Relationships between comprehensive characteristics of nurse work schedules and adverse patient outcomes: A systematic literature review

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19 Scopus citations


Aims: To review the comprehensive characteristics of adverse nurse work schedules and to synthesise the evidence of their relationships with adverse patient outcomes. Background: To manage nurse shortages and fluctuations in patient censuses, nurses often work overtime. This increases nurses’ work hours and causes them to have fewer breaks. Such extended work schedules, long shift length, long weekly work hours and insufficient beaks can be considered as adverse nurse work schedules. Understanding how these adverse nurse work schedules affect patient outcomes is important to ensure patient safety. Design: A systematic review of nursing and healthcare literature was conducted in this study. Methods: Eight electronic bibliographic databases (CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS and Web of Science) were used to search research articles published from 2000 to 2019. The study selection process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Results: From the search, 2,366 articles were identified, 22 of which were included in this review. Working more than 12 hours in a day had an adverse effect on patient outcomes, as was working more than 40 hours per week. There were mixed findings in the relationship between nurse overtime and adverse patient outcomes. Conclusions: This study found a conclusive relationship between excessive nurse work hours and adverse patient outcomes. This review highlights the importance of managing adverse nurse schedules such as long daily and weekly work hours to improve patient safety and prevent adverse patient outcomes. Relevance to clinical practice: Study findings support the importance of monitoring and regulating nurse work schedules and adverse scheduling practices to improve nurse well-being and health and to prevent adverse patient outcomes.

Original languageEnglish
Pages (from-to)2202-2221
Number of pages20
JournalJournal of Clinical Nursing
Issue number15-16
StatePublished - Aug 2021

Bibliographical note

Funding Information:
Editorial support for the manuscript was provided by the Ewha Womans University. Eunjeong Goo assisted literature search.

Publisher Copyright:
© 2021 John Wiley & Sons Ltd


  • breaks
  • daily work hours
  • nurse schedule
  • overtime
  • patient outcomes
  • weekly work hours


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