|Year : 2019 | Volume
| Issue : 3 | Page : 147-154
The relationship between staff nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care
Noor A Abd-El-Aziz1, Eglal A.A Wahab2
1 Nursing Specialist, Cairo University, Cairo, Egypt
2 Nursing Administration, Egypt
|Date of Submission||02-Mar-2020|
|Date of Decision||15-Mar-2020|
|Date of Acceptance||17-Mar-2020|
|Date of Web Publication||20-Aug-2020|
Noor A Abd-El-Aziz
Prof. in Nursing Administration Department, Cairo University
Source of Support: None, Conflict of Interest: None
Introduction Nurse satisfaction and nurse scheduling are the major factors that improve quality of patient care. Long working hours contribute to poor patient outcomes, which affects patient satisfaction and quality of care.
Aim The aim was to investigate the relationship between staff nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care.
Design A descriptive correlational design was used for this study.
Participants and methods The study was conducted in 1-Day Surgeries Hospital, Nasr City, Cairo. Two samples were included in the study: convenient sample of nurses (36 nurses), and a random sample of patients (50 patients). Data were collected using two tools: a developed questionnaire about nurses’ satisfaction with their schedule and an adopted questionnaire about patients’ satisfaction with quality of care.
Results The results revealed that the total mean percent of nurses satisfied with their schedule was 68.1%, which indicates moderate satisfaction. Moreover, the mean percent of total patients satisfied with the quality of care was 64.5%, which indicates moderate satisfaction. In addition, there was no statistically significant positive correlation (r=0.051, P=0.767) between patients’ satisfaction with quality of care and nurses’ satisfaction with their schedule.
Conclusion Nurses were moderately satisfied with their schedule, and also, patients were moderately satisfied with quality of care. There was no statistically significant positive correlation between nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care.
Recommendations The authors recommend to increase staff participation in schedule and include preferences as a motivator to improve nurses’ morale and satisfaction; to include nurses, who work extended shifts, in health promotion and disease prevention programs; and to decrease weekly working hours with high working-time autonomy and workplace flexibility.
Keywords: nursing satisfaction, nursing schedule, patient satisfaction, quality care
|How to cite this article:|
Abd-El-Aziz NA, Wahab EA. The relationship between staff nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care. Egypt Nurs J 2019;16:147-54
|How to cite this URL:|
Abd-El-Aziz NA, Wahab EA. The relationship between staff nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care. Egypt Nurs J [serial online] 2019 [cited 2020 Oct 20];16:147-54. Available from: http://www.enj.eg.net/text.asp?2019/16/3/147/292495
| Introduction|| |
Hospitals require services and staffing around the clock. To cover the need for staff at all times, the work is organized in shifts, for example, day, evening, and night shifts, which in turn are organized into schedules, to ensure patient safety and continuity of care. Nurse scheduling is the major factor that improves quality of patient care, nurses’ morale, and relationships among the nursing staff. Staff allocation needs to balance service requirements with fairness and cost effectiveness to ensure that safe and effective care to be provided. Moreover, scheduling must consider many constraints such as nurse demands, hospital policies, work regulations, and nurses’ preferences, as poorly constructed shift schedules can lead to fatigue, mistakes, and affect the quality of patient care (Azimi et al., 2015; Clark et al., 2015; Kullberg et al., 2016).
However, scheduling is the provision of productive resources over time to prevent the production process from coming to a stop, and to enable the organization to carry out its required functions (Ali et al., 2018). In other words, Bowie et al. (2019) defined schedule as the assignment of the right people to the right task, to the right time, and to the right place.
The main target of nurse scheduling problem is to assign an optimum number of different skilled nurses for each shift to ensure high quality of care while considering the completeness and continuity of care and patient safety, as well as minimizing the hospital’s cost, maximizing the nurses’ preferences, and satisfying all operational constraints. There are several factors affecting the nurse scheduling problem: the governmental regulations, labor laws, hospital policy, and the status of nurses (Michael et al., 2015; Capan et al., 2017; El Adoly et al., 2018).
