analysis and Interpretation

The gathered data was encoded, processed and analyzed using the Statistical

Package for Social Sciences (SPSS). Analysis of the results of the study was done with

the help of the statistician. Frequency distribution, mean and percentage were used to

describe the characteristics of the respondents. Mean was used to get the average working

shift. Chi-square test was used to determine the relationship between each variable such

as characteristics of the respondents to the shift length and shift length to the efficacy or

outcomes. All statistical results were generated through the use of SPSS.

Scoring of Variables

For on personal, hospital and patient efficacy of nurses working on extended shift,

the scores were classified with subsequent interpretation as follows:

 Score Interpretation

4.21- 5.0 Highly Effective

3.41- 4.20 Effective

2.61-3.40 Complacent

1.81-2.60 Less Effective

1- 1.80 Ineffective
 CHAPTER IV

RESULTS AND DISCUSSION

This chapter presents the analysis and discussion of the findings of this study. The

results are discussed in the following areas: profile of the respondents, hours of shift

length, and efficacy of nurses working in extended shift length, p values between profile

and shift length of nurses and p-values between efficacy and shift length of nurses.

Table 1. Profile of the Respondents

N= 95
Variables Frequency Percentage
Years of Experience
1-5 years 66 69.6
6 years or more 29 30.5
Age
30 years old and below 67 70.5
More than 31 years old 28 29.5
Marital Status
Single 66 69.5
Married 28 29.5
Widowed/Separated 1 1.1
Household Size
1 – 2 Family members 8 8.4
3 – 5 Family members 65 68.4
6 or more Family members 22 23.2
Monthly Salary
Below PHP 10,000 43 45.3
PHP 10,000 – 20,000 52 54.7

As shown in Table 1, a little more than half (69.5%) of the respondents have

earned 1-5 years of experience while a little more than one fourth (30. %) has 6 or more
years of experience as staff nurse. Majority of them are at the age of 30 years old and

below (70.5%) while,a little more than one fourth (29.5%) are more than 30 years old.

Out of 95 respondents, 66 are single (69.5%), more than one fourth (29.5%) of them are

married and only 1 is widowed or separated (1.1%). As to household size, more than half

(68.4%) have 3-5 family members, followed by those whose family is composed of 6 or

(23.2%) while only (8.4%) have 1-2 members of the family.

In terms of monthly salary, a little more than half (54.7%) have a monthly salary

of 10,000 to 20,000 pesos while (45.3%) are receiving a monthly salary of 10,000 pesos

and below.

Based on the data gathered, nurses that has short tenure, young, single and

belongs to the medium size family has the higher number than those who has long tenure,

old, married and has big family size. And it showed that more of them received10,000-

20,000 pesos as their salary that those who received 10,000 pesos and below.

Table 2. Number of Hours of Shift Length of Nurses in the Hospital

Variable Frequency Percent

Average Working Hours
12 hours 58 61.1
16 hours 37 38.9

As presented in Table 2, .more than half (61.1%) are working in the hospital for

12 hours a day, while (38.9%) stayed for work in the hospital for 16 hours a day duty. It

could be inferred that nurses are working more than the required number of hours for an

employee to serve in a day.

 According to Parkinson, et all (2010). Family life, communication with nurses,

patient care, continuity of care, time off, and job satisfaction received the highest score in

the survey, indicating that 12 hours shift allowed greater satisfaction. In addition to this

The positive effects of working extended shifts include the ability to work a second job,

more days away from work, and more free time with family and friends. Nurses have

more time for leisure and social activities, more time for domestic duties, fewer shift

“hangovers,” and less travel time to and from work. Organizations favour extended shifts

because managers have to provide staffing for only two shifts instead of three, experience

less staff turnover, and have less overtime. Nurses have less pressure to complete

assignments in an 8-hour day and better continuity of care (Knauth, 2007; Richardson et.

al., 2007).

