Factors affecting observations of vital signs in hospital during the night shift: nurses’ perspectives

Background: Innovations to improve identification of physiological decline in hospitalised patients rely on timely measurement of vital signs. However, studies have indicated observations may be delayed or omitted, especially during night shifts.Aim: To improve our understanding of patient surveillance at night through a description of knowledge, beliefs and attitudes of nurses working night shifts. Methods: In June 2015, we sent email invitations to a web-based survey to all registered nurses, midwives, and health care support staff working in a 1200-bed NHS hospital Trust. We used exploratory factor analysis to correlate survey items. Using multivariable linear regression we related factor scores with nurse characteristics (e.g. role, experience) to predict nurses’ knowledge, beliefs and attitudes about vital signs observations. Results: Of 695 surveys received, 497 (71.5%) respondents worked at least one night shift (RNs 321 (64.59%); HCSWs 120 (24.14%); midwives 24 (4.83%); student nurses 32 (6.45%)). Survey items correlated into four factors. Nurses with greater experience believed workload and capacity to impact work at night (factor 1: workload and resources). Student nurses and midwives reported greater inclination to prioritise tasks at night. Respondents working only or more often at night, used knowledge over early warning scores to prioritise tasks during night shifts (factor 2: prioritization). Role, number of night shifts worked, and shift patterns affected perceptions of quality of care delivered at night (factor 4: responsibility and control). Discussion: The extraction of four independent factors showed the multidimensional aspect of nurse work at night. Nurse characteristics (role, experience, and number of night shifts worked) associated with completion of care tasks. These correlated to prioritisation strategies of care tasks (attitudes and behaviours) and having a sense of control over the care at night. Conclusion: Results of the regression model indicated the need to understand how nurse characteristics influence compliance with surveillance protocols in acute care wards.