Shift Patterns on the Clinical Performance of Staff Nurses in a Government Hospital

This study aimed to compare the clinical performance of staff nurses working under 8-hour and 12-hour shift patterns in a government hospital in Surigao City, Philippines. A comparative descriptive research design was utilized involving staff nurses assigned to different hospital units. Data were collected using the Six-Dimension Scale of Nursing Performance developed by Schwirian, which measures both the extent and quality of nursing performance across leadership, critical care, teaching or collaboration, planning or evaluation, interpersonal communication, and professional development. Descriptive statistics and inferential statistic measure were used to analyze the data. Findings revealed that nurses demonstrated a generally high level of clinical performance under both shift schedules. Significant differences were observed in the frequency of clinical performance in leadership, critical care, and teaching or collaboration activities, while no significant differences were found in planning or evaluation and interpersonal communication. In terms of performance quality, only leadership showed a significant difference according to shift schedule. The results suggest that nurses maintain effective clinical performance regardless of shift length, although certain aspects of nursing practice may vary depending on shift structure.

Clinical performance, Nursing shift patterns, 8-hour shift, 12-hour shift, Staff nurses

1. AbuAlRub, R. F., Al-Azzam, M., & Alzayyat, A. (2022). The impact of work environment and unit characteristics on nurses’ work outcomes. Journal of Nursing Management, 30(2), 345–353. This sample and correct format. [Google Scholar] [Crossref]

2. Alanmi, B., Alharazi, R., & Almutary, H. (2025). Night shift and occupational fatigue among nurses who work 12 hours in Jeddah. Journal of Education and Health Promotion, 14(1), 308. https://doi.org/10.4103/jehp.jehp_75_25 [Google Scholar] [Crossref]

3. Aiken, L. H., Sloane, D. M., Ball, J., Bruyneel, L., Rafferty, A. M., & Griffiths, P. (2021). Patient satisfaction with hospital care and nurses in England: An observational study. BMJ Open, 11(1), e042592. https://doi.org/10.1136/bmjopen-2020-042592 [Google Scholar] [Crossref]

4. Alghamdi, M., Topp, R., & AlYami, M. (2023). The effect of nurse staffing and workload on patient outcomes in hospital settings: A systematic review. Journal of Nursing Management, 31(2), 276–285. https://doi.org/10.1111/jonm.13741 [Google Scholar] [Crossref]

5. Altmiller, G., & Pepe, M. (2022). Influence of continuing professional development on nurses’ clinical competence and patient care outcomes. Journal of Continuing Education in Nursing, 53(7), 301–308. https://doi.org/10.3928/00220124-20220615-05 [Google Scholar] [Crossref]

6. Australian Commission on Safety and Quality in Health Care. (2025). Nursing workforce and clinical performance standards in acute care settings. ACSQHC Publications. [Google Scholar] [Crossref]

7. Ball, J. E., Griffiths, P., Rafferty, A. M., Lindqvist, R., & Murrells, T. (2022). Association of 12-hour shifts and nurses’ job satisfaction, burnout and intention to leave. Journal of Nursing Management, 30(2), 355–364. https://doi.org/10.1111/jonm.13472 [Google Scholar] [Crossref]

8. Beckman, R. J., Hutton, S., Czekanski, E., Vance, K., & Mohr, D. C. (2022). A comparison of shift length and nursing and quality outcomes in acute inpatient mental health units. Journal of Nursing Administration, 52(10), 560–565. https://doi.org/10.1097/NNA.0000000000001199 [Google Scholar] [Crossref]

9. Boamah, S. A., Laschinger, H. K. S., Wong, C., & Clarke, S. (2022). Effect of transformational leadership on job satisfaction and patient safety outcomes. Journal of Advanced Nursing, 78(2), 401–414. https://doi.org/10.1111/jan.14911 [Google Scholar] [Crossref]

10. Clari, M., Albanesi, B., Bova, C., Conti, A., Gonella, S., Campagna, S., Di Giulio, P., Dall’Ora, C., & Dimonte, V. (2023). Impact of 12-hour shifts on nurse, patient, and organizational outcomes: A critical review [Article in Italian]. Journal of Nursing Management, 31(8), 1702–1720. https://doi.org/10.1702/4338.43233 [Google Scholar] [Crossref]

11. Dall’Ora, C., Ball, J., Griffiths, P., & Simon, M. (2023). Association of 12-hour shifts and nurses’ job satisfaction, burnout and intention to leave: Findings from a cross-sectional study of 12 European countries. BMJ Open, 13(1), e063367. https://doi.org/10.1136/bmjopen-2022-063367 [Google Scholar] [Crossref]