12-hour shifts are relatively common: in a survey of nurses across the UK, 41% of

NHS hospital nurses and 63% of nurses in care homes regularly work 12-hour shifts.

Employers are reported to prefer 12-hour shifts because of increased continuity of

staffing, lower staffing costs, and potential improvements in staff morale. Positive effects

were found with planning and prioritizing care, improved relationships with

patients/relatives, good quality time off work and ease of travelling to work. Less

favourable effects were with caring for patients in isolation cubicles and the impact on

staff motivation and tiredness. Acceptable patterns of work were suggested for ‘numbers

of consecutive shifts’ and ‘rest between shifts’.

The result of the questionnaire sshowed that there is a higher number of nurses

who go for 12 hours shift than of that in the 16 hours shift. Nurses shared that their

schedules were not made by them but was prepared by the Nursing Service Office and at
times they chose to go for extended shift to help their collegues because of the higher

ration of the patients than nurses.

Table 3a. Efficacy of Nurses in terms of Personal working in Extended Shift Length

Neither
Strongly
Strongly Agree/ Disagree
Questions Agree (4) Disagree
Agree (5) Nor Agree (2)
(1)
(3)

f % F % f % f % f %
1. I often got sick because of 15.7 14.7 2 27.3
2 2.1 15 14 38 40
inadequate rest. 9 4 6 7
2. My knowledge on patient 32.6 62.1
31 59 5 5.26
cases was enhanced. 3 1
3. I am still happy to render
30.5 51.5 11.5
comprehensive nursing care 29 49 11 6 6.32
3 8 8
despite of tiredness.
4. I was made to write an
15.7 23.1 1 11.5
incident report because of 15 9 9.47 22 38 40
9 6 1 8
clinical errors.
5. I feel motivated when I see
58.9 32.6
improvement on my patient’s 56 31 8 8.42
5 3
health.
6. I have developed rapport and
56.8
teamwork with the medical 54 38 40 3 3.16
4
team.
7. I easily get irritated when 26.3 38.9 25.2
5 5.26 25 37 24 4 4.21
bothered by patients and folks. 2 5 6
8. I cannot have quality time 13.6 18.9 47.3 1 16.8
3 3.16 13 18 45
with my family. 8 5 7 6 4

9. My skills were enhanced due 49.4

39 41.1 47 7 7.37 2 2.11
to longer bedside exposure. 7
10. I do not have time to attend 17.8 15.7 50.5 1 10.5
5 5.26 17 15 48
to my personal needs. 9 9 3 0 3
The above table shows that more than one half of 95 nurses disagreed and strongly

disagreed (40 vs. 27.37%) that they often got sick because of inadequate rest while only

very few agreed on the said statement. More than half of them (62.11%) have positive

view on the statements which states that their knowledge on patient cases was enhanced.

Almost the same frequency and percentage of the nurses (51.58%) stated that they are

still happy to render comprehensive nursing care despite f tiredness. This implies that

their shifts length does not affect their performance. On the statements which states that: I

was made to write an incident report because of clinical errors, there were 38 or 40%

disagreed and 11 or11.58% strongly agreed. However, 22 or 23.16 cannot accurately

decide on this issue.

More than half (58.95%) feel motivated when they see improvement on their

patient’s health, followed by those who agreed (32.63%). They have developed rapport

and team work with the medical team as shown by a frequency of those who strongly

agreed which is 54 or 56.84% and agreed equivalent to 38 or 40%. However, they are

divided on the statement that they easily get irritated when bothered by patients folks as

supported by a frequency and percentage of those who agreed equivalent to the frequency

of 25 or 26.32% while undecided are 37 or 38.95% and those who disagreed have

frequency f 25 or26.32% while undecided are 37 or 38.95% and those who disagree do

have frequency of 24 or 25.26%.

