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. 2021 Aug 16;16(8):e0256300. doi: 10.1371/journal.pone.0256300

Table 2. Papers included in the scoping review (arranged by aspect of shift and descending chronological order).

Shift aspect & patterns Author(s) and date Country of origin Role Setting Sample size Aims of study Methods Theme(s) Aspect of shift(s)
Shift length: 24 hours Koy, V., et al. (2020) Cambodia RNs Hospital 30 To explore the perception and experiences of 30 ICU RNs regarding their working 24h shifts Focus groups

  1. Exhaustion

  2. Compromised hospital care

 Shift work per se Shift length
Female = 17
Male = 13
Shift length: 12 hours Suter, J. and T. Kowalski (2020) England RNs and HCAs Acute mental health trust 70 To examine the impact of extended shifts on employee strain in a large mental healthcare organisation Semi-structured interviews

  1. Context (challenge related to patient care)

  2. Consultation process

  3. Modification of context with introduction of extended shifts

  4. Impact of modified context on strain

  5. Temporal strain-based spillover

 Shift work per se Shift length
Female = 54
Male = 16
Shift length: 12 hours Suter, J., et al. (2020) England RNs, HCA & managers Acute mental health trust 70 To evaluate how employees in acute mental health settings adapt and respond to a new 12h shift system from a wellbeing perspective Semi-structured interviews

  1. Perception of quality of care (improvement and deterioration)

  2. Stamina and pacing of work to complete shift

  3. Social support and reflection

  4. Significant factors influencing 12-hours shift: old age

  5. Significant factors influencing 12-hours shift: public healthcare commitment

  6. Significant factors influencing 12-hours shift: work life balance

 Shift length
Female = 54
Male = 16
Shift length: 12 hours Ose, S. O., et al. (2019) Norway RNs Hospital 24 To record the experiences of 24 nurses working 12h shifts Semi-structured interviews

  1. Organisational shift structure

  2. Health consequences

  3. Quality of patient care

  4. Family situation and friends

  5. Tasks at work

 Shift work per se Shift length
Female = 24
Shift length: 12 hours Webster, J., et al. (2019) Australia RNs Hospital 266 To investigate the effect on nurses and patients of 8h rostering compared with 12h rostering among 266 RNs Questionnaire with open-ended questions

  1. Patient care

  2. Increase in professional development

  3. Improvement in communication with all levels of senior staff

  4. Health and hygiene

  5. Social and leisure

  6. Recruitment and retention

 Shift length
Female = 209
Male = 57
Shift length: 12 hours Parkinson, J., et al. (2018) USA RNs Hospital 30 To explore the perceptions of rehabilitation nurses who are working in or who have worked 12h shifts in an acute rehabilitation hospital and to identify the advantages and disadvantages of 12h shifts Mixed-method study with qualitative questions

  1. Increased time off-work

  2. Continuity of care

  3. Increased fatigue

  4. Changing patient assignments

 Shift length
Female = 27
Male = 3
Shift length: 12 hours Thomson, L., et al. (2017) England Unregistered healthcare staff Hospital, Community trusts, Care homes 25 To explore unregistered healthcare staff’s perceptions of 12h shifts on work performance and patient care Focus groups

  1. Nurses perceived that 12-hour shifts would benefits patients through continuity of care

  2. Satisfaction with performance through continuity of care

  3. Negative impact of staff fatigue

  4. Other factors moderate the impact of 12-hour shifts

 Shift work per se Shift length
Female = nr
Male = nr
Shift length: 12 hours McGettrick, K. S. and M. A. O’Neill (2006) Scotland RNs Hospital 54 To elicit critical care nurses’ perceptions of working 12h shifts Focus group

  1. Preferences for 12-hour shift

  2. Most popular "Strongly agree": Patient care perceived to be improved; Job satisfaction; Off duty; Family life

  3. Most popular "Disagree": Communication; Fatigue/freshness, Education

  4. Most popular "Not sure": Education, Communication

  5. Staffing levels

  6. Work breaks

 Shift work per se Shift length
Female = 50
Male = 4
Shift length: 4 or 8, 8 and 12 Gao, X., et al. (2020) China RNs Hospital 14 To explore 14 nurses’ experiences regarding shift patterns while providing front-line care for COVID-19 patients in isolation wards of hospitals in Shanghai and Wuhan Semi-structured interviews