12. Dall’Ora, C., Ball, J., Redfern, O. C., Griffiths, P., & Recio-Saucedo, A. (2023). Association between long nursing shifts, fatigue, and quality of care in hospital settings: A systematic review. Journal of Nursing Management, 31(4), 1125–1134. https://doi.org/10.1111/jonm.13875 [Google Scholar] [Crossref]

13. Ejebu, O. Z., Dall’Ora, C., & Griffiths, P. (2022). Correction: Nurses’ experiences and preferences around shift patterns: A scoping review. PLOS ONE, 17(6), e0270446. https://doi.org/10.1371/journal.pone.0270446 [Google Scholar] [Crossref]

14. Farag, A., Gallagher, J., & Carr, L. (2024). Examining the relationship between nurse fatigue, alertness, and medication errors. Western Journal of Nursing Research, 46(4). https://doi.org/10.1177/01939459241236631 [Google Scholar] [Crossref]

15. Griffiths, P., Saville, C., Ball, J., Jones, J., Pattison, N., & Monks, T. (2022). Nursing workload, staffing levels and missed nursing care in hospital settings: A systematic review. International Journal of Nursing Studies, 129, 104185. https://doi.org/10.1016/j.ijnurstu.2022.104185 [Google Scholar] [Crossref]

16. Ito-Masui, A., Sakamoto, R., Kawamoto, E., Motomura, E., Tanii, H., King, Z. D., Suzuki, K., Sano, A., & Shimaoka, M. (2025). Sleep and well-being before and after a shift schedule change in ICU nurses: An observational study using wearable sensors. Journal of Occupational Health, 67(1), uiaf053. https://doi.org/10.1093/joccuh/uiaf053 [Google Scholar] [Crossref]

17. James, L., Elkins-Brown, N., Wilson, M., James, S. M., Dotson, E., Edwards, C. D., Wintersteen-Arleth, L., Stevens, K., & Butterfield, P. (2021). The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study. International Journal of Nursing Studies, 123, 104041. https://doi.org/10.1016/j.ijnurstu.2021.104041 [Google Scholar] [Crossref]

18. Kieft, R., de Brouwer, B., Francke, A., & Delnoij, D. (2021). How nurses and their work environment affect patient experiences of the quality of care: A qualitative study. BMC Health Services Research, 21, 110. https://doi.org/10.1186/s12913-021-06178-4 [Google Scholar] [Crossref]

19. Koopmans, L., Bernaards, C. M., Hildebrandt, V. H., Schaufeli, W. B., de Vet, H. C. W., & van der Beek, A. J. (2021). Conceptual frameworks of individual work performance: A systematic review. Journal of Occupational and Environmental Medicine, 63(6), e309–e318. https://doi.org/10.1097/JOM.0000000000002199 [Google Scholar] [Crossref]

20. Li, M., Lowrie, E., Huang, C., Lu, X., Zhu, Y., Wu, X., & Aiken, L. H. (2023). Evaluating the relationship between nursing care quality and nurse performance in hospital settings. International Journal of Nursing Studies, 137, 104395. https://doi.org/10.1016/j.ijnurstu.2022.104395 [Google Scholar] [Crossref]

21. Li, M., Shao, M., Cai, H., & Li, J. (2023). Working hours associated with the quality of nursing care and missed nursing care in Chinese hospitals: A cross-sectional study. Nursing Open, 10(4), 2280–2290. https://doi.org/10.1002/nop2.1487 [Google Scholar] [Crossref]

22. Lopez, R. A., & Rivera, M. C. (2022). Work hours, cognitive fatigue, and clinical errors among nurses in tertiary hospitals in Southeast Asia. Asian Journal of Nursing and Health Sciences, 5(2), 44–53. [Google Scholar] [Crossref]

23. Martinez, J.-J. T., & Tapia, J. (2025). Exploring the impact of shift duration on nurses’ perceived stress and quality of working hours: A comparative study of 8-hour versus 12-hour shifts. Human Resources Management, 7(1), 254–272. https://doi.org/10.51584/IJRIAS.2024.912025 [Google Scholar] [Crossref]

24. McCombes, S. (2023, June 22). Descriptive Research | Definition, Types, Methods & Examples. Scribbr. Retrieved November 29, 2025, from https://www.scribbr.com/methodology/descriptive-research/ [Google Scholar] [Crossref]

25. Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2021). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 75(4), 433–450. https://doi.org/10.1037/amp0000298 [Google Scholar] [Crossref]