Almost ne half of them with a frequency f 45 or 47.37% disagreed that they

cannot have quality time with their family and 16 or 16.87% strongly disagreed on this

idea. Only very few agreed on this statement which is 9. A significant number agreed or

strongly agreed that their skills were enhanced due to longer to longer bedside exposure
showing the frequency of 39 or 41.1% of those who strongly agreed and 47 or 49.47% of

those who agreed. 10 more than half strongly disagreed that they do not have time to

attend to their personal needs as evidenced by a frequency f 48 or 50.58%. The above

data imply that their self-efficacy of nurses is nit negatively affected by the shift length.

Findings also support the study of Maram Banakhar on “The Impact of 12 hours

shift on nurse’s health, well- being and job satisfaction: A Systemic Review” (2017) of

the 4 studies measuring the impact of 12 hours shift n fatigue, three studies showed that

the nurses experienced more fatigue in the 12 hours shifts in comparison to 8 hours shifts;

nevertheless, one study did not find a significant difference in fatigue and critical

thinking performances between 12- and 8 hour shifts. In addition, to this, the Kings

College (2015) conducted a study abut “12 hour shifts for Nurses could Impact Patient

Care” they stated that researches noted a move away from traditional patterns of work

over the last two decades with many hospitals supporting 12-hour shift as they believe it

is a cost – effective way for providing around the clock care. Nurses were also found to

prefer working longer hours over fewer shifts, as they claim it gives those greater levels

of flexibility and more days at home their families and friends.

Table 3b. Efficacy of Nurses in term of Hospital Outcomes Working in Extended Shift Length

Questions Strongly Agree (4) Neither Disagree Strongly

Agree (5) Agree/ (2) Disagree
Nor Agree (1)
 (3)
F % F % F % f % f %
1. The hospital is known by its
29 30.52 55 57.89 10 10.53 1 1.05 0
competent and able nurses.
2. The hospital is sought after by
31 32.63 44 46.32 16 16.84 3 3.16 1 1.05
the doctors and patients.
3. The hospital gives employees
18 18.95 41 43.16 25 26.32 9 9.47 2 2.11
benefits on time.
4. I have made the hospital pay the
24 25.26 29 30.53 18 18.95 22 23.16 2 2.11
bills of my patient.
5. Community people prefer to be
30 31.58 52 54.74 12 12.63 1 1.05
cared by our nurses.

6. The hospital faced lawsuits

6 6.32 31 32.63 41 43.16 14 14.74 3 3.16
because of nurses’ negligence.
7. The hospital administrators
complimented our nurses’ 8 8.42 36 37.89 25 26.32 9 9.47 17 17.89
performance.
8. The hospital receives good
21 22.11 50 52.63 21 22.11 3 3.16
feedback from to the public.
9. The hospital receives many
complaints from dissatisfied 6 6.32 14 14.74 48 50.53 22 23.16 5 5.26
clients.
10. The hospital management
conducted counselling over my 17 17.89 14 14.74 29 30.53 26 27.37 9 9.47
performance.

Table 3.b shows that more than half of them with a frequency of 55 or 57.89%

agreed that the hospital is known by its competence and able nurses followed by those

who strongly agreed with a frequency of 29 or 30.52%. 2. They believed that the hospital

is sought after by the doctors and patients as proven by those who agreed with a

frequency of 44 or 46.32% and those who agreed with a frequency of 31 or 32.63. 3.

Forty one or 43.16% agreed that the hospital gives employees benefits on time; however,

25 or 26.32% of them are undecided regarding the said issue.

On the statement which states that: I have made the hospital pay the bills of my

patient”. 24 or 25.26% strongly agreed, 29 or 30.53% agreed, while 18 or 18.95% are

undecided, 22 or 23.16% disagreed and only 2 or 2.11% strongly disagreed. 5. More than

half of them agreed that community people prefer to be cared by their nurses as shown by

the number of 52 or 54.72% then followed by those who strongly agreed on the statement

with 30 or 31.58%. On the statement which states that the hospital faces lawsuits because

of nurses’, negligence, almost half of them are undecided with a frequency of 41 or

43.16% followed by those who agreed with a frequency of 31 or 32.63%.

