Research Problem

One of the primary objectives of the healthcare profession is to provide quality and equitable care services quality custom essay to all the patients with the hope of improving the health condition of the population in general. One of the challenges that have been identified as a hindrance to achieving this objective is a shortage of nurses, which is most common within the emergency departments. It has been found that many emergency departments in the US operate under fewer nurses than they are supposed to. As a result, one of the common measures that the healthcare facilities adapt to solve this problem is to initiate the long working hours regulations as well as mandatory overtime. The implication of such requirements is that the nurses end up being overworked, and it results in the increase in the levels of stress, fatigue, and risk of developing other health-related conditions, such as obesity and musculoskeletal disorders. The impact of the long working hours has been studied in depth, but there is limited research on how this affects the level of patient safety. Therefore, this research aims at addressing this gap by investigating how the patient safety within the emergency departments varies with the working patterns of the nurses. Significance of the Problem

Several previous research works have studies the impact of the long working hours on the performance of nurses in general. It has been identified that people who work for long shifts, especially 14 hours a day, experience the increased levels of fatigue and stress, which reduces their productivity and efficiency at work. Apart from that, it has been found that the quality of healthcare as well as the patient safety within the emergency departments in the US have been deteriorating with time. Therefore, this research is significant in the sense that it might help determine if long working hours contribute to the decrease in the patient safety as well as quality of healthcare within the emergency departments, and this information might be necessary for making informed decisions on how this condition can be improved. Research Purpose

The general purpose of this research is to enhance the quality of healthcare services within the emergency departments, which are the most important facilities within a hospital. The specific objective is to investigate if the long working hours among the nurses lead to a reduction in the level of patient safety within these units. Therefore, the main aim is to find out if for the longer shifts than the recommended 8 hours per day result in an increase in the number of events, such as medication and medical errors, that contribute to the unsafe patient environment. Proposed Hypothesis

Null hypothesis (Ho): There is no statistically significant association between the shift lengths among the nurses within the emergency department and safety of the patients.

Alternative hypothesis (Ha): There is a statistically significant association between the shift lengths among the nurses within the emergency department and safety of the patients. Literature Review

Several previous research works have studied the impact of the overtime and long working hours regulations on the quality of healthcare within a hospital setting. Despite the importance of the emergency department within the healthcare facility, it has been found that this division is most affected by the cases of nurse shortage and huge work overload, thus resulting in 60% of its nurses working for more than the recommended hours, which is 8 hours per day. In addition, it was determined that most of the nurses work during the shifts that are more than 16 hours, and this poses a great risk to the quality of healthcare provided. The quality of healthcare and patient safety within the emergency departments in the US have been found to be on a decline, and this has been evidenced by a significant increase in events, such as hospital-acquired infections as well as medical and medication errors. It has been found that there is a relationship between the risk of experiencing fatigue and stress resulting in cases of medication errors and shift lengths of the nurses. It implies that the nurses who work for longer shifts or who take overtime have a higher chance of experience at least one of the events that result to medication errors.

In addition, a study conducted in the UK revealed that 72% of the nurses who worked for more than 12 hours per day had a higher likelihood of providing low-quality health services within the general medical units. Moreover, the impact of the long working shifts on the patient satisfaction has been researched. It was found that almost 45% of the patients treated by the nurses who have worked for more than 12 hours per day recorded a dissatisfaction with the services they received, but the proportion of patients dissatisfied due to the services offered by medical staff who worked for less than 12 hours was less than 35% . It has also been found that the nurses who work for more than 8 hours a day result to poor health outcomes, such as extended patient hospitalizations and delayed patient recovery period, as compared to those who work for 8 hours shifts. It implies that long working hours have an effect on the healthcare outcomes as well as the satisfaction levels of the patients.

