The impact of moving to a 12h shift pattern on employee wellbeing: A qualitative study in an acute mental health setting

BACKGROUND: Against a backdrop of increasing demand for mental health services, and difficulties in recruitment and retention of mental health staff, employers may consider implementation of 12 h shifts to reduce wage costs. Mixed evidence regarding the impact of 12 h shifts may arise because research is conducted in divergent contexts. Much existing research is cross sectional in design and evaluates impact during the honeymoon phase of implementation. Previous research has not examined the impact of 12 h shifts in mental health service settings. OBJECTIVE: To evaluate how employees in acute mental health settings adapt and respond to a new 12 h shift system from a wellbeing perspective. DESIGN: A qualitative approach was adopted to enable analysis of subjective employee experiences of changes to organisation contextual features arising from the shift pattern change, and to explore how this shapes wellbeing. SETTING(S): Six acute mental health wards in the same geographical area of a large mental health care provider within the National Health Service in England. PARTICIPANTS: 70 participants including modern matrons, ward managers, clinical leads, staff nurses and healthcare assistants. METHODS: Semi-structured interviews with 35 participants at 6 months post-implementation of a new 12 h shift pattern, with a further 35 interviewed at 12 months post-implementation. RESULTS: Thematic analysis identified unintended consequences of 12 h shifts as these patterns changed roles and the delivery of care, diminishing perceptions of quality of patient care, opportunities for social support, with reports of pacing work to preserve emotional and physical stamina. These features were moderated by older age, commitment to the public healthcare sector, and fit to individual circumstances in the non-work domain leading to divergent work-life balance outcomes. CONCLUSIONS: Findings indicate potential exists for differential wellbeing outcomes of a 12 h shift pattern and negative effects are exacerbated in a stressful and dynamic acute mental health ward context. In a tight labour market with an ageing workforce, employee flexibility and choice are key to retention and wellbeing. Compulsory 12 h shift patterns should be avoided in this setting.