On the statement which states the hospital administrators complimented their

nurses’ performance, 36 or 37.89% agreed, however, there are those who are undecided

with a frequency of 25 or 26.32%. The hospital receives good feedback from the public

as evidenced by a more than half agreed with a frequency of 50 or 52.63% followed by

those who disagreed having frequency of 22 or 23.16%. 10. The greatest number of 29 or

30.53% is undecided while 26 or 27.37% disagreed that the hospital management

conducted counselling over performance. These imply that 12 hour shift has good

hospital outcome and hospital administrators prefer 12 hours shift length for nurses due to

its beneficial effects. Findings conform to the study “12 hour nursing shifts in critical

care” (2015) it has been reported that 12-houe shifts lead to poor performance e due to

physiological strain, fatigue, burn-out and job dissatisfaction, which consequently

negatively impacts patient care and safety. A number of studies of US hospital nurses

demonstrated that the risks of making an error are significantly increased when work
shifts are longer than 12 hour, when nurses work overtime, or when they worked more

than 40 hour per week. In a number of similar studies, nurses working shifts of 12-hour

or more and those working overtime, reported lower quality and safety, increased risk of

errors and decreased nurses’ vigilance. But despite of this reason, nurses still render their

best care to their patient the reason why the hospital administrators complimented them,

aside from this, nurses who work on 12 hour shift have their benefits like flexibility to

work, more time to family and friends, longer day off and also they gain an extra pay as

this was supported by the study of Colduvell (2017) in her Study Advantages of 12 hour

shifts.

Table 3 c. Efficacy of Nurses in terms of Patient Working in Extended Shift Length

Questions Strongly Agree (4) Neither Disagree Strongly

Agree (5) Agree/ Nor (2) Disagree
Agree (3) (1)

f % f % f % f % f %
1. My patients are happy when I’m 27 28.42 46 48.42 20 21.05 2 2.11
the one attending them.
2. 4. My patient condition worsened 30 31.58 37 38.95 22 23.16 5 5.26 1 1.05
because of my negligence.
3. 9. My patient did not develop 22 23.16 52 54.74 18 18.95 3 3.16
complications due to continuity
of care
4. My patients’ needs are well 38 40 44 46.32 11 11.58 2 2.11
attended.
5. My patient can easily open up 11 11.58 50 52.63 30 31.57 4 4.21
their problem with me.
6. My patients were afraid I might 18 18.95 33 34.74 32 33.68 11 11.58 1 1.05
get confused and make a mistake.
7. My patients are looking forward 10 10.53 44 46.32 34 35.79 2 2.11 5 5.26
that I can pray with them.
8. My patients do not complaint 10 10.53 46 48.42 27 28.42 12 12.63
much.
9. My patient can understand his\her 15 15.79 49 51.58 29 30.53 2 2.11
condition because I have time to
explain to them.
10. My patient got confused because 26 27.37 36 37.89 26 27.37 3 3.16 4 4.21
 of my irritating gestures.

As shown in table 3.c 1. Forty six or 48.42% and 27 or 28.42% stated that their

patients are happy when they are the one attending them. Thirty seven or 38.95% while

30 or 31.58% revealed that the patients’ condition worsened because of their negligence.

On the statement which states that: “My patient did not develop complications due to

continuity of care” More than half agreed with a frequency of 44 or 46.32% they agreed

that their patients’ needs are well attended to follow by those who likewise strongly

agreed having a frequency of 38 or 40%.. It was revealed that their patient can easily

open up their problem with them as tested to by more than half of the respondents with 50

or 52.63% who agreed, however, there are those who are undecided with a frequency of

30 or 31.57%. Thirty three or 34.74 agreed, thirty two or 33.68% or undecided and 18 or

18.95% strongly agreed that their patients were afraid they might get confused and make

a mistake. In like manner, 44 or 46.32% agreed, 34or 35.79 are undecided on the

statement which state that their patients are looking forward that they can pray with them.

