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Shifts of 12 hours or longer are common in nursing services within general hospital wards. Concerns have been raised about their safety, but previous research has mostly used staff-reported measures of quality and safety and has occurred in general hospital settings only. This study aims to measure the association between the use of 12+ hour shifts in nursing staff (including registered nurses, healthcare support workers or nursing assistants, and nursing associates) and the rate of patient incidents in mental health and community hospitals. This is a longitudinal study using routinely collected data from two mental health and community NHS trusts in the South of England. We accessed rosters of nursing staff and patient incident data from April 2018 to March 2021. We extracted 1,018,971 shifts and excluded those not worked by nursing staff, with a final sample of 898,143 shifts. We extracted 53,078 incidents. We only included incidents that involved patients and that occurred in wards. Our final sample consisted of 38,373 patient incidents. We linked all patient incidents and nurses' worked shifts at the ward-day level. Depending on the distribution of incident rates, we used either negative binomial mixed-effects models or Poisson mixed-effect models to investigate the association between the proportion of 12+ hour shifts and all patient incidents, violence against staff, falls, self-injury, disruptive behaviour, and medication management incidents at the ward-day level. We found a relationship between 12+ hour shifts and the incident rate. Compared to days in wards with no long shifts, increasing the proportion of long shifts was initially associated with a small increase in the overall rate of incidents, but the rate increased sharply as the proportion of long shifts was above 70%. Rates of self-injury increased more steadily as the proportion of long shifts increased. The mandatory implementation of long shifts should be discouraged. [ABSTRACT FROM AUTHOR]

The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses' wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses. [ABSTRACT FROM AUTHOR]

Objective: To explore the evidence on nurses' experiences and preferences around shift patterns in the international literature. Data sources: Electronic databases (CINHAL, MEDLINE and Scopus) were searched to identify primary studies up to April 2021. Methods: Papers reporting qualitative or quantitative studies exploring the subjective experience and/or preferences of nurses around shift patterns were considered, with no restrictions on methods, date or setting. Key study features were extracted including setting, design and results. Findings were organised thematically by key features of shift work. Results: 30 relevant papers were published between 1993 and 2021. They contained mostly qualitative studies where nurses reflected on their experience and preferences around shift patterns. The studies reported on three major aspects of shift work: shift work per se (i.e. the mere fact of working shift), shift length, and time of shift. Across all three aspects of shift work, nurses strive to deliver high quality of care despite facing intense working conditions, experiencing physical and mental fatigue or exhaustion. Preference for or adaptation to a specific shift pattern is facilitated when nurses are consulted before its implementation or have a certain autonomy to self-roster. Days off work tend to mitigate the adverse effects of working (short, long, early or night) shifts. How shift work and patterns impact on experiences and preferences seems to also vary according to nurses' personal characteristics and circumstances (e.g. age, caring responsibilities, years of experience). Conclusions: Shift patterns are often organised in ways that are detrimental to nurses' health and wellbeing, their job performance, and the patient care they provide. Further research should explore the extent to which nurses' preferences are considered when choosing or being imposed shift work patterns. Research should also strive to better describe and address the constraints nurses face when it comes to choice around shift patterns. [ABSTRACT FROM AUTHOR]

In the Funding statement, the funding recipient is listed incorrectly. The correct funding statement is: CDO received funding from NIHR Applied Research Collaboration Wessex; https://www.arc-wx.nihr.ac.uk/research-areas/workforce-and-health-systems/nursing-shift-patterns-in-acute-community-and-mental-health-hospital-wards/. [Extracted from the article]