  1. To assess the competency of nurses to assign nursing work scientifically and reasonably

  2. To reorganise nursing workflow to optimise shift patterns

  3. To communicate between managers and front-line nurses to humanise shift patterns

  4. Nurses’ various feelings and views on shift patterns

 Shift work per se Shift length
Female = 12
Male = 1
Shift length: 8, 10 and 12 hours Haller, T., et al. (2020) USA RNs Hospital 190 To explore clinical nurses’ perspectives of shift length among 190 clinical nurses Questionnaire with open-ended questions

  1. Preferences for 12-hour shift

  2. Improved work-life balance

  3. Improved patient care

  4. Burnout & reduction in physical and mental health

 Shift length
Female = nr
Male = nr
Shift length: 10 and 12 hours Horton Dias, C. and R. M. Dawson (2020) USA RNs Hospital 21 To explore hospital shift nurses’ experiences and perceptions of influences on making healthy nutritional choices while at work Semi-structure interviews

  1. Nursing roles and responsibilities restrict freedom of movement and minimize individual control over dietary practices

  2. Hospital food environment is oppressively unhealthy

  3. Free food is currency and influences consumption

  4. Shift work is a major barrier to healthy eating

 Shift length
Female = nr
Male = nr
Shift length: 8 and 12 hours Baillie, L. and N. Thomas (2019) England RNs and NAs Hospital 22 To investigate how nursing care is organised on wards where nursing staff work different lengths of day shifts, and how length of day shift affects the staffing of wards Qualitative interviews

  1. Organising nursing care and staff activities

  2. Staffing wards with different length of day shift

 Shift work per se Shift length
Female = nr
Male = nr
Shift length: 8 and 12 hours Haller, T. M., et al. (2018) USA RNs Hospital 87 To explore clinical nurses’ perceptions of 12h shifts versus traditional 8h shifts Semi-structured interviews

  1. Perception of relationship of shift length to patient outcomes

  2. Flow of the workday

  3. Home wellness

  4. Physical toll of shift length

 Shift work per se Shift length
Female = nr
Male = nr
Shift length: 8 and 10 hours Centofanti, S., et al. (2018) Australia RNs and midwives Hospital 22 To investigate the way nurses and midwives utilised napping and caffeine countermeasures to cope with shift work, and associated sleep, physical health, and psychological health outcomes among 130 shift-working nurses and midwives Qualitative interviews

  1. Napping

  2. Caffeine

 Shift work per se Shift length
Female = 19
Male = 3
Shift length: 8 and 12 hours Baillie, L. and N. Thomas (2017) England RNs and NAs Hospital 22 To explore how length of day shift affects patient care and quality of communication between nursing staff and patients/families in older people’s wards Mixed-method study with qualitative questions

  1. Effects of day shift length on patient care

  2. Effects of day shift length on continuity of care and relationships

  3. Effects of day shift length on communication with patients and families

 Shift work per se Shift length
Female = nr
Male = nr
Shift length: 8 hours Rathore, H., et al. (2012) India RNs Hospital 60 To have an insight into the problems faced by female nurses in shift work Qualitative interviews

  1. Lack of sleep

  2. Physiological (reduced alertness) and psychological fatigue

 Shift work per se Shift length
Female = 60
Shift length: 8 and 12 hours Reid, N., et al. (1994) England Student nurse Hospital 47 To report on the attitudes of nurse educators and students to the 12-hour shift and their views on the impact such a shift has on nursing education among students registered general/mental nurse Qualitative interviews

  1. Preference for 12-hour shift

  2. No change in quality and continuity of care

  3. Leisure

  4. Recruitment

  5. Study time

 Shift length
Female = 46
Male = 1
Time of shift: Night shift Landis, T. T., et al. (2021) USA RNs Hospital 16 To describe and interpret the lived experience of hospital night shift nurses taking breaks and the meaning of this phenomenon as it relates to the workplace. Semi-strucured interviews

  1. Primary purpose of breaks: Eating

  2. Ability to take breaks depended on unit-level structures

  3. Breaks were perceived as a luxury

 Time of shift
Female = 14
Male = 2
Tine of shift: Morning, evening and night Epstein, M., et al. (2020) Sweden RNs Hospital 11 To explore newly graduated nurses’ strategies for, and experiences of, sleep problems and fatigue when starting shift-work Semi-structured interviews

  1. Factors contributing to sleep problems

  2. Strategies for sleep

  3. Experiences of fatigue

  4. Strategies for fatigue

 Shift work per se Time of shift
Female = 10
Male = 1
Time of shift: Night shift Smith, A., et al. (2020) USA RNs Hospital 39 To elicit night shift nurses’ perceptions of drowsy driving, countermeasures, and educational and technological interventions. Semi-structured interviews

