Developing nurse and midwife centred rostering principles using co-design: a mixed-methods study

Holton et al. BMC Nursing (2024) 23:938 https://doi.org/10.1186/s12912-024-02522-7 BMC Nursing Open Access RESEARCH Developing nurse and midwife centred rostering principles using co-design: a mixedmethods study Sara Holton1,2*, Bodil Rasmussen1,2*, Karrie Long3, Madison Bellizia3, Jac C. Mathieson3, Shane Crowe4, Douglas Mill4, Harry Pasion4, Claire Rankin 4, Maree Woodhouse5, Meaghan Douglas5, Nadine Glanville5, Kylie Baker5, Kethly Fallon6, Megan Hoffmann6, Nicole Sliwa6, Denise Heinjus6, Lisa Fitzpatrick7 and Paul Gilbert7 Abstract Background Current nursing and midwifery rosters are based on guidelines which may no longer adequately meet the needs of health services or staff and often result in decreased job satisfaction, poor health and wellbeing, and high turnover. Little is known about the rostering needs and preferences of contemporary nurses and midwives in Australia. The aim of this study was to identify the rostering concerns, needs and preferences of nurses and midwives, and co-design acceptable, equitable and feasible rostering principles. Methods A mixed-methods design using a co-design approach with three components: survey, discussion groups, and co-design workshops. Nurses and midwives employed at three public health services in Victoria, Australia were invited to participate. The quantitative (survey) data were analysed using descriptive statistics and the qualitative (discussion groups and co-design workshops) data using thematic analysis. Results Surveys were completed by 715 nurses and midwives including unit (n = 14) and roster (n = 13) managers. Nurses and midwives (n = 688) were mostly satisfied with their roster (mean satisfaction score = 57.4). Many had responsibilities or commitments which impacted their roster availability (n = 406, 61.6%) and over half had taken personal leave due to roster-related fatigue (n = 335, 59.1%) or unmet roster requests (n = 310, 54.7%). Midwives reported significantly less satisfaction (p < 0.001) and more challenges with current roster practices than nurses. Roster and unit managers described spending considerable time preparing and reworking rosters. Thirty-nine nurses and midwives participated in a focus group and outlined concerns about the fairness and equity of current roster practices, and the adverse impact on their health, work, and personal lives. Ninety-one nurses and midwives participated in a co-design workshop and identified a need for roster practices and guidelines which ensure flexibility, fairness and equity, and fatigue management. Conclusions Although nurses and midwives were mostly satisfied with their rosters, they often experienced frustrations and challenges with current roster guidelines and practices as well as adverse effects on their health and *Correspondence: Sara Holton Bodil Rasmussen Full list of author information is available at the end of the article © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Holton et al. BMC Nursing (2024) 23:938 Page 2 of 14 work and personal lives. Nurses and midwives identified a preference for fair and equitable rosters which provide flexibility and enable them to manage their other commitments and responsibilities, reduce roster-related fatigue, and provide high quality patient care. Keywords Nurses, Midwifery, Health services, Hospitals, Occupational health, Fatigue, Shift work, Rostering Background The work of nurses and midwives is emotionally demanding, and they often experience high levels of occupational stress because of long work hours, heavy workloads, and irregular schedules [1, 2]. Rostering (scheduling) is an important process to enable efficient, effective and safe delivery of health care [3]. However, shift work is associated with several adverse health outcomes for nurses and midwives including burnout [4–7], fatigue [8, 9], musculoskeletal disorders [10], obesity [11, 12], higher rates of smoking [12], headaches [13], social isolation [13], mental distress [14] and sleep disorders [15–20]. Night shifts, early morning shifts, ‘quick returns’ and requests to work on scheduled days off are known to cause significant sleep loss and contribute to nurse fatigue [12, 15]. Nurses’ and midwives’ quality of professional life is also significantly affected by shift duration [21], time [22] and frequency [8]. Nurses and midwives working shifts also report lower levels of job satisfaction [14, 23] and job satisfaction is lower for those working fixed night shifts [24] and longer shift lengths [25]. An Australian study found nurses working rotating shifts experienced more psychological distress than those working a fixed roster [26]. Nurses’ and midwives’ work schedules have also been found to affect patient care. A South Korean study found that longer work hours were associated with missed nursing care [27]. Fatigue from working shift work has been shown to contribute to reduced productivity and patient safety and increased medical errors and workplace-related incidents [28]. Although the number of nurses and midwives employed and registered in the state of Victoria has increased recently [29–31], Australia’s health services are experiencing nursing and midwifery workforce shortages due to the reduced migration of skilled nurses and midwives, an increase in the number of nurses and midwives who intend to leave or have left the profession, and a great demand for nurses and midwives due to an increased number of patients [32]. Nurses and midwives have identified the need for improved working conditions [33] including the ability to better manage their paid work and personal lives and ‘avoid’ shift work [32]. Current nursing and midwifery rosters are based on guidelines which may no longer adequately meet the needs of nurses and midwives or health services. In Australia, legislation [34] and an industrial agreement [35] provide guidance for employers (e.g. health services) and nurses/midwives about rostering practices. These documents include principles and recommendations about individual flexible working arrangements, change of working hours and rosters, breaks, nurse/midwife (including skill mix): patient ratios, and ros (...truncated)