Running head: RESEARCH PROPOSAL
Research Proposal
Marisa Dirk
University of Athabasca
Nursing 328
3030411
Kari Mardian
July 16, 2015
RESEARCH PROPOSAL
2
Research Proposal
This is a proposed research study, exploring the relationship between nursing staff
working night shifts, and the increased risk of these nurses making a medication error. Nurses
work in a challenging, constantly changing workplace. Nurses are individually responsible for
giving patients the correct medication based on the verification of the patient, drug, dose, time
route and documentation. Even with these checks, nurses are making mistakes, consequently
affecting the patients health. We must first bring attention to management, nursing staff and
clinicians that these problems exist, and after this research has been well documented it is then
that changes can occur in nursing practice. Within this paper I have outlined the proposed
research study, using Loiselle and Profetto-McGraths text Canadian Essentials of Nursing
Research (2011) to guide me through the process.
Research Problem: Patient safety is a nursing concern at all times. During the night shift
(any time from 2200-0700 hrs) patients safety is put at increased risk. Lack of sleep, decreased
attention, increased workload and minimal nursing staff available may be the cause of the
increased amount of errors nurses make during the night shift. Nurses who work day/evening
have the luxury of having regular sleep patterns, where as night shift workers are often changing
their sleep schedules.
Problem Statement: In this study we will explore the medication errors made by nurses
on night shifts compared to medication errors made on day shifts.
Goals: To increase awareness, and provide information to nurses, management and
nursing educators about the safety risks patients have during the night shit. Nurses will be able to
recognize the increase of errors made during a night shift versus a day or evening shift and will
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adopt changes into their nursing practice. Nursing management and clinical educators may make
necessary changes for the nursing staff working nights.
Significance of Research: Nurses play a critical role in keeping patients safe and
providing the best nursing care they can. Patients overall health is dependent on the care nurses
provide, therefore it is important that we recognize any risks of patient safety; involving fatigued,
overworked nursing staff. Medication errors can be detrimental to the health of a patient, thus it
is necessary we find ways to decrease the chance of errors made by nursing staff. Medication
errors can be difficult to accept and overcome by she/he whom made the error. Guilt,
nervousness and fear may be common feelings nurses have after a medication error is made.
Nurses need to have support while working through the night and be able to ask questions about
medication, or have medications double-checked by nursing colleagues.
Search terms: Night shift nursing errors, nursing medication errors, night shift patient
safety, and patient safety risks.
Literature review: According to Berger and Hobbs shift work, which they define as
worked hours outside of daylight, can result in problems such as sleep disturbances, increased
accidents and injuries, and social isolation (Berger & Hobbs, 2006, p. 465). Nurses work hours
that are often unpredictable, and sleep patterns are often disturbed. When nurses sleep is
interrupted, or when awake for extended periods patient safety is threatened (Berger & Hobbs,
2006, p. 465). Nurses who work the night shift have been reported to have fewer hours of sleep
per day. As reported by Berger and Hobbs, a study done in 1992 by Gold et al showed that in a
study of 635 nurses, only 29% of rotating nurses and 21% of night nurses reported sleeping for
longer than seven hours compared to 39% of the day and evening nurses (2006, p.466). The
impact working through the night can be felt physically and mentally, safety is impaired when
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individuals struggle to stay awake during the seconds half of a shift, especially at night (Berger
& Hobbs, 2006, p. 467). Medications may be given at any time throughout the night; therefore
it is necessary that nursing staff remains alert, and able to perform his/her duties at any given
time.
A second piece of literature studying this topic investigated the relationships between
sleep deprivation and occupational and patient care errors among staff nurses who work the night
shift (Johnson, Jung, Brown, Weaver, & Richards, 2014, p. 17). After conducting a study with
289 night shift nurses, their hypothesis was supported that sleep deprived nurses had a larger
mean number of patient care errors than non-sleep deprived nurses did (Johnson, Jung, Brown,
Weaver, & Richards, 2014, p. 18). Again, it is noted, that nurses who work night shift hours are
put at risk of sleep deprivation due to scheduling constraints, and are therefore at risk of making
an error while on duty. The researchers concluded that the most accurate way to detect
medication errors was by direct observation rather than chart review or incident reports. Nurses
require adequate amount of sleep to perform there given duties, at any time. Nurses need to be
education on the important of their sleep early in their career. The researchers suggested that an
emphasis on improved sleep quantity and quality would contribute to decreasing sleep
fragmentation and sleep deprivation and increase patient quality (Johnson, Jung, Brown,
Weaver, & Richards, 2014, p. 21).
Gaps in Literature: It was difficult to find evidence on this topic. There is a large body
of research done on the risks of patient safety with nurses working overtime, or extended hours.
But specifically, research done on the amount of nursing errors made on night vs other times was
difficult to find. Nursing studies should involve nursing staff from various health care settings,
to obtain an unbiased and realistic result. Further qualitative and quantitative studies should be
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done involving observing and interviewing nursing staff, reviewing documented medication
errors, and reviewing and implementing suggestions for nursing staff to increase theirs hours of
sleep per day while working nights.
Research question: Do nurses who work night shifts (anytime between 2200-0700hrs)
make more medication errors than nurses who work day shifts (any hours outside of the stated
night shift hours)?