  1. Drowsy driving experience

  2. Existing countermeasures

  3. Social influences

  4. Barriers

  5. Educational program perspectives

  6. Drowsy driving mitigation technology perspectives

 Time of shift
Female = 26
Male = 13
Time of shift: Night shift Matheson, A., et al. (2019) Australia RNs Hospital 10 To explore women’s experiences of working shift work in nursing whilst caring for children Semi-structured interviews

  1. Being guilty

  2. Being juggler

 Shift work per se Time of shift
Female = 10
Time of shift: Night shift Books, C., et al. (2017) USA RNs Hospital 101 To study night shift work and its health effects on nurses Questionnaire with open-ended questions

  1. Health promotion

  2. Night shift effect on health

  3. Health perception

 Shift work per se Time of shift
Female = 88
Male = 13
Time of shift: Shifts including late night and overnight work Gifkins, J., et al. (2017) Australia RNs Hospital 21 To compare perceptions of nurses exposed to short- or longer-term shift work and their experiences working under this type of scheduling Semi-structured interviews

  1. Working in shifts

  2. Coping with shifts

  3. Support from family, friends and senior nurses

 Shift work per se Time of shift
Female = 21
Time of shift: Night shift West, S., et al. (2016) Australia RNs Hospital 1355 To develop a conceptual model of nurse-identified effects of night work among 1355-night working RNs employed in a state/public health system Questionnaire with open-ended questions

  1. ‘Lives’ of night working nurses

  2. ’Bodies’ of night working nurses

  3. ‘Work’ of nurses at night

  4. Nurses’ workplace at night

 Shift work per se Time of shift
Female = 115
Male = 192
Time of shift: Off-shift (night and weekend) de Cordova, P. B., et al. (2013) USA RNs Hospital 23 To qualitatively explore 23 RNs perceptions of off-shift nursing care and quality compared with regular hours Semi-structured interviews

  1. Collaboration among self-reliant night nurses & teamwork

  2. Completing more tasks

  3. Taking a breather on weekend day shift

  4. New nurse requirement to work at night first before working during the day

  5. Mixture of registered nurse personnel

  6. Night nurse perception of under-appreciation

 Time of shift
Female = 20
Male = 3
Time of shift: Night shift Faseleh Jahromi, M., et al. (2013) Iran RNs Hospital 20 To describe 20 Iran novice nurses’ perception of working night shifts Focus groups

  1. Value system

  2. Physical and psychological problems

  3. Social relationships

  4. Organizational problems

  5. Appropriate opportunity

 Time of shift
Female = nr
Male = nr
Time of shift: Night shift Powell, I. (2013) Australia RNs Hospital 14 To report a study that explored the experiences of night-shift among 14 nurses, focusing on employee interrelationships and work satisfaction. Semi-structured interviews

  1. Work relationship

  2. Work environment

  3. Work practices

 Time of shift
Female = 14
Time of shift: Night shift Fallis, W. M., et al. (2011) Canada RNs Hospital 13 To explore nurses’ perceptions, experiences, barriers, and safety issues related to napping/not napping during night shift Focus groups

  1. Environmental scan

  2. Impact of napping: energized or disoriented

  3. Consequences of not napping: foggy thinking

  4. Mixed views about management and the public regarding nurses napping during night shift

 Shift work per se Time of shift
Female = 11
Male = 2
Time of shift: Night shift Nasrabadi, A. N., et al. (2009) Iran RNs Hospital 18** To describe the perceptions held by Iranian registered nurses (IRNs) concerning their night shift work experiences Semi-structured interviews

  1. Socio-cultural impacts of night work

  2. Health-related impacts of night work

  3. Night work as an opportunity for gaining more clinical experiences and learning more

 Shift work per se Time of shift
Female = 11
Male = 5
Time of shift: Early shift (6 to 7am) Bauer, I. (1993) Germany RNs Hospital 14 To explore perception of German nurses of early shift Semi-structured interviews

  1. The impact of rising early on the individual

  2. The detrimental effect of alternating shifts on well-being

  3. Disturbances to personal life

  4. The rationale for early start

  5. Consequences for patients

 Time of shift
Female = 13
Male = 1

HCA = Health Care Assistant NA = Nursing Assistant nr = not reported

**As reported by the authors