Forty six or 48.42% of them agreed that their patients do not complain much but there are

those who are undecided on the issue having a frequency of 27 or 28.42%. it was shown

that their patient can understand his/her condition because the nurses have time to explain

to them as a tested to by a little more than half (51.58% )of the respondents. Finally, they

believed that their patient got confused because of their irritating gestures. This is attested

to buy the frequency of 36 or 37.89% who agreed 26 and 27.37% who strongly agreed.

Based on the study of Tang (2011) revealed effective support such us respectful

and caring behaviours as the highest contributors towards patients satisfaction. The

finding of this study was found to be in consistent with the past studies where by patients
reported satisfaction with care pertaining to being treated as a specific individual and

given personal, patient-focused care to meet their unique needs.

Findings also supported by the findings of Tera (2012) wherein the study revealed

that patients expressed lack of autonomy in relations to managing their health care. This

findings was also supporting previous studies which revealed that patients were less

satisfied when nurses did not recognize their opinions during their hospital care. Hence,

nurses need to be more incentive with patients’ decisional control or sense of autonomy

when providing care. In this context, allowing some degree of freedom for patients in

decision-making and choices of care would improve patient satisfaction. Appropriate

measure need to be instituted to further improve the quality of nursing care for the

patients.

Table 3d. Efficacy of Nurses Working in 10-14 hours

Efficacy Average Working Hours

Mean Scores Interpretation
Personal Efficacy 3.47 Effective
Hospital Efficacy 3.52 Effective
Patient Efficacy 3.75 Effective

As presented in Table 3, the efficacy of nurses working in extended shift length in

terms of personal, hospital and patient efficacy are all effective even if they are working

from 10 hours to 14 hours. This implies that their effectiveness and dedication are not

affected by the length of time they work in the hospital.

Table 3e. Efficacy of Nurses Working in 16 hours and more

 Efficacy Average Working Hours
Mean Scores Interpretation
Personal Efficacy 3.46 Effective
Hospital Efficacy 3.68 Effective
Patient Efficacy 3.94 Effective

As presented in Table 3, the efficacy of nurses working in extended shift length in

terms of personal, hospital and patient efficacy are all effective even if they are working

from more than 16 hours a day. This implies that their effectiveness and dedication are

not affected by the length of time they work in the hospital.

A recent study based on a survey of 22,275 registered nurses (RN) in 4 US states

found that nurses who worked shifts of ≥12 hours were significantly more likely to report

poor quality of care and poor patient safety when compared with nurses working 8- to 9-

hour shifts. Patients in hospitals where a higher proportion of nurses worked longer shifts

also reported lower satisfaction. In addition to this, Fitzpatrick et al. said it is possible that

factors such as mental and physical fatigue may have inhibited nurses’ overall

performance in shifts longer than 8 hours. Additionally, if fatigue affects the performance

of nurses working longer shifts, diminished performance levels may be compounded if a

nurse works several consecutive longer shifts. This study negate in our result, data

reflected on table 3 only shows that there is no significant relationship between the

personal efficacy to the average working hours besides this was supported in the study of

Aiken et.,al in the year 2015,according to them, from the nurse perspective, longer shifts

offer a potential to benefit from a compressed working week, with fewer work days and

more days off-work, lower commuting costs and increased flexibility. Furthermore, a
recent study among European nurses investigated the association between shift length and

nurses’ psychological well-being. The findings show that nurses preferred 12 hour shifts

because more time off helped them balance work and personal commitments. The result

that we attain only means that despite of extended working hours, nurses still render their

care without fail.

Table 4 Present the result of the Nurses profile and their Shift Length

Variables X2 Value Df p- value Sig.

