Elsevier

Radiography

Volume 27, Issue 2, May 2021, Pages 512-518
Radiography

The 12-hour shift: radiographers’ perspectives and its applicability during a pandemic

https://doi.org/10.1016/j.radi.2020.11.007Get rights and content

Abstract

Introduction

Traditionally, shift work for radiographers at our institution comprised of three shift patterns – morning (8am-2pm), afternoon (2pm–9pm) and night (9pm-8am). However, when COVID-19 was first detected in Singapore in January 2020, the 12-h shift was introduced for better team segregation and deployment to meet the service needs of the Emergency Department. The 12-h shift consisted of the day (9am-9pm) and night (9pm-9am) shifts. While the 12-h shift is common to nursing practices, it is new to the radiography profession within the study centre. This study explores the radiographers' perspectives of the new shift and the impact of shift patterns on radiographers' wellness and work performance compared to the original three shift patterns.

Methods

A mixed-methods design study was adopted for this single-centre evaluation. An anonymous online questionnaire was administered to radiographers who had experienced both shift types. Additionally, the number of radiographers who had taken sick leave, and images rejected and accepted from the X-ray consoles were retrospectively collected to measure the impact of the new shift.

Results

Radiographers experienced fatigue and appreciated the longer rest days associated with the 12-h shift. Additionally, the sick leave rates and image reject counts were more favourable with the 12-h shift pattern.

Conclusion

The findings indicate that the extended shift hours are effective during a pandemic but may result in radiographer burnout during a prolonged outbreak.

Implications for practice

Studying these variables will provide an effective starting point in understanding the efficacy and applicability of a 12-h shift system during pandemic periods.

Introduction

Round-the-clock radiological services, such as general radiography and Computed Tomography (CT) in particular, are not peculiar to hospitals' Accident and Emergency (A&E) Departments in Singapore. Radiographers, as part of the multidisciplinary team, undergo shift work to provide care to patients in the acute setting. Until the Coronavirus disease (COVID-19) pandemic, the shift patterns for radiographers at the study centre have always comprised of three shift patterns (Table 1a). Radiographers doing shift work would rotate between the in-patient location and A&E Department on a weekly or fortnightly basis, working with different colleagues at every rotation. However, when the disease was first detected in Singapore in January 2020, the 12-h-long shift (Table 1b) was introduced for better team segregation and deployment to meet the service demands of the A&E Department. Radiographers providing radiological services at the in-patient location continued with the three-shift pattern and did not have any contact with suspected or confirmed COVID-19 patients. With these changes, radiographers would then remain in the same team for at least a month at their respective locations, only rotating to other locations depending on the department's operational needs. If more than 25% of the team were on sick leave simultaneously, the whole team would be replaced with a back-up team. Otherwise, no additional manpower would be provided.

The study centre is a 1000-bed hospital located in the eastern sector of Singapore with a 6000 strong staff base. As a public hospital, it has a wide range of medical specialties serving the estimated one million adult populations in that region. The radiology department performs approximately 240,000 general radiography and 120,000 specialised examinations annually. The imaging examinations are supported by a group of 150 radiographers, 50 radiologists, 50 nurses and 50 administrative and support staff.

When Singapore confirmed its first COVID-19 case on 23 January 2020, public healthcare institutions such as the study centre were swift to identify the outbreak, drawing from previous lessons such as the Severe Acute Respiratory Syndrome (SARS)1 and avian influenza (H1N1)2 pandemic to begin implementing protocols and safety measures for patient treatment. The leadership of the department promptly initiated the escalation of responses for team segregation to ensure service continuity. As a result, the 12-h shifts were established with the department's roster committee members. The goals were to reduce contact between staff and to limit possible spread3 of coronavirus from the community or within the hospital. Concurrently, another centre in Singapore had re-organised their workforce4 for manpower deployment to areas of higher workload to meet the service needs. Other operational strategies in managing COVID-19 included dedicated imaging rooms and equipment,5 scanning of COVID-19 suspected cases in batches5 and staggering work and lunch hours4 to ensure safe distancing.

Internationally, the 12-h shifts have sparked debate amongst the nursing community, with fatigue and safety being the main concerns raised.6, 7, 8, 9 Longer working hours may have adverse fatigue-related effects on healthcare workers, with the higher rates of patient-care errors, needle-stick injuries, musculoskeletal disorders, drowsy driving, and sleep deprivation being reported.10 However, the 12-h shift system has remained popular as it allowed for lesser commuting and longer breaks, hence leading to more personal time and greater work satisfaction.8,11 Prior to the pandemic, radiographers in Singapore had minimal experience operating in 12-h shifts. Additionally, there is a lack of data with regard to radiographers' perspectives toward a new 12-h shift system in the current literature. Hence, the aims of this study is to (1) validate the 12-h shift system during the COVID-19 pandemic, (2) understand the perspectives of radiographers involved in COVID-19 medical imaging services whilst working the 12-h shifts, (3) understand the impact of shift patterns on sick leave rates in radiographers in the A&E and in-patient settings as well as (4) the reject analysis of images (surrogate measure of performance) of A&E radiographers.

Section snippets

Methods

A partially mixed concurrent equal status design was adopted to advance the understanding of the differences in radiographers' perspective and its applicability. This design included two phases of simultaneous data collection in which the quantitative and qualitative phases would weigh approximately the same.12 The results for both phases would only be integrated upon collection and interpretation of all data.

Questionnaire on radiographers' shift preference

A 100% (n = 48) response rate was achieved from the A&E radiographers. The participants' demographics (Table 2) showed 17 (35%) male and 31 (65%) female participants of various age groups. The workforce consisted of young radiographers with only 15% of them are more than 40 years old.

Almost all participants (96%, n = 46) interacted with suspected COVID-19 patients, while only 83% (n = 40) had interactions with confirmed COVID-19 patients (Table 3). These were self-reported responses and that

Discussion

The COVID-19 pandemic has highlighted the importance of timely response in operational strategies to ensure the continuity of services in all healthcare institutions. To date, this is the first study that strives to understand the radiography viewpoint of implementing a new shift pattern in the midst of a healthcare crisis. Being part of the hospital's frontline medical team, radiographers are critical in providing for timely radiological services. One approach to ensure service sustainability

Limitations

This study has several limitations. Firstly, given that the study was limited to a single medical imaging centre, the generalisability of the results across other geographic locations or differing demographics would be unclear. Secondly, the study duration was limited to five months. The duration of exposure to the 12-h shift may not have been sufficient for radiographers to conclude on their preferences for the different shift types. Similarly, the study analysis of images acquired and sick

Conclusion

The shift preferences amongst the radiographers were inconclusive, with 12% more participants favouring the 12-h shifts over the three-shift pattern. Majority opined that the 12-h shifts had longer rest days, but shift work itself became more tiring. There were more favourable image reject counts and lesser sick leave taken with the 12-h shift, possibly related to circumstances brought about by the pandemic. Studying these variables will provide an effective starting point in understanding the

Conflict of interest statement

None.

Acknowledgements

We wish to thank various individuals for their contributions to this study; Mr Gabriel Leong (Head Radiography), for his support in this study; Ms. Tan Pei Ting (Biostatistician), for her valuable support on the statistical analysis portion of the project; Mr. Tsai Koh Tzan (Principal Radiographer) and Mr. Bradley Keith Emuang (Radiographer), for their help in collecting data on the questionnaire and images acquired respectively.

This research did not receive any specific grant from funding

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