Introduction: Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job preferences of early-career and late-career nurses working in the NHS, so tailored policies can be developed to better retain these two groups., Methods and Analysis: We will collect job preference data for early-career and late-career NHS nurses, respectively using two separate discrete choice experiments (DCEs). Findings from the literature, focus groups, academic experts and stakeholder discussions will be used to identify and select the DCE attributes (ie, job features) and levels. We will generate an orthogonal, fractional factorial design using the experimental software Ngene. The DCEs will be administered through online surveys distributed by the regulator Nursing and Midwifery Council. For each group, we expect to achieve a final sample of 2500 registered NHS nurses working in England. For early-career nurses, eligible participants will be registered nurses who graduated in the preceding 5 years (ie, 2019-2023). Eligible participants for the late-career survey will be registered nurses aged 55 years and above. We will use conditional and mixed logit models to analyse the data. Specifically, study 1 will estimate the job preferences of early-career nurses and the possible trade-offs. Study 2 will estimate the retirement preferences of late-career NHS nurses and the potential trade-offs., Ethics and Dissemination: The research protocol was reviewed and approved by the host research organisation Ethics Committees Research Governance (University of Southampton, number 80610) (https://www.southampton.ac.uk/about/governance/regulations-policies/policies/ethics). The results will be disseminated via conference presentations, publications in peer-reviewed journals and annual reports to key stakeholders, the Department of Health and Social Care, and NHS England/Improvement retention leaders., Registration Details: Registration on OSF http://doi.org/10.17605/OSF.IO/RDN9G., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Taxes and restrictions on promotions have recently been proposed as policy instruments to reduce consumption of unhealthy foods. The objective of this study is to add to the limited evidence on the comparative effectiveness of price changes, price promotions and volume promotions in changing household purchasing of unhealthy foods, using biscuits, crisps and savoury snacks as examples., Design: Longitudinal regression analysis of consumer microdata., Setting: Secondary data on itemised household purchases of biscuits, crisps and savoury snacks from 2006 to 2012., Participants: Sample of 3024 households in Scotland., Main Outcome Measures: Changes in the number of calories (kcal) purchased in the product category by a household caused by changes in the price for the product category, any temporary in-store price promotions and any temporary in-store volume promotions. Changes are measured at the mean, median, 25th percentile and 75th percentile of the household purchasing distribution for the full sample. Subgroup analyses were conducted by household income band and for households with and without children., Results: Between product categories, the scale of purchasing response to incentives varies significantly. Within product categories, the mean calories (kcal) purchased by a household are more responsive to any volume promotion than to price or any price promotion for all product categories. As the volume of items purchased increases, households are less responsive to price, less responsive to any volume promotion and more responsive to any price promotion. Statistically significant differences are observed between household income groups in their response to price and promotion incentives within the biscuits category only. In cases where statistically significant differences are observed, households with children are more responsive to promotion and price incentives than households without children., Conclusions: For all product categories analysed (biscuits, crisps and savoury snacks), household purchasing is most responsive to any volume promotion. Therefore, assuming the response of consumers to incentives remains constant following legislation, the most effective policy instrument to reduce the calorie intake from these products may be a ban on volume promotions., Competing Interests: Competing interests: This work was supported by the Scottish Government Rural and Environment Science and Analytical Services division and the Chief Scientist Office of the Scottish Government Health and Social Care Directorates., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

In the absence of routinely collected household food insecurity data, this study investigated what could be determined about the nature and prevalence of household food insecurity in Scotland from secondary data. Secondary analysis of the Living Costs and Food Survey (2007⁻2012) was conducted to calculate weekly food expenditure and its ratio to equivalised income for households below average income (HBAI) and above average income (non-HBAI). Diet Quality Index (DQI) scores were calculated for this survey and the Scottish Health Survey (SHeS, 2008 and 2012). Secondary data provided a partial picture of food insecurity prevalence in Scotland, and a limited picture of differences in diet quality. In 2012, HBAI spent significantly less in absolute terms per week on food and non-alcoholic drinks (£53.85) compared to non-HBAI (£86.73), but proportionately more of their income (29% and 15% respectively). Poorer households were less likely to achieve recommended fruit and vegetable intakes than were more affluent households. The mean DQI score (SHeS data) of HBAI fell between 2008 and 2012, and was significantly lower than the mean score for non-HBAI in 2012. Secondary data are insufficient to generate the robust and comprehensive picture needed to monitor the incidence and prevalence of food insecurity in Scotland.