Article
Service quality implications of extended periods of consecutive working days: An empirical study of neonatal intensive care nursing teams
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Authors
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Felix Miedaner
- Ostfalia Hochschule für angewandte Wissenschaften, Wolfsburg, Deutschland
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Ludwig Kuntz
- Universität zu Köln, Köln, Deutschland
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Kerstin Eilermann
- Universität zu Köln, Köln, Deutschland
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Bernhard Roth
- Universität zu Köln, Köln, Deutschland
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Stefan Scholtes
- University of Cambridge, United Kingdom
| Published: | October 2, 2023 |
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Outline
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Background and state of research: Staffing guidelines and staff scheduling in healthcare organizations are often based on safe levels of workload per worker, such as nurse-to-patient ratios. When managers respond to unexpected surges in demand, staff sickness or staff vacancies they will often rely on team members working extended periods of consecutive working days. This may have potential negative consequences on quality and safety, outweighing the gains of safe workload levels. This paper studies the interplay between workload per worker and extended periods of consecutive working days.
Research question and objectives, hypothesis: We study the interplay between workload levels and extended periods of consecutive working days of nurses and their impact on service quality in 62 German neonatal intensive care units.
Method: We combine daily nurse staffing and medical outcome data over a period of six months, following 847 babies with very low birth weight. Using survival analysis, we estimate the impact of average consecutive working days of nursing teams on the time to full enteral feeding of the patient. We investigate the moderating effects of workload (nurse-to-patient ratio) and task complexity. Day specific informations serve as instrumental variables to support causality.
Results: We find that the level of average consecutive working days has a statistically significant and clinically relevant negative impact on the time to enteral feeding of a newborn in critical care. While for less complex patients the negative impact occurs only in combination with high workloads per worker, complex patients are negatively impacted independently of workload levels.
Discussion: Workforce planning and management systems need to complement daily staffing level targets with metrics on consecutive working days. While for non-complex patients, high staffing levels can safeguard against negative effects of prolonged periods of consecutive working days, this is no longer the case for complex patients.
Implication for care: Not only safe levels of workload, but also prolonged periods of consecutive working days for nurses have to be taken into account in order to improve quality of care.
