2011 Theses Doctoral

Off-Shift Nursing and Quality Patient Outcomes

Cordova, Pamela B. de

Acute care hospitals function 24-hours-a-day, 7-days-a-week. A majority of that time is characterized as off-shifts (i.e., nights, weekends, and/or holidays). Researchers have found that patient outcomes are generally worse on off-shifts as compared to regular hours. However, the underlying mechanism of why these outcomes are worse remains unclear. This dissertation explores off-shift care including nurse staffing and human capital variables and their impact on patient safety in acute care hospitals. The importance of off-shift quality care in acute care hospitals is discussed in the first chapter. In the second chapter, findings from a systematic literature review are presented. The third chapter describes mixed methods and the theoretical framework that guided the development of an interview guide and the quantitative portion of the dissertation. The fourth chapter includes the qualitative study of off-shift nursing and the fifth chapter, is a quantitative study of testing variations in nursing inputs (i.e., staffing and human capital variables) by shift and their impact on length of stay. Finally, in the sixth chapter, the findings from Chapter 2, 4, and 5 are summarized and synthesized into a concluding chapter of the dissertation.