Nurse satisfaction is an indicator of the quality of health services in the hospital. Low levels of job satisfaction are related to not only employee withdrawal and intention to leave but also employee mental health and burnout. On the contrary, employees who are highly satisfied with their jobs have been shown to be more productive, creative, and remain within the working organization for longer periods of time. It is important to increase staff participation and include preferences as a motivator to boost morale as well as improve nurse satisfaction. Through flexibility and control over the schedule, this leads to improved morale and less staff turnover. Job satisfaction in nursing has been found to have a significant effect on patients’ satisfaction (Liu et al., 2016; Svirsko et al., 2019).
The main goal of healthcare system is to deliver equitable, effective, and accessible health care services, so nurses’ main responsibility is to give quality care to patients, to enhance patient satisfaction. Recently, the health care regulators have shifted toward a market-driven approach of turning patient satisfaction surveys into a quality improvement tool for overall organizational performance. Moreover, patient satisfaction reflects patients’ involvement in decision making and their role as partners in improving the quality of health care services. There is no consensus on how to define the concept of patient satisfaction. Donabedian’s quality measurement model defined patient satisfaction as a patient-reported outcome measure. Patients who are more satisfied with their care are more likely to follow medically prescribed regimens and thus contributing to the positive influence on health. Measuring patients’ satisfaction with nursing care could be effective in improving nursing service quality (Al-Abri and Al-Balushi, 2014; Devkaran, 2014; Elrazik, 2018; El Adoly et al., 2018; Karaca and Durna, 2019).
Extended work shifts of 12 h or longer are common and even popular with hospital staff nurses, but little is known about how such extended hours affect the care that patients receive or the well-being of nurses. Survey data from nurses in four states showed that more than 80% of the nurses were satisfied with scheduling practices at their hospital. However, as the proportion of hospital nurses working shifts of more than 13 h increased, patients’ dissatisfaction with care increased. Furthermore, nurses working shifts of 10 h or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patient care. Policies regulating work hours for nurses, similar to those set for resident physicians, may be warranted. Nursing leaders should also encourage workplace cultures that respect nurses’ days off and vacation time, promote nurses’ prompt departure at the end of a shift, and allow nurses to refuse to work overtime without retribution.
Service excellence is pivotal to health care delivery and requires sustained effort toward zero-defection to succeed. Among factors that affect the delivery of a quality care are nursing staffing, scheduling/shifts, work environment, and job satisfaction. The Institute of Medicine defined quality of care as ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’ (Aron, 2015). In addition, a good indicator of quality healthcare is that it should be timely, safe, effective, and patient oriented. Quality is grounded on the conceptual framework of continuous improvement (Anabila et al., 2019).Quality of care is a dominant concept in quality assurance and quality improvement programs in the health care sector. Patient satisfaction is a concrete criterion for evaluation of health care and therefore quality of nursing care. Patients who are more satisfied with their care are more likely to follow medically prescribed regimens and thus contributing to the positive influence on health. Measuring patients’ satisfaction with nursing care could be effective in improving nursing service quality (Devkaran, 2014; Xesfingi and Vozikis, 2016; Karaca and Durna, 2019).
Significance of the study
In the present situation, there was an increase in nurses’ absenteeism and sick leaves, which could be owing to problems in nursing schedule, so the hospital tried to compensate this problem by contracting with private nurses and nurse aids to provide nursing and non-nursing duties. However, workload on the hospital nurses increased, leading to increased family problems, owing to the schedule, because of the uncommitment of private part-time nurses, owing to uncontrolled hospital policies. Therefore, the present study findings might spot light on true sources of satisfaction and dissatisfaction with their schedules to improve the situation on evidence. Moreover, it will identify patients’ satisfaction with quality of care, to enhance strong areas and improve weak areas.
| Aim|| |
The present study was aimed to investigate the relationship between staff nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care.
- To fulfill the aim of the study, the following research questions were formulated:
- What is nurses’ satisfaction level with their schedule?
- What is patients’ satisfaction level with the quality of care?
What is the relationship between satisfaction of staff nurses with their schedule and patients’ satisfaction with quality of care?
- Nursing schedule used in this study is planned by the units’ managers; it includes nurses’ shifts, as well as days off and on during 1 month.
