WORK SCHEDULE OF NURSING OFFICERS – A REVIEW

Abstract

A survey was conducted among 345 nursing officers working in hospitals of Army, Navy and Air Force to find out their preferences on type of shift system, working hours in each shift, duration of night duties, entitlement of compensatory 'off days’ and distribution of 'off days’. Majority of them has demanded a change from the existing pattern of duty system, split shift to a 'modified shift’ system. The 'modified shift’ will have 6 hours each in first and second shifts and 12 hours in the third shift (night). Their preference for night duties is for a duration of two weeks with two compensatory 'off days’ at the end of the night duties in one instalment. But they opt for the compensatory 'off days’ of day shifts in instalments of one per week.

Introduction

Any institution like hospital, that functions day and night will have people on shifts. The types of shift system that are followed in hospitals are straight shift, modified shift and split shift. The straight shift has day divided into three shifts of 8 hours. In the modified shift the night shift will be longer as the remaining two shifts are truncated to fit in day time. The split shift system is the long-short-night duty that is followed in the Armed Forces in which all the staff of the day duty report in the morning and after the peak hours, the long duty staff continue till night shift after a short break while the short duty staff work uninterrupted till afternoon. It also has a long night shift of 12 hours.

In the past the service hospitals had an inherent advantage of having dedicated nursing officers on their pay rolls staying next to the hospitals. They were mostly unmarried and stayed in their messes. Things have changed. At present most of them are married and staying away from the messes. Many of them staying without their working spouses, have the burden of looking after their children and households by themselves. Some of their messes are either closed down or have become inactive throwing their once vibrant social life in doldrums. It is also alleged that, many of them have gone into a state of 'dolce far niente’ resentment or frustration resulting in marked increase in absenteeism, indiscipline and disregard to profession.

It is said that continuous night shifts for 12 hours for a long duration may disturb the biological rhythm of workers. It may weaken the individual physically and mentally leading to loss of appetite, tiredness, disorientation, poor memory and even total loss of efficiency. Hospital staff have to work on Sundays and holidays, while their dependents are holidaying. The nursing staff get four holidays in a month. After night duties for a period of two weeks, they get three holidays in the form of one 'night off and two 'days off'. The policy on distribution of 'days off and 'night off is fancy, divergent and often unscientific. Lack of uniform policy has resulted in individual interpretation and thereby inevitable but avoidable conflicts. The ensuing situation has promoted a survey to find out the preferences of the nursing officers on the above issues.

The Military Nursing Service has a total work force of about 3000 nursing officers. Eleven per cent of them belong to various age groups, ranks and marital status were selected for the survey. A questionnaire was prepared with 11 parameters with a provision for additional suggestions. It was circulated among nursing officers working in 45 hospitals of Army, Navy and Air Force. Many of the administrative nursing officers were requested to comment upon the finding of the survey and chalk out strategies in fulfilling the personal aspirations of the nursing officers after considering the constraints in resources and infrastructure.

A significant result was an overwhelming demand for modified shift system instead of the existing split shift system. But the issue of distribution of working hours in each shift during summer and winter created an array of suggestions; an astounding 40 of them. The most accepted schedule of the modified shift system for summer and winter is given at Table 1. Accordingly the day shift will have six hours each and the night shift will have 12 hours irrespective of the climate. All the nursing officers will attend only one shift per day. The most preferred duration of night duties is the existing two weeks.

TABLE 1.

Popular shift

Shift	Summer timings	Winter timings
I	0800 h – 1400 h	0800 h – 1400 h
II	1400 h – 2000 h	1400 h – 2000 h
III	2000 h – 0800 h	2000 h – 0800 h

The patients in a particular ward may prefer to have same nurses permanently. The other members of the staff who work alongwith nurses in a particular ward may also opt for permanent nurses. The nurses themselves would like to work in the same ward for a long duration. This is possible if the nurses in a ward are rotated in all the three shifts. But it is impractical as the requirement of the nurses in each shift will vary. The morning shift may be busier than the other shifts due to many factors like morning round of all specialists and administrators, medications and collection of samples, results and stores etc. An alternative may be grouping of certain wards based on speciality, intensity of diseases or nearness of location to pool all the nurses and then rotating them in shifts.

It is suggested by many authors that an increase in efficiency among the nurses may curtail the additional demand of nurses during morning shifts. Their efficiency can be increased by taking off some of the non-professional jobs like indenting and store keeping from them and thus expanding their professional time [2], by exposing them to the basics of management, as the personal care of the patients by the nurses can not be separated from basic management functions required for the well running of the ward and co-ordinating of health care team [1] and by achieving an equity in their work load by their suitable rotation from shift to shift and ward to ward.

Many of them demanded that they should have ‘days off’ equivalent to the total number of Sundays and holidays unlike the present fixed quota of four ‘days off in a month. The administration feels that such an inadequacy is compensated to a certain extent by prefixing and suffixing Sundays and holidays alongwith casual leave and annual leave. The Sundays and holidays are actually working days for the nursing staff.

Another issue that came up in the survey was about distribution of 'off days’. Most of them suggested distribution of off days during the day shift in instalments of one per week while the 'night off’ and 'days off after night duties may be given in one instalment. The 'night off should be given immediately after the night duties for recouping the individuals and bringing them to normal biological rhythm. The ensuing two 'days off also may be given immediately for a complete recovery.

Military Nursing Service has been playing an intimate role in the delivery of health care in the Armed Forces. The recent erosion in their social life and their changing attitude towards the establishment and the patient care have forced many to think about alternatives. Some have pleaded that the existing nursing assistants must be groomed to replace the nursing officers. Local midwives/auxillary nurses may be employed in the family wards to augment them. But before taking such steps, it is prudent to improve the existing policies closer to their requirement without impeding the organisational objectives.