Expanding What We Know about Off-Peak Mortality in Hospitals

Some 64 percent of care is delivered by nurses during nights and on weekends. In these off-peak environments, nurses have less access to support, work with less supervision, and have strained communication with on-call health care providers. Hospital mortality increases during these times, yet little is known about what causes the variation and what can be done to improve patient outcomes.

Researchers funded under the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative surveyed nurses and conducted focus groups to discover what features of the work environment varied between weekends and weekdays. They then determined that they needed more information to asses why off-peak care leads to higher mortality. They have framed their research around three questions:

  1. What challenges do nurses encounter on evenings and weekends?
  2. What strategies do nurses use to deliver care during off-peak periods?
  3. How do health care policies and practices influence or structure nurses’ work environment, actions and judgments in unintended ways during off-peak periods?

This research project, which is ongoing, will use institutional ethnography to analyze the working environment of nurses in order to expand the information available for nurse administrators to make decisions about providing safe, high-quality care, 24 hours a day, seven days a week.