- Patient satisfaction is patients’ perceptions and feelings toward quality of care received. This quality of care is in the form of interpersonal communication skills, technical quality of nursing skills, and in-patient room services.
| Patients and methods|| |
A descriptive correlational design was utilized for this study. The descriptive correlational design is used to describe variables and examine relationships among these variables. Using this design facilitates the identification of many interrelationships in a situation rather than to infer cause-and-effect relationships. Descriptive correlational studies are usually cross-sectional (Polit and Beck, 2012).
The study was conducted in One-Day Surgeries Hospital, Nasr City, Cairo. The hospital is affiliated to the Specialized Medical Center, which is affiliated to the Ministry of Health and Population, which provides free, insurance services and paid services for varieties of patients. The occupancy rate was ∼55%.
The total bed capacity in the hospital was 43 beds, distributed as 22 inpatient, six CCU beds, four NICU incubators, three ER with three observation beds and three OR with two recovery beds. The hospital was staffed with 112 nurses who were classified as 60 permanent staff nurses, 11 contracted staff nurses, 22 head nurses, and 19 nurse aids, who worked in all hospital departments.
Regarding participants, two samples were included in the study:
A convenient sample of nurses was recruited in the study, with the following inclusion criteria: only permanent staff nurses who provides direct patient care, and actively work in the hospital were included. The total sample size was 36 of 60 nurses, as four nurses refused to participate and the rest (20) were on different leaves.
A simple random sampling of the patients was done, with the following inclusion criteria: adult, both sexes, fully conscious patients, able to read and write, and hospitalized for at least 24 h after admission. The total patient sample was 50, and all were recruited over a 6-month duration.
The first tool was ‘nurses’ satisfaction with their nursing schedule questionnaire’. This questionnaire was developed by the investigator based on reviewing literature, mainly Bailyn et al., (2007), and Gharib (2013), and translated into Arabic according to the aim and nature of the current study. It consists of two parts: the first part concerns with nurses’ personal data, which include code, years of experience, qualification, sex, marital status, department, and number of children. The second part consists of three domains, with 45 items: the first domain describes the schedule nurses’ pattern, and had 16 items, the second domain comprised schedule problems and included 20 items, and the third domain included suggestion for improvement and had nine items. The scoring system was a three-point Likert scale that ranged from 1 to 3, representing ‘1’ for dissatisfied, ‘2’ for uncertain, and ‘3’ for satisfied. The level of satisfaction was computed as follows, where the cutoff point of satisfaction level mean percent was 60%; while, less than 60% indicated dissatisfaction; as well as, 60% to less than 75% indicated moderate satisfaction; and 75% and more indicated high satisfaction.
The second tool was ‘patients’ satisfaction with the quality of care questionnaire’. This questionnaire was adopted from Gharib (2013), after permission was obtained. It consists of two parts: the first part concerns with patients’ personal data, which include code, age, and level of education and the second part consists of three dimensions with 28 items: the first domain comprised interpersonal communication skills and had five items; the second domain comprised technical quality of nursing skills and included seven items; and the third domain comprised inpatient room services and included 16 items. The scoring system was a three-point Likert scale that ranged from 1 to 3, representing ‘1’ for dissatisfied, ‘2’ for uncertain, and ‘3’ for satisfied. The level of satisfaction computed was as follows, where the cutoff point of satisfaction level mean percent was 60%: less than 65% indicated dissatisfaction, 65 greater than 75% indicated moderate satisfaction, and greater than 75% indicated high satisfaction.
Initial approval from the Ethical Committee of Scientific Research at the Faculty of Nursing at Cairo University was taken, and to collect data for this study, an official permission was obtained from hospital director to conduct the study. Written permission was granted for the tool from the original author (Gharib, 2013) and submitted to ethical committee. Written consent was obtained from the two sample groups (nurses and patients) after being revised. The ethical issue considerations included voluntary participation explaining the purpose and nature of the study and possibility to withdraw at any time. Anonymity and confidentiality also was assured. Final approval from the Ethical Committee of Scientific Research was obtained after data collection.
