Junior doctors often work extremely long
and stressful hours, but their patient
outcomes are improved when a nurse assists
them during night shift.
Image: iStockphoto
Hospital patients are significantly less likely to reach the stage where they need ‘urgent’ care, and patient outcomes are improved, when junior doctors working overtime shifts are supported by an Advanced Practice Nurse (APN) according to a recent UNSW study.
A research team lead by Dr Markus Groth from Organisation and Management at the Australian School of Business, in collaboration with Dr Bruce Way and APN, Steven Coote, examined the experience of junior doctors at Sydney’s Prince of Wales Hospital over an 18 month period.
An Australian Research Council linkage grant provided the opportunity to monitor the impact of having a senior APN present on the overtime shift as an added support resource, a model which was significantly different from previous hospital practice.
Shifts were matched so the same junior doctor was assessed both with and without the assistance of the APN. The team assessed 91 junior doctors over 192 shifts.
Dr Anya Johnson, an organisational psychologist and member of the research team, says junior doctors working the overtime shift experience a very stressful workplace with a great deal of uncertainty.
“Junior doctors, often in their first year out of medical school, work an overtime shift from 5 pm til 11pm approximately two times a week. This is on top of their daytime shift. There is a lot of demand placed on them during this time, and much less support.
“A lot of exhaustion builds up over that period. In terms of staying psychologically healthy it’s challenging,” says Anya.
The hospital recognised this problem and was keen to explore ways to enhance the performance of junior doctors. They also felt it was important to be able to measure and assess the impact of proposed changes.
“For us it was an opportunity to work in a real world situation and really understand how changing the environment might have an impact on people’s performance,” says Markus.
“The idea was to build in a support mechanism that changes their environment, gives them information, helps them control the situation, and provides them with re-assurance. So we looked at whether an APN could provide this,” he says.
The junior doctors and the APN kept detailed records of their tasks. Three tasks were categorised as “high complexity” – responding to an emergency, responding to an urgent situation in a very sick patient, and responding to an urgent situation in a stable patient.
The research team found a significant difference in the number of “high complexity” tasks junior doctors reported on their shifts. This varied from, on average, three or four per night on unsupported shifts to one or two per night on supported shifts.
“Statistically we found there were fewer urgent situations when the APN was on so it increased patient safety,” says Anya. “There was also a reduction in the admission of ward patients to the high dependency unit and the intensive care unit on shifts where doctors were supported,” she says.
Researchers say the positive effect occurred in part by building confidence in the junior doctors, and in part because the APN carried out routine tasks that in turn freed up the junior doctors´ time and capacity.
“For junior doctors we found having that support provided a buffer; it offered some relief and reduced the workload, particularly for those who were feeling rather overwhelmed and emotionally burnt out. For those who were more confident and experienced, it also provided an opportunity to learn and build on their skills,” says Anya.
“The APN reduced the amount of urgent situations because they were on top of the problem before it happened. There was closer monitoring, picking up symptoms earlier, making slight adjustments to medication or slight changes to the situation the patient was in, and that was preventative,” she says.
As a result of the research, the Prince of Wales Hospital has implemented the APN position on a permanent basis. The study has highlighted the advantages of a collaborative approach to patient care, increased teamwork and respect for the nurse’s role, and opened up opportunities for further collaboration in the future.
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