Principal Investigator: Dr Chiara Dall'Ora, University of Southampton

Project partners: University of Southampton; Nottingham University Hospitals NHS Trust; Herefordshire and Worcestershire Health and Care NHS Trust; Northumbria Healthcare NHS Foundation Trust; Sheffield Children’s NHS Foundation Trust; Southern Health NHS Foundation Trust; Nursing and Midwifery Council

Team: Dr Hannah R. Barker (Qualitative lead), Prof Peter Griffiths (Senior Mentor), Dr Chiara Dall’Ora (Project lead)

Public & staff involvement: Nursing staff, ward managers and matrons from 5 Trusts helped shape the DCE survey and future research priorities

Funded: Academy of Medical Sciences Springboard grant

Started: 1/9/23

Ended: 31/8/24

Lay summary

What is the problem?

If the COVID-19 pandemic has taught us something, it is how important the wellbeing of the health workforce is. Nurses form a big part of the health workforce, yet many leave their job because of poor working conditions. In recent years, hospital managers introduced long shifts for nurses, hoping nurses would be happier with their work-life balance.

However, our research found that long shifts have negative effects for nurses and patients. We still do not know what good shift patterns look like.

What we asked: How can shift patterns be designed to better support nurses’ wellbeing and help the NHS retain staff?

We conducted interviews with nursing staff, ward managers and NHS directors across five Trusts, and a large UK survey (discrete choice experiment) with 1,449 registered nurses.

What we found: Nurses value (1) consistency and predictability in rotas; (2) adequate rest between shifts; and (3) opportunities to enjoy work through meaningful time with patients and teams. Rigid, last‑minute rosters and very long shifts erode wellbeing.

From the national survey: Night‑only patterns and having no whole weekends off are the least acceptable rota features and require the largest compensation to tolerate. Predictable schedules and having scope to request shifts are strongly valued. Nine‑to‑ten‑hour shifts are preferred over 12.5‑hour shifts.

What this means: Collaborative rostering that balances service needs with personal circumstances can improve satisfaction and reduce turnover. Guaranteeing protected weekends where feasible, improving predictability, and avoiding very long duties are practical levers for better retention and patient care.

What we did with the new knowledge: We ran 5 dissemination and co‑design workshops with NHS Trusts (Jan–Feb 2025) to share qualitative findings and plan next steps.

Used findings to refine a national discrete choice experiments (DCEs) on rota preferences (n=1,449) and generate policy‑ready benchmarks for rota design and enhancements.

Engaged workforce matrons and managers to shape future studies on flexible rostering and shift design.

What's next?

-Publish the DCE paper.

-Produce a policy brief (ongoing with Public Policy | Southampton)

-Attract funding to evaluate how flexible rostering can reduce sickness absence, turnover and costs

-Co‑design of a shift‑work intervention with staff and managers (Hannah Barker NIHR Development & Skills Enhancement Award)

-Support Trusts to pilot more predictable rotas, protected weekends and 9-10‑hour options where feasible.

See article: Moving Beyond 12 Hour Shifts: How Evidence is Powering Change