Working Hour and Schedule Characteristics among Nurses: A Retrospective Study

Research Article

Austin J Nurs Health Care. 2022; 9(2): 1074.

Working Hour and Schedule Characteristics among Nurses: A Retrospective Study

Peršolja M*

Vipava Unit of Faculty of Health Sciences, University of Primorska, Slovenia

*Corresponding author: Peršolja M, Vipava Unit of Faculty of Health Sciences, University of Primorska, Slovenia

Received: September 24, 2022; Accepted: November 01, 2022; Published: November 08, 2022


Introduction: To describe and compare characteristics of working hours and work schedules among nurses in 2019 and 2021. Evidence about the association regarding the relationship between nurses’ working hours and schedules with the COVID-19 pandemic is limited.

Materials and Methods: The research was conducted at a medical unit of a secondary care regional hospital in Slovenia. Of 71 employees who were eligible, 24 fulfilled the criteria and their data were included in the study.

Results and Discussion: There were substantial differences in working hour and schedule characteristics between 2019 and 2021. Compared to 2019, nurses in 2021 worked more hours, more long shifts, had fewer free weekends and education days, and almost double the number of sick days.

Conclusion: While the nurse manager managed some of the working hour and schedule characteristics appropriately, additional awareness raising, and implementation of a related computer program, are suggested to optimize and develop work schedules.

Keywords: COVID-19; Nursing Service Hospital; Nurse Scheduling; Workload


In 2020 and 2021, medical institutions, especially hospitals, needed to increase their preparedness for patients with COVID-19 who required hospitalization [1]. The pandemic put great psychological pressure on nurses, which increased rates of anxiety, suicide, fear, and depression [2-4], as the qualitative and quantitative changes in their tasks increased the related job demands [5,6]. Moreover, even without a pandemic times the classic schedule (7 am to 3 pm, working only during the week) is an exception among nurses [7]. However, working hours in the EU are governed by the EU’s Working Time Directive (European Parliament, 2003) [8].

Shift scheduling in nursing can be described as having cyclic or non-cyclic patterns. In cyclic scheduling fixed patterns of days on and off are established, and staff are rotated continuously through them [9]. In non-cyclic patterns nurses are asked to sign up for those shifts that they wish to work. Each planning period is considered independently, and new schedules are prepared at the beginning of each month [10]. Adjustments and decisions need to be made daily, and there are many changes in shift at short notice [11]. The objective is to find a balance between satisfying individual preferences and minimizing personnel costs [12,13].

Managers should consider many characteristics of schedules, as they can disrupt employees’ circadian rhythms with improper scheduling patterns. The literature describes the following schedule characteristics as being important for employees: rapid changes in schedule [14,15], the direction and speed of shift rotation [16,17], shift length (mainly 12-hour shifts) [14,17-21], shift start and finish times [14], short breaks between shifts and quick returns [19,21-24], work on scheduled days off [25], and a high number of hours per week (over 60 hours) [26]. The key strategy is to make sleep a priority and adopt a slow, forward-shifting rotation pattern, rotate shifts after 2-week periods and allow an average of 2 days off per week [27], regular breaks [16], choice over shift work schedules [14], and use 8-hour shifts when possible [20]. The organization of work in health care settings has been shown to affect the health of employees [28,29], and a strong risk factor for poor health is shift work [29,30].

This study aimed to describe and compare characteristics of working hours and work schedules among hospital nurses in 2019 and 2021. It was assumed that the COVID-19 pandemic in the year 2021 would result in changed working hours and schedules. The specific objective was to answer the following research questions: Are there differences between 2019 and 2021 in the nurses’ working hour and work schedule characteristics? How many working hours/days do nurses have per week/month? How many consecutive working days? What is the length of work shifts? Which is the direction of rotating shifts? Do nurses have to quickly return? What is the maximum number of consecutive night shifts they do? How many day/evening/ nights shifts do they do per year? How many weekends are nurses free per year? Are there any unusual characteristics of nursing schedules not yet described in the literature?

Compiling data about nurses’ working conditions is important, but most of the published studies on the working hours and schedules of nurses have been done in high income countries, based on shift scheduling computer programs or self-reported data. This paper can contribute to a better understanding of nurses’ working hours and schedules in developing counties, with the aim to intervene to mitigate any possible negative effects. Such knowledge is useful, since it provides insights into how best to deal with the issues raised with various changes to work schedules.

Material and Methods

Study Design

A retrospective observational study was conducted in a Slovenian secondary care regional hospital in 2022. It aimed to observe and describe a situation in two years (2019 and 2021 when the COVID-19 pandemic was active). Data collection was performed by the principal researcher.


The researched Slovenian hospital has 26 specialty departments with approximately 300 beds. Approximately 430 nursing care personnel – mostly nursing technicians (NT) (n=280; 65.12%), and a third of them being registered nurses (RN) (n=150; 34.88%) – provide the necessary services. The hospital deals with nearly 20,000 prospective payment system episodes a year, with an annual bed occupancy rate of 62%. This research was done on a medical ward with 109-bed capacity and 6,125 hospitalized patients in 2019, and 6,828 in year 2021. The hospital was anonymized at the request of the management of the institution.