Validity was established by a group of five jurors in nursing administration in the hospital and in the Faculty of Nursing; they were asked to check the developed nursing satisfaction with their schedule questionnaire for content coverage, clarity, wording, length, format, and overall appearance. Based on juries’ comment and recommendations, some changes were made in the form of rewording of some items or removing of duplicated items.
A pilot study was carried out on 10% of the study samples (four nurses and five patients) to test the applicability and relevance of the tools, also to estimate the time necessary to answer the tools (nurses took from 15 to 20 min, whereas patients took from 5 to 10 min), and to test the clarity of these tools. Based on the pilot study, no modifications were made. So, the pilot samples were included in the total study samples.
Cronbach’s α coefficient was performed for the questionnaire data to assess its reliability; the result of developed tool showed reliability of 0.82, which is accepted, as well as the adopted tool showed reliability of 0.89, which is accepted.
Procedure of data collection
Nurses’ questionnaire sheet was handed to the nurses in the unit, after oral explanation of the aim of the study and the content of the sheet. The suitable time for data collection was at the end of morning shift but sometimes in the afternoon shift and rarely in the early morning before night shift nurses leave. The investigator requested the nurses to submit the filled questionnaire with the units’ head nurse, as she distributed and collected the questionnaire sheets. The rate of return was 100%.
As for the patients, hospital units were assessed daily to select patients’ sample according to the inclusion criteria. Three visits to the hospital units per week were done for the same reason. Depending on the rate of admission and occupancy rate, recruitment of patients was done to complete the patient sample. This period extended for 6 months started from January 2018 to June 2018.
Patient’s questionnaire sheets were handed to each patient individually, after explanation of the aim of the study and the content of the sheets. The suitable time for data collection was at the end of morning and afternoon shifts. Patients were let to answer freely, but the investigator was around to answer any question and to collect the completed questionnaires on the same day.
Upon completion of data collection, the data were coded, scored, modified, tabulated, and analyzed using Statistical Package for the Social Sciences (SPSS), version 20 (Chicago). Descriptive and inferential statistics were carried out. Numerical data were expressed as a mean and SD. Qualitative data were expressed as frequency, percentage, mean, range, and SD. The P value is the degree of significance. If the P value less than 0.05, it indicates significant result, whereas P value less than or equal to 0.01 indicates high significant. The test was used to identify the significance of correlations among the study variables. The correlation coefficient (r) ranges from −1 to +1 (positive or negative), indicating the relationship and the strength of relationship among the variables. A negative correlation indicates one variable increases, the other decreases. A positive correlation is where the two variables react in the same way, increasing or decreasing together.
| Results|| |
Regarding personal characteristics of the studied samples, the nurses’ sample showed that 97.2% were females, 50% had technical diploma, 33.3% had experience ranged from 15 less than 20 years, 72.2% were married, 55.6% had three or less children, and 27.8% worked in inpatient department. However, the patients’ sample showed that 28% were highly educated and 34% ranged from 25 less than 35 years.
[Table 1] shows the total mean score and mean percent of nurses who were satisfied about the work schedule. It revealed that the total mean percent was 68.1% regarding nurses’ satisfaction with their schedule, which indicates moderate satisfaction. Moreover, the highest mean percent was 73.5% regarding nurses’ satisfaction regarding schedule pattern, followed by the highest mean percent of 63.9% regarding nurses’ satisfaction regarding schedule problems. Moreover, the mean percent was 92.1% regarding nurses’ satisfaction about suggestions for improving work schedule.
|Table 1 Total mean score and mean percent of nurses’ satisfaction about work schedule (n=36)|
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[Table 2] shows the total mean score and mean percent of patients who were satisfied with quality of care. It revealed that the mean percent was 64.5% regarding total patients’ satisfaction with quality of care, which indicates moderate satisfaction.
|Table 2 Total mean score and mean percent of patients’ satisfaction with quality of care (n=50)|
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[Table 3] shows the correlation between nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care. The findings revealed that there was no statistically significant positive correlation (r=0.051, P=0.767) between nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care.