26. Sánchez Onrubia, I. M., Resta Sánchez, E. J., Cabañero Contreras, T., Perona Moratalla, A. B., & Molina Alarcón, M. (2025). Emergency nursing staff’s well-being, burnout, and sleep on 12-hour shifts. Enfermería Clínica, 35(2), 102141. https://doi.org/10.1016/j.enfcle.2025.102141 [Google Scholar] [Crossref]

27. Schwirian, P. M. (1978). Evaluating the performance of nurses: A multidimensional approach. Nursing Research, 27(6), 347–351. https://doi.org/10.1097/00006199-197811000-00002 [Google Scholar] [Crossref]

28. Scott-Marshall, H. K., & Matthews, L. R. (2024). Safe limits on work hours for the nursing profession: A rapid review. Frontiers in Global Women’s Health, 5, 1455422. https://doi.org/10.3389/fgwh.2024.1455422 [Google Scholar] [Crossref]

29. Shehata, A. B., Abdallah, N., & El-Sayed, H. (2024). Work schedule preferences and perceived continuity of care among nurses working long hour shifts. Nursing Practice and Workforce Research Journal, 6(3), 101–115. [Google Scholar] [Crossref]

30. Stanley, D., Stanley, K., & Dyess, S. (2021). Clinical leadership in nursing practice: A concept analysis. Journal of Nursing Management, 29(4), 721–730. https://doi.org/10.1111/jonm.13210 [Google Scholar] [Crossref]

31. Statistics Easily. (2025). What is: Comparative Study – A Detailed Overview. Glossario. https://statisticseasily.com/glossario/what-is-comparative-study-a-detailed-overview/ [Google Scholar] [Crossref]

32. Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2021). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 40(11), 1714–1722. https://doi.org/10.1377/hlthaff.2021.00520 [Google Scholar] [Crossref]

33. Ulupınar, F., & Ulupınar, S. (2025). Effects of shift work on cognitive and motor performance in nurses: A systematic review and meta-analysis. Worldviews on Evidence-Based Nursing, 22(5), e70078. https://doi.org/10.1111/wvn.70078 [Google Scholar] [Crossref]

34. Verhagen, M. J., Frouws, M. A., Timmer, R. A., Schepers, A., Brunsveld-Reinders, A. H., de Vos, M. S., & Hamming, J. F. (2024). How to support communication between nurses and residents during shift work: A mixed-methods study into local practices and perceptions. Journal of Surgical Education, 81(8), 1034–1043. https://doi.org/10.1016/j.jsurg.2024.05.017 [Google Scholar] [Crossref]

35. Vitale, E., Cesarelli, G., & Calabrò, G. E. (2022). Clinical competence and performance assessment in nursing: Revisiting the Six-Dimension Scale of Nursing Performance. Journal of Nursing Management, 30(5), 1152–1161. https://doi.org/10.1111/jonm.13592 [Google Scholar] [Crossref]

36. Vitale, E., Lupo, R., Fortunato, S., Gualano, A., Giammarinaro, M. R., Bardone, L., Mea, R., Calabrò, A., D’Anna, G., Della Pietà, C., & Germini, F. (2022). Correlations between performance and shift work in the nursing activities: A pilot approach [Performance and shift work in nursing]. Acta Biomedica, 93(3), e2022251. https://doi.org/10.23750/abm.v93i3.12403 [Google Scholar] [Crossref]

37. Wei, H., Sewell, K. A., Woody, G., & Rose, M. A. (2022). The state of the science of nurse work environments in hospitals. Nursing Outlook, 70(3), 361–371. https://doi.org/10.1016/j.outlook.2021.10.003 [Google Scholar] [Crossref]

38. World Health Organization. (2023). Global strategic directions for nursing and midwifery 2021–2025. WHO Publications. [Google Scholar] [Crossref]

• Measuring Waste of Patient Time in Health Care at Non-Digitized Hospital: An Observational Study in Bangabandhu Sheikh Mujib Medical University, Bangladesh
• Reaffirming Clinical Confidence in Atorvastatin Therapy: A Digital Outreach Case Study from Tamil Nadu, India
• Clinical Manifestations and Therapeutic Response in a Patient with Hypothyroidism: A Case Report
• Eranda (Ricinus Communis) In Gridhrasi (Sciatica): Classical Rationale, Pharmacology and Clinical Evidence- A Narrative Literature Review
• Magnetotherapy in Pain Management: Mechanisms, Clinical Applications, and Future Perspectives – A Review