Research approach and design: A quantitative study will be implemented to obtain an
answer to our question. We will review submissions made by nurses using the safety learning
reporting system. This system was established for nursing staff to report medication errors done
by themselves, or others. In each submission we will be able to see the time the medication error
was made, and any adverse outcomes it may have had on the patient. The safety learning reports
will come only from nursing staff (not pharmacy or physicians) and will be submitted from
nurses working throughout the hospital where the research is taking place. We will review
submission from 2012-2014 at the Alberta Childrens Hospital. The nursing staff will remain
anonymous, and nursing management will not be involved in this study until all research is
analyzed and ready to be presented.
Hypothesis: Nurses working night shift hours (2200-0700hrs) make more medication
errors than nurses who work day or evening shifts (0700-2200hrs).
In this study, because it is a quantitative study, independent and dependent variable will
be used. The dependent variable is the amount of medication error. The independent variable is
the time worked by nursing staff (night, day, or evening shifts)
Target population: The results will be shared with nursing staff, nursing management,
clinical educators and nursing program advisors.
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Accessible populations and Sampling plan: Although it would be effective to gather
research from various health care settings, it is not feasible, nor is their enough time to do such
research. Therefore, the accessible population in this research study are the nurses at the Alberta
Childrens Hospital, who have submitted medication error reports. These nurses work throughout
the hospital, including: emergency department, inpatient units, and mental health. All the areas
have nursing staff on twenty-four hours a day, and have submitted errors anonymously. The
nurses are either Registered Nurses or Licensed Practical Nurses. There is no limit to how many
nursing submissions will be included as we will review the submissions within the time frame
allowed for this research study. Because we are included nurses from various units within one
hospital, we hope to represent the population of nurses as a whole.
Researchability and Feasibility: The proposed research problem is clearly defined. By
using Bonnie Rogers article Resarchability and Feasibility Issues in Conducting Research
(1996) I was able examine the researchability and feasibility of the proposed study effectively. I
feel committed in conducting this research, as patient safety is a nurses responsibility. A mentor
will be required, as I am a novice researcher. I have avoided making a complex design, and have
a sampling plan that is easy to access. Approval from the health care regions authority, to access
the safety learning reports will be obtained. Because nursing staff remains anonymous, there is
no need to contact the nurses involved. The proposed study will benefit the nursing staff, nursing
management and most importantly, the patients. The time devoted for this research study will be
six months in total, working on this research outside of hours worked as a staff nurse. The study
will be conducted at the Alberta Childrens Hospital and permission to do so will be obtained.
The costs will be minimum as computers will be supplied to us from the hospital. There are no
safety or health concerns related to conducting this type of research. Patient identification will be
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in the form of a number not related to their health care number. Like mentioned previously,
nursing staff will remain anonymous the only information researchers will be able to see is the
time the incident occurred, which unit/department, the name of the medication and if there were
any adverse outcomes for the patient. After evaluating the researchability and feasibility of the
research study, I am confident that this study will promote patient safety, and build on a stronger
nursing practice.
Throughout the planning of the proposed research study, I have gained further knowledge
of the challenges nursing researchers face. Deciphering between a quantitative or qualitative
study has become clearer to me throughout this process. I altered my research question quite a
few times, to make sure that it was strong and that research would be accessible for my
question. I imagine, that once a researcher has an idea to study, the question may evolve as the
researchers gain more information from current literature. It was difficult for me to find current,
related research articles for this study. I used the Universitys library to obtain the two pieces of
literature I cited in this paper. Even when I went outside of the Universities library to research, it
was still difficult, and minimal information was available. This proves, that more research must
be done on this topic.
Conclusion: In this paper I discussed the relationship between night shift nurses, and the
risk of their patients. Night shift nurses are at risk of making medication errors, due to fatigue,
staffing issues and being overworked. This quantitative study examined submissions made by
nursing staff between 2012-2014 in regards to medication errors they made, or that they came
across throughout their day/evening/night shift. The literature that I reviewed proved to concur
my hypothesis and hopefully with further research there will be discussions among nursing staff
and management on ways to decrease medication errors during the night. The research proposal
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included all areas required for a research study: goals, problem statement, significance, literature
review including gaps, approach and design, variable, target population, etc. I believe if this
research study was conducted it would prove to be sufficient information in verifying that night
shift nursing staff is put an increased risk of making medication errors. Consequently, with this
information the safety of patients would be improved, and nursing staff and management could
make appropriate changes to implement safer working areas.
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References
Berger, A. M., & Hobbs, B. B. (2006). Impact of Shift Work on the Health and Safety of Nurses
and Patients. Clinical Journal of Oncology Nursing, 10.4, 465-471.
Johnson, A., Jung, L., Brown, K., Weaver, M., & Richards, K. (2014). Sleep Deprivation and
Error in Nurses who Work the Night Shift. The Journal of Nursing Administration, 44.1,
17-22.
Loiselle, C., Profetto-McGrath, J., Polit, D., & Beck, C. (2011). Canadian essentials of nursing
research (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.
Rogers, B. (1996). Researchability and Feasibility Issues in Conducting Research. AAOHN
Journal, 44.1, 58-59.