|Table 3 Correlation between nurses’ satisfaction with their schedule and patients’ satisfaction about quality of care|
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[Table 4] describes the relationship between nurses’ total satisfaction and their personal data. The findings revealed that there was a statistically significant relation of nurses’ satisfaction with their schedule according to their work department and qualifications, respectively (F=3.913, P=0.008), (F=3.526, P=0.041). However, there was no statistically significant relation of nurses’ satisfaction with their schedule according to their years of experience, marital status, and number of children successively (F=2.630, P=0.053; F=0.476, P=0.625; and F=1.802, P=0.181).
|Table 4 The relationship between patients’ total satisfaction and their personal data|
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[Table 5] describes the relationship between patients’ total satisfaction and their personal data. The findings revealed that there was a significant statistical relation (F=2.646, P=0.046) of patients’ satisfaction with quality of care regarding their qualifications. However, there was no significant statistical relation (F=0.397, P=0.810) of patients’ satisfaction with quality of care according to patients’ age.
|Table 5 The relationship between nurses’ total satisfaction and their personal data|
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| Discussion|| |
Regarding nurses’ satisfaction with their schedule, the highest mean percent of nurses’ satisfaction was regarding scheduling patterns. It could be owing to they becoming familiar with the schedule and adapting their lives according to it, as well as they all agreed that their schedule allowed them to give a good nursing service. This result agreed with Koning (2014), who studied the relation between self-scheduling and nurses’ job satisfaction in Canada. Results revealed that self-scheduling influences job satisfaction. However, the study findings do not match with Abd El Latief et al. (2018), who studied burnout among health care providers in Egypt. Their result indicated that health care providers reported high levels of depersonalization (52.5%) and low levels of personal accomplishment (45.7%). Moreover, the study findings do not match with Baillie and Thomas (2019), who studied changing of shift pattern from 12 to 8 h in UK. Its result showed that nursing staff were dissatisfied with their care delivery and handovers.
On the contrary, the study revealed that the highest percentage of nurses were dissatisfied with working in the afternoon shifts from 2 to 8 pm. It could be owing to afternoon shifts do not allow them to take care of their children, or it might be owing to limited opportunity for social activity. This result agrees with Jensen et al. (2018), who studied the effect of shift work on nurses’ lives in Denmark. Their results showed that shift work was found to influence the opportunities for spare time activities, and ∼25% of both evening- and night-shift groups found that working shifts sometimes led to social isolation. However, one-third of them dis-satisfied with frequent changes are made after schedule was announced. This result agrees with Clark et al. (2015), who studied rescheduling of nursing shifts in UK. Their results revealed that poor rescheduling can result in greater disruption to planned nursing shifts and may negatively affect the quality and cost of patient care, nurse morale, and retention. Moreover, the study findings match with Svirsko et al. (2019), who proposed modeling to improve nurse-scheduling process in Pittsburgh. Their result indicated that self-scheduling increases nurse satisfaction.
In relation to nurses’ satisfaction with their schedule, the study revealed that the highest mean score regarding schedule problems exist; two-thirds of them agreed about the presence of cooperation between staff. It could be owing to the friendship relation between each other, or might be the close relation as their years of experience extended to 15 or 20 years. However, more than half of nurses were uncertain about the appropriateness of hospital leave system, balances between family needs and work, and number of working nurses in shift during holidays. It might be owing to years of working in hospital and could not verbalize their satisfaction. On the contrary, the highest percent of nurses disagreed about hospital and shift incentives and complain of tired after shift work. It could be owing to exhaustion from long sifts of 12 h that affect their family life, and consequently matches with low incentives. The study findings are consistent with Aron (2015), who studied the relation between nurses’ job satisfaction and quality of health care in Minnesota. Their result indicated that workload, staff scheduling, and pay/compensation were found to affect nurses’ job satisfaction most. Moreover, the study findings agreed with Radwan and Mohamed (2019), who studied barriers to effective communication in Egypt. Its results showed that main barriers of communication reported by the nurses were being overworked, shortage of nurses, and fatigue.