Years of Experience and Average Working Hours 2.26 1 .13 NS
Age and Average Working Hours .934 1 .33 NS
Marital Status and Average Working Hours .645 2 .72 NS
Household Size and Average Working Hours 3.86 2 .14 NS
Monthly Salary and Average Working Hours .28 1 .59 NS

As depicted in Table 4, as proven by the respective p- values that are more than

0.05, the shift length of nurses is not significantly related to profile of nurses such as

years of experience (.13), age (.33), marital status (.72), household size (.14) and monthly

salary (.59). This implies that their working time in the hospital is not affected by these

variables. The hypothesis therefore which states that the profile of nurses is not related to

their shift length is accepted.

According to the study of Rebecca Loudon, her study about “Balancing Shift

work and Life outside Work: Do 12-hour shifts Make a Difference?” it was found out that

profile analysis revealed no significant relationships between shift length and work/non-

work conflict. In terms of age, as shown in the table above, nurses ages 30 years old and

below were the one who claimed that despite of prolonged working hours they can still

render their care to the patient effectively than those nurses who ages 30 years old and
above. Even though there were studies that say older nurses which are working in more

than 8 hours of duty per shift are more prone to burnout, this study found out that in spite

of extended shifts, nurses ages 30 and above has proven that they can still provide quality

care that their patient deserves.

In addition to this, a strong argument in favour of 12-hour shifts is that these

worked arrangements have the potential to eliminate or reduce some of the problems of

shift work because work is usually compressed into fewer days each week. Thus, workers

are generally required to work fewer shifts (therefore fewer night shifts) than they are on

8/hour shifts. Aside from this, in the study of National Nursing Unit ( March, 2013) it

was stated that employers are reported to prefer 12-hour shifts because of increased

continuity of staffing, lower staffing cost, and potential improvements in staff morale.

Likewise 12-hour shifts reduces travel costs (by compressing working hours onto

fewer days), gives more work free days, and do not feel it affects their performance

adversely. In terms of family and loved ones bonding emotional interference maybe

alleviate under 12-hour shifts because workers may be able to use their increased number

of days off work to structure their recovery time around their partners’, friends’ or

children schedules.

Table 5. Presents the Efficacy and Shift Length of Nurses

Variables X2 Value Df p- value

Personal Efficacy and Average Working Hours 18.96 16 .27
Hospital Efficacy and Average Working Hours 19.31 16 .25
Patient Efficacy and Average Working Hours 14.35 15 .49
General Efficacy and Average Working Hours 37.33 31 .20
 The relationship between efficacy and shift length of nurses is shown in table 5.

The respective P-values that are more than 0.5 tell that shift length of nurses does not

significantly relate to efficacies such personal (.27); hospital (.25); and patient (.49). the

average efficacy is not significantly relate to average working hours as proven by P-value

of .20 which is more than 0.05. This implies that the length of time in working in the

hospital does not necessarily affect the performance and dedication of nurses. Even if

there are already tired their dedication to perform their duties is not affected. The

hypothesis that a performance efficacy of nurses is not related to their shift length is

accepted.

This findings support to the findings of Roger (2014) that the use of extended

work shift and overtime has escalated as hospitals cope with a shortage of registered

nurses and the increasing ratio of the patient that sometimes exceed to the number that the

nurse that too care of them. Also nurses’ wants to help their colleagues in their duty

regardless of the benefits they can get but the hospital administrators g=has seen the

effort of their nurses so they also give incentives to compensate for their time.

Several trends in hospital use and staffing patterns have converged to create

potentially hazardous condition for patient safety. High patient acuity levels, coupled

with rapid admission and discharge cycles and a short age of nurses, post serious

challenges for the delivery of safe and effective nursing care for hospitalized patients.

