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<jats:sec><jats:title>Objectives</jats:title><jats:p>12-hour shifts worked by nurses on acute hospital wards have been associated with increased rates of missed care reported by nurses. This study aimed to measure the association between nurses working shifts of at least 12 hours and an objective measure of missed care: vital signs observations taken on time according to an acuity-based surveillance protocol.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A retrospective observational study using routinely collected data from March 2012 to March 2015.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>32 general inpatient wards at a large acute hospital in England.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>658 628 nursing shifts nested in 24 069 ward days.</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>The rate of daily delayed and missed vital signs observations. We focused on situations where vital signs observations were required at least every 4 hours and measured the number of instances where observations were delayed or missed, per 24-hour period. For each ward and each day, shift patterns were characterised in terms of proportion of care hours per patient day deriving from ‘long’ shifts (≥12 hours) for both registered nurses and healthcare assistants.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>On 99 043 occasions (53%), observations were significantly delayed, and on 81 568 occasions (44%), observations were missed. Observations were more likely to be delayed when a higher proportion of the hours worked by healthcare assistants were part of long shifts (IRR=1.05; 95% CI 1.00 to 1.10). No significant association was found in relation to the proportion of hours registered nurses worked as long shifts.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>On days when a higher proportion of hours worked by healthcare assistants are from long shifts, the risk of delaying vital signs observations is higher, suggesting lower job performance. While longer shifts are thought to require fewer staff resources to maintain nurse-to-patient ratios, any benefits may be lost if staff become less productive.</jats:p></jats:sec>

Original publication




Journal article


BMJ Open



Publication Date





e024778 - e024778