Nurses' shift length and overtime working in 12 European countries: The association with perceived quality of care and patient safety

Peter Griffiths*, Chiara Dall'Ora, Michael Simon, Jane Ball, Rikard Lindqvist, Anne Marie Rafferty, Lisette Schoonhoven, Carol Tishelman, Linda H. Aiken, Walter Sermeus, Koen Van Den Heede, Luk Bruyneel, Emmanuel Lesaffre, Luwis Diya, Herbert Smith, Douglas Sloane, Simon Jones, Juha Kinnunen, Anneli Ensio, Virpi JylhäReinhard Busse, Britta Zander, Miriam Blümel, John Mantas, Dimitrios Zikos, Marianna Diomidous, Anne Scott, Anne Matthews, Anthony Staines, Inger Margrethe Holter, Ingeborg Strømseng Sjetne, Tomasz Brzostek, Maria Kózka, Piotr Brzyski, Teresa Moreno-Casbas, Carmen Fuentelsaz-Gallego, Esther Gonzalez-María, Teresa Gomez-Garcia, Lisa Smeds Alenius, Sabina De Geest, Maria Schubert, René Schwendimann, Maud Heinen, Theo Van Achterberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

207 Citations (Scopus)


Background: Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12-to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs.

Objectives: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone.

Methods: Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries.

Results: A total of 50% of nurses worked shifts of r8 hours, but 15% worked Z12 hours. Typical shift length varied between countries and within some countries. Nurses working for Z12 hours were more likely to report poor or failing patient safety [odds ratio (OR) = 1.41; 95% confidence interval (CI), 1.13-1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10-1.53), and more care activities left undone (RR = 1.13; 95% CI, 1.09-1.16). Working overtime was also associated with reports of poor or failing patient safety (OR = 1.67; 95% CI, 1.51-1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23-1.42), and more care left undone (RR=1.29; 95% CI, 1.27-1.31).

Conclusions: European registered nurses working shifts of Z12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.

Original languageEnglish
Pages (from-to)975-981
Number of pages7
JournalMedical Care
Issue number11
Publication statusPublished - 10 Nov 2014


  • Efficiency
  • Europe
  • Nurses
  • Quality
  • Safety
  • Shift work
  • Workforce


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