However, stone and colleagues (2016) found that nurses who worked 12-hour shifts were

generally more satisfied with their job, report less emotional exhaustion, and were about

10x more satisfied with their work schedules, compared with those working 8-hour shifts

(Rollins, 2016). The Lippincot nursing education last January 8, 2017 featured that “
Hospital are often asking their nurses to work more hours. Those who pick up extra shift

are offered financial incentive. “in general , a nurses self-efficacy is colleagues with

professional autonomy and empowerment. Nurses with high levels of self-efficacy

consider barriers as opportunities rather than threats. Besides, the individuals with

adequate belief in their self-efficacy aim to overcoming difficult situation a rather

avoiding them. They are better able to cope with particular situation and are more likely

to perform a tasks until they excel in it.(Simin Soudagar, 2013).

The self-efficacy theory of Albert Bandura holds through to this study that one has the

power to do what is expected of him. That is capable of performing a desired task as

preserve by him with expectation that he can master a situation and produce positive

outcomes. Regardless of the situation or events that make affect their lives.
 CHAPTER V

SUMMARY, CONCLUSIONS AND RECOMMENDATION

This chapter focuses on the major findings of the study, the conclusions obtained

from them and the recommendations presented.

Summary

This study utilized descriptive-quantitative design, employing descriptive type for

qualitative data. A researcher-made questionnaire were used to gather information about

the nurses profile and efficacy in terms of personal, hospital and patients, duly validated

by the panel members.

Respondents of the study were regular staff nurses, patients who have stayed at

least three (3) days in the hospital and hospital administrators composed of chief of the

hospital, chief nurses, nurses, supervisors, head nurses and human resource director.

The major findings of the study

 1. Majority of the nurses were young aged 30 years old and below with the hospital

years of experience of below 5 years. Most of them are single with 3-5 members

of the family, receiving the salary of PHP 11,000.00- 20,000.00 per month.

2. Nurses in private hospitals go on average duty for 12 hours per shift.

3. As nurses go on extended duty hours per shift their personal, hospital and patient

efficacy outcomes were still effective. This means that regardless of long duty

hours, nurses portray their love and dedication to their clients to serve and give

their best services.

4. There is no relationship between the nurses’ profile and the nurses shift length.

Regardless of their age, working experience, civil status, household size and

salary. The kind of service they give is still of quality even if situation are

unfavorable to them.

5. There is no relationship between the nurses shift length and their personal,

hospital and patients efficacy. Nurses have proven that they are hardworking,

dedicated, selfless and self-sacrificing. Regardless of long working hours, they

maintain the level of performance outcomes that is expected of them.

Conclusion

In the view of the preceding findings, the following conclusions were drawn.

1. Nurses in private hospitals are young, single with short hospital experiences,

earning low income and belonging to medium size family.

2. Average duty hours rendered in the hospitals is 12 hours a day.

 3. Regardless of their profile and the long hours of clinical duty, nurses’

performance as seen by themselves, hospital administrators and patients were

effective.

4. Nurses’ profile is not associated to their long working hours.

5. Regardless of long working hours nurses are still effective in their discharge of

their duties and responsibilities.

Recommendations:

Based on the conclusions, the following actions are favourably recommended:

1. There is a need for hospital administrators to extend support to this young, low

earning and short experience nurses. They can create a program where nurses can

gain more knowledge and skills in hospital work especially in patient care.

2. There is a need for the hospital administrators to re-examine or re-evaluate the

salary of nurses. An excess of 8 hours duty a day should be considered overtime

and nurses are entitled to receive an overtime pay in accordance to the labor laws.

3. Since nurses efficacy is effective regardless of long working hours, hospital

administrators need to consider the needs of these nurses like providing them free

meals, snacks, coffee and the like nurses may not get sick since they are also

human beings.

4. A system of recognition is highly recommended to hospital administration that

nurses dedication to serve will be given due recognition to boost their esteem and

self-worth.
5. The nursing administration need to consider the welfare and well-being of their

nurses. Despite of long working hours, nurses are still effective in the discharge of

their duties yet are also human that they need rest and recreation. They can create

social activities that nurses can have a break and enjoy while performing their

calling as nurses, a work – life balance.