Participants and Data Sources

The researcher asked the hospital management for permission to do the research and presented the aims and methods of the study. During the related staff meeting, the nursing manager invited all medical ward nurses to collaborate in this study. All nursing staff participated, but many were excluded from the sample because of their specific tasks: the head nurse, the nurse responsible for ordering supplements, nurses who were deployed on COVID-19 units, students, and nurses who resigned during the research period.

There were 45 NT and 28 RN employed on the researched medical ward on 1 January 2019, and 51 NT and 28 RN on 31 December 2021. Of the 71 employees who were eligible, only 24 (33.8%) fulfilled the criteria and all were included in the study (n=12 nurses were moved to different units; n=13 were absent because of maternity or paternity leave; 8 nurses quit their jobs in the hospital, 5 nurses worked short schedules (4 or 6 hours).

There were 10 (41.7%) RNs and 14 (58.3%) NTs in the sample. Five (20.8%) of the nurses were male. The nurses were mostly (n=13, 54.2%) aged 31 to 40 years, 4 (16.7%) were 30 years or younger, 5 (20.8%) were 41 to 50 years old, and 2 (8.3%) were 51 or older. Most of the nurses had two children (n=10, 41.7%). The age of the youngest child varied from 0 to 33 years (Mean = 8.917, SD=10.21). Nurses were employed in nursing from 4 to 33 years (Mean=14.67, SD=9.47).


The independent variables were as follows: (a) observation year (2019, 2021); (b) staff demographic data (gender, age, number of children, age of the youngest child, years employed in nursing, shift usually worked); (c) staff education (RN, NT).

The dependent variables were: (a) the characteristics of the schedule (hours of work shift, long weeks (> 40 hours per week), number of consecutive night shifts, number of day shifts per year, number of evening shifts per year, number of night shifts per year, number of free weekends per year, the direction of rotation shifts); (b) the characteristics of the working hours (weekly working hours, number of working days, number of sick days, number of education days, amount of annual leave, working hours per working day, number of consecutive work days).

Shifts were classified according to time of day: day shift (starts after 06:00, ends before 15:00); evening shift (starts after 14:00, ends before 21:30); night shift (starts after 19:00, ends before 07:30). Shift of more than 9 hours were classified as long shifts. The number of working days is not equal to the number of shifts, as nurses can work one or more shifts on the same day. Net working hours are the hours of employee presence at the work place, gross hours include annual leave, sick and education days. Quick returns are when there is less than 11 rest hours between two shifts.

Direction of rotation means the order of shift change: A forward rotation is in the clockwise direction, from day to evening to night shift. A backward rotation is in the counter-clockwise direction, from day to night to evening shift.

Work patterns consisting of combinations of shifts were characterized as long weeks (> 40 hours per week), continuous work days (maximum number of continuous working days), and free weekends (free on Saturday and Sunday).

Characteristics of shifts and work patterns were summed by individual and then divided into four categories: 0, 1-100, 101-200 and >200 shifts/person/year. Day, evening, night, long weeks were also divided into four categories: 0, 1-12, 13-50, and >50 per person/ year.

We also looked at all shifts within the year for each nurse, and classified them as permanent day, morning or evening (no night), rotating or other.

Data Sources

The data was obtained from 24-month nursing schedules (12 from 2019 and 12 from 2021). The schedules were handwritten on paper, in A3 format, and prepared by the head nurse every month for the next 4 weeks. Before the research, the names of nurses were hidden, and every nurse got an identification number which was the same for the years 2019 and 2021. Only the hospital head nurse had the original schedules with the nurses’ names.


Ethical approval was received from the hospital included in this study. The need for consent by participants was deemed unnecessary, as the data were anonymized before starting the analysis. The study was conducted in accordance with the Declaration of Helsinki.

Statistical Methods

Reliability was reached in the data analysis with the random selection of those nurses who met the criteria described earlier. Exploratory data were performed to inspect the data and identify inconsistencies. IBM SPSS Statistics 26.0 was used for data analysis, at the level of the individual nurse. Quantitative data analysis was performed using descriptive methods: mean (M), Standard Deviation (SD), frequency (n), percentage (%), Pearson’s correlation (r). Correlation strengths were valued as follows: 0–0.09 not correlated, 0.1–0.3 weak, 0.31–0.6 medium, and 0.61–1 strong correlation (31). The repeated measures t-test and independent groups t-test were used to determine whether the difference between means for two sets of scores was the same or different. The significance was set at p <0.05. Cronbach’s Alpha for the instrument was 0.895 (n=419).

Results and Discussion

The nurses mostly (75%, n = 18) worked rotating shifts, but there were 12.5% (n=3) who worked day or evening but not night shift, and 12.5% (n = 3) with another schedule. In total 24 nurses worked 54,166.26 gross hours in 2019 and 54,707.91 in 2021.

For the rotating schedule it was not possible to define the direction of rotation, as the sequences changed all the time from backward to forward. There were no quick returns in the observed sample.

There was a significant increase in working hours per year in 2021 as compared to 2019 (Table 1). Nurses worked mostly 3 weekends per month with a minimum of 5 (2019, 2021) free weekends per year to a maximum of 44 (2019) and 42 (2021). Nurses had fewer free weekends in 2021. The difference between the annual frequency of sick days is significant, the mean of sick days almost doubled in 2021 (2019: min. = 0, max. = 16 days; 2021: min. 0, max. =50 days). A fifth (20.8%, n=5) of nurses were on sick leave more than 10 days in 2019, and just over a third (37.5%, n=9) in 2021 (Table 2).