II. Methodology

The research aims at using a correlational research design. The design is a type of qualitative research methods and involves the use of the gathered continuous data in testing if there exists a significant relationship between the variables under investigation. The independent variable to be investigated in this research is the working shift of a nurse, while the dependent variable is a level of patient safety. The patient safety can be defined by the cases of the medication errors experienced during the working shifts of the patients, and it would be measured by counting the number of events that result in medication errors. Such cases include wrong dosage, administration of inappropriate medication, or wrong prescription of a drug. Therefore, this dependent variable would be measured on a continuous (interval) scale. The independent variable, which is the working shift of the nurses, would be defined as the number of hours that the nurse works within a period of 24 hours. The shift would be regarded as long if the nurse works for more than 8 hours, which is a recommended shift length. It implies that the independent variable would be measured on a continuous (interval) scale.

The data would be collected through the use of an observational method. The researcher would observe the nurses who would be included in the study to determine their shift length and the number of medication errors events that occur during their shifts. Lastly, this research would put in place measures that would ensure that the human rights and the population are protected. The privacy and confidentiality of all the study participants would be guaranteed. The research would not require the participants to provide any personal or confidential information, such as their names or NSSF numbers. In addition, the data collected would only be used for the purposes of this research. Moreover, there is no data that would be given to the third parties without the consent of the participants. Lastly, an informed consent would be obtained before the start of the study. All these measures would ensure that the study participants know what the study is all about and would protect their privacy and confidentiality.

III. Theoretical Framework

The research uses the Kurt Lewin theory, which is utilized when the objective is to change the behavior of the human beings or processes. The framework is based on a 3-phase model, namely unfreezing-change-refreeze. In the first step, the study participants as well as the healthcare facilities would be investigated to determine how they can be influenced to avoid their old unproductive practices. The second step would involve changing the thoughts and behavior of both the target population, while the last step would include initiating the actual change. The theory is best suited for this research since the main aim is to change the working behavior of the nurses by encouraging the hospital facilities to stop using the long working hours regulations and encourage 8-hour shifts.

IV. Setting and Sample

The study would be based in the US, whereby it would be conducted at the US hospitals. The emergency departments within the hospitals considered would be used as the specific units of research, whereby a sample of nurses would be selected and investigated. Therefore, the target population would be the nurses working within the emergency departments. The participants who would be included in this research would be expected to have been working within the emergency department for at least 1 year, have the relevant CEN certification, and have at least a BSN or ADN education qualification. The visiting nurses, nurses who have worked for less than one-year within the emergency department, and part-time nurses are excluded from this study. The sampling method that would be used is simple random sampling, whereby the sample participants would be selected completely at random. The sampling method would ensure that the sample is representative of the target population and the results are generalizable.

V. Discussion/Conclusion

Although it is speculated that this proposed research would experience some challenges, it is expected that its ultimate goal would be achieved. It is speculated that the research would be completed within the expected timeline and the recommendations obtained would be adopted by the necessary healthcare bodies and hospital management. The main nursing practice implication of this study is that it would lead to obtaining evidence that would lead to improving the quality of healthcare by ensuring the safety of the patients. Some of the possible limitations of this study include failure to achieve the expected sample size due to the unwillingness of the participants to take part, high dropout rates, financial constraints, and obtaining inaccurate data. Failure to obtain the needed sample size would have an implication on achieving a representative sample, and this might affect the quality of the data and results obtained. Moreover, the presence of inaccurate data may be a result of the participants failing to give the correct information due to privacy and confidentiality fears. The limitations would be addressed by ensuring that the participants understand what the study is all about, the importance of the study, and how they would benefit from participating. The financial constraint would be addressed by identifying possible donors who would financially support the project. In conclusion, it is evident that the deterioration of patient safety within the emergency departments is a serious issue that needs to be addressed. It is necessary to investigate the impact that the long working hours among the nurses have on the issue of deterioration of the quality of care. Therefore, this proposed research aims at finding out the relationship between the working shifts among the nurses and the patient safety within the emergency departments.