Researchers: Tamar Shochat¹, Einav Srulovici¹, Natalie Zion², Hagar Baruch³

Background: Among nurses, working in shifts with short break duration (quick returns) is associated with short sleep duration, which may increase the risk of impairment in cognitive function and the quality of care.

Objectives: To examine five moderated-mediation models in which quick returns are related to outcomes at the nurse level (cognitive function and burnout) and patient level (missed nursing care [MNC] and satisfaction), while considering sleep duration as a mediating variable and motivation as a moderating variable.

Method: A prospective, nested, multi-source study involving 135 nurses in two hospitals during 607 shifts was conducted. Nurses wore an accelerometer during a workweek, performed cognitive tests during shifts, and assessed work motivation and MNC at the end of each shift. At the end of the workweek, they completed a burnout questionnaire. Patients treated by the participating nurses also completed MNC and satisfaction surveys. Five moderated-mediation models were examined via mixed models, which are suitable for nested data.

Findings: Quick returns were associated with short sleep duration by 134 minutes (p < 0.01). Among the five moderated-mediation models tested, only MNC was supported. Specifically, even when quick returns led to shorter sleep duration, high motivation reduced MNC compared to low motivation (p = 0.05).

Conclusions: Quick returns adversely affect the sleep duration of nurses; however, high motivation can protect the quality and safety of care even with limited sleep hours.

Recommendations: Nurse managers should avoid scheduling that include quick returns and simultaneously promote interventions to improve nurses' motivation.

Research end date: 11/2023