Regarding nurses’ suggestions for solving schedule problems, the highest mean score of nurses’ agreement regarding suggestions for improving work schedule were about a declared schedule policy to all staff, new permanent nursing staff to be recruited, nursery for care of their children, participation in schedule’s decisions, overtime compensation, and self-scheduling. It could be owing to their need to be powered and motivated by knowledge and autonomy, and also to overcome the problems of babies, where the nursery will help to keep the staff and improve shortage as well as workload. The study findings are consistent with Stalpers et al. (2017), who studied nurses’ perception of quality of care and work environment characteristics in the Netherlands. Their findings indicated that nurse-perceived quality was positively associated with adequacy of staffing. Moreover, the study findings match with Kang et al. (2016), who studied nurse workload and patient adverse events in Korea. Its results revealed that hospitals with a relatively high proportion of nursing workforce to be sufficient showed a low rate of workload.
Concerning the relationship between nurses’ personal data and satisfaction with schedule, the highest mean score of nurses’ satisfaction with their schedule was regarding outpatient department nurses. It could be owing to low workload than other departments or presence of nurses aids to support staff department. Moreover, the highest mean score of nurses’ satisfaction with their schedule regarding their qualification was the baccalaureate degree. It could be owing to that they have less afternoon shifts and no night shifts, whereas technical nurses have more afternoon and night shifts, according to hospital policy, or that the baccalaureate degree were assigned as head nurses, whereas technical nurses were assigned as staff nurses. However, the highest mean score of nurses’ satisfaction with their schedule was regarding years of experience 5 less than 10. It could be owing to they were single or children were young, or because they have another job to satisfy their needs.
In relation to patients’ satisfaction with quality of care. The study revealed that the highest mean score of patients’ satisfaction was regarding quality of care. As they all agree about treatment and medication were provided, good communication and respect from staff as well as they respond to questions, make the effort to provide comfort during hospitalization, try to ease their pain, and keeping their privacy. This result could be owing to nurses’ sense of empathy, responsibility, caring, and accountability, as well as the hospital policy to achieve accreditation, and the effort of good supervision from all nursing discipline as quality, infection control, education departments, and nursing administration. This result matches with DiGiacinto et al. (2016), who studied how to improve patient satisfaction in the USA. Its result revealed that a pleasant experience, increased communication through written information, or face-to-face with providers have shown to have a positive effect on patients’ overall satisfaction and perceived quality of care. Moreover, the study findings are in agreement with Karaca and Durna (2019), who studied the relation of patient satisfaction with the quality of nursing care in Turkey. Their results showed that patients were more satisfied with the concern and caring by nurses. On the opposite, the study findings do not match with Kamel et al. (2019), who studied the relation of nurses’ awareness of patient safety and patients’ satisfaction in Egypt. Their result revealed that nurses’ awareness is only influenced by working in shifts, and there was low patient satisfaction. Moreover, the study findings do not match with Karaca and Durna (2019), in which patients were dissatisfied with the information they were given.
Concerning the relationship between patients’ personal data and satisfaction with quality of care, the highest mean score of patients’ satisfaction about quality of care regarding their qualification was the high educated patients. It could be owing to that high educated patients knew their rights and responsibilities, as well as were more aware about quality standards and aware that their satisfaction was important for hospital management. This result does not match with Kamel et al. (2019), who showed that less than a third of the patients were satisfied, and satisfaction decreased with higher education. However, the highest mean score of patients’ satisfaction with quality of care was regarding patients’ age 15 less than 25. It could be owing to they do not have much expectations, or they become more familiar and friendly with staff members. The study findings are consistent with Karaca and Durna (2019), which revealed that patients who were 18 less than 35 years old were more satisfied with the nursing care.
| Conclusion|| |
The study concluded that nurses of 1-Day Surgeries Hospital, Nasr City, Cairo, were moderately satisfied with their schedule, and patients were moderately satisfied with quality of care. There was no statistically significant positive correlation between nurses’ satisfaction with their schedule and patients’ satisfaction with quality of care.
We recommend to increase staff participation in schedule and include preferences as a motivator to boost morale as well as improve nurse satisfaction; to include shift and night workers in health promotion and disease prevention initiatives; and to decrease weekly working hours with high working-time autonomy and workplace flexibility.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]