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Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts
  1. Teresa Gómez-García1,
  2. María Ruzafa-Martínez2,
  3. Carmen Fuentelsaz-Gallego3,
  4. Juan Antonio Madrid4,
  5. Maria Angeles Rol4,
  6. María José Martínez-Madrid5,
  7. Teresa Moreno-Casbas1
  8. on behalf of the SYCE and RETICEF Group
    1. 1Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, Ministry of Science and Innovation, Madrid, Spain
    2. 2Faculty of Nursing, University of Murcia, Murcia, Spain
    3. 3Vall d'Hebron Hospital, Nursing and Healthcare Research, Barcelona, Spain
    4. 4IMIB-Arrixaca, CronoLab, Department of Physiology, University of Murcia, Murcia, Spain
    5. 5Department of Physiology, University of Murcia, Murcia, Spain
    1. Correspondence to Dr T Moreno-Casbas; mmoreno{at}


    Objective The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work.

    Methods This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns.

    Results 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017).

    Conclusions Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers.

    • Work Environment
    • Burnout
    • Sleep quality
    • Shift work
    • Patient safety
    • Quality of care

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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