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  0!_))0 )8]\]@=<;:9876,7  Z[`adefgb$c-rӔp9 b$ Kjч \p]Tf~9 $"$l!Ȟ=}ve $$$2$ H5F $2$:Gw>t5j$2$211^b1|@o> 0AA@___www@wwwd g4=d=dI0x: 0fppp@ <4!d!d\ 0l<4dddd\ 0lg4ddddK0x: 0p@ ppʚ;6ʚ;<4dddd\U 0\r0___PPT10 pp2___PPT9/ 0? %O ="6Professionalism and Long Working Hours in NHS Nursing77International Labour Process Conference 2005 Strathclyde University Sarah Wise Research Associate Employment Research InstituteMethodology & Background(The Study Work-life Balance and Careers in NHS Nursing and Midwifery Work-life balance policies and practices in an environment which presents significant barriers to their operation (female dominated, resources constrained, 24/7, front-line service) Long working hours emerged as a major element in nurses experience of work-life conflict Field Work Large, acute urban NHS  Trust (Apr  Nov  03) 64 interviews  grades D to I (Registered nurses and midwives) 3679 questionnaires distributed 1084 returned  29% response rate M  ;Y /?B^<'Profiling the Length of Working Hours $(% MContracted Hours + Overtime + Other Additional Hours = Total Working Hours :N7  IOvertime63% of staff worked longer than contracted hours in their main job Overtime hours increased with clinical grade 9% paid for overtime; 39% TOIL; 13% paid or TOIL. 39% said  Overall I am not compensated for overtime I work Estimated value of uncompensated overtime for this sample was 15k per week Probably under estimated  does not include unpaid rest breaks and all time owed in lieuC-;2>Y^#Barriers to Taking Time Off In LieuWorkload and  Substitutability I used to note down overtime but I gave up the ghost& My manager is supportive and tells me to take it but there s no opportunity. For me to take a day off they d have to get agency in which would only make matters worse. (Ward Manager) Unconditional Commitment of Time I do try to take time back but I m told that I m  lucky to be able to do this & it s really frowned upon if you take time back but it shouldn t be like that. (Team Leader) !#  "  JOther Additional Hoursl=Estimated Total Hours Worked_Reasons m>4Causes of Long Working Hours: Senior Nurse Managers2Expanding Roles and  NPM Most weeks I get by with 50 hours - this lets me get my core job done but additional projects and responsibilities can take it up to 60 to 80 hours. (Assistant Directorate Manager) I m often paged or phoned at home in the evenings and at weekends & If you want to be involved in projects and move patient care forward you have to stay late. (Operations Manager)% &tEL uF` 2Caring Professionals All staff nurses stay on after hours and do extra duties they re not paid for - this has been going on for the 25 years I ve been a nurse. The NHS wouldn t survive if we didn t do it. (Staff Nurse) It has suited the people who run the NHS that nurses are conscientious  that they will stay until the job s done properly & they use the goodwill of the staff. (Senior Staff Nurse)MConclusions & Implications63% of respondents worked longer than contracted hours. An estimated 13% worked 48+ hours p/w: a significant minority in a female-dominated workforce. A large proportion of overtime worked was uncompensated providing a large subsidy to the cost of labour. A quarter of respondents worked additional shifts. Lower grades worked these shifts for financial reasons  implications for service and individual safety given gruelling shift patterns? Evidence of a long hours culture  barriers to taking TOIL, pressure and expectations of managers and colleagues and poor organisational time management.  Double Dose of professional expectations  as  managers and  carers , the latter possibly having greater influence. Unlike similar professions, nurses cite  workload not  enjoyment of the job as the reason they work long hours. nHZjxsZ]=Work-life Balance and Careers in NHS Nursing and Midwifery [For more project information and downloads go to: www.napier.ac.uk/depts/eri/research/esf $\3(3'/.8;<=>?@ABKZ[]^P  0` ̙33` ` ff3333f` 333MMM` f` f` 3>?" dd@~?" dd@  " @ ` n?" dd@   @@``PR    @ ` ` p>> L0 N(    6v P  T Click to edit Master title style! !  0y   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  0"`@ : 2 n  C 8A Triangle25mmRGB"w}H  0޽h ? ̙33 Default Design 0 @(*(  ( ( 0\$ P   C X*  ( 0p$    $ Z* d ( c $ ?  $ ( 0 $  @ $ RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S ( 6XC `P  $ X*  ( 6$ `  $ Z* H ( 0޽h ? ̙3380___PPT10.b%h 0p(  p p 0$ P   $ X*  p 0$    $ Z*  p 6$ `P  $ X*  p 6$ `  $ Z* H p 0޽h ? ̙3380___PPT10.b%. 0 L0 \~(  \r \ S C C r \ S CC`  C R \ C *ANUEblackIH \ 0޽h ? ̙33y___PPT10Y+D=' (= @B + K 0 L0 t$(  tr t S @CP  C r t S uC C H t 0޽h ? ̙33y___PPT10Y+D=' (= @B +B 0 L0  0(  x  c $qCP  C x  c $xrCPY  C H  0޽h ? ̙33y___PPT10Y+D=' (= @B + A 0 L0 B(  l  C 4^CP  C l  C bCp  C   s XA . `S`TS`To@ p  0 dC h2Average overtime hours per week by grade (n=1029)*3 23  0iCp`@ 0 j** ANOVA SIG = 0.000 (99% confidence level)$+ 2) H  0޽h ? ̙33y___PPT10Y+D=' (= @B + [ 0 L0 |(  x  c $C  C   c $ECY<$ 0 C , @ABCH  0޽h ? ̙33___PPT10v.+mOtD' (= @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B+checkerboard(across)*<3<*+8+0+0 +H @ 0 L0 WO@(   l  C 6CP  C `  c $A  ??    08C` s=Respondents working other additional hours each week (n=1084)> 2>H  0޽h ? ̙33y___PPT10Y+D=' (= @B +- ? 0 L0 <4P (  r  S  CP  C    s XA. `S`TS`T"P    0Cg v$Average Total Hours Per Week (n=977)6% 2    0$C`  FAverages: 43 hours (full-time) 28.6 hours (part-time) 13% worked over the limits of the Working Time Directive compared to 11% in UK and 5% of UK women. D grades and H/I grades most likely to work long hours.L 2 ,9ZH  0޽h ? ̙33y___PPT10Y+D=' (= @B + ] 0 L0 @H(  x  c $CP  C `  c $A "??s "(  04C` Respondents main reason for working longer than contracted hours (n=641)J 2JH  0޽h ? ̙33y___PPT10Y+D=' (= @B + > 0 L0 `\(  x  c $C  C   c $Cp<$ 0 C H  0޽h ? ̙33___PPT10v.+mOtD' (= @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B+checkerboard(across)*<3<*+8+0+0 + = 0 L0 pI(  b  6lk<,$ 0 Balancing Clinical and Management Roles I have  management days but I m in the numbers so if the ward is busy I will be working on the ward which means there is a backlog of paperwork. I come to the office at 4 o clock and I m just starting my day s work. (Ward Manager) We have a lot of inexperienced staff out there and it s not fair to leave them out there, they have to have a grounding and that has to be done here so I end up taking the paper bits home with me. (Ward Manager) ((2 2(2 2(2 2(  6| W A-Causes of Long Working Hours: G Grade NursesH  0޽h ? ̙33___PPT10j+PD' (= @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B+checkerboard(across)*<3<*+8+0+0 +  < 0 L0 K(  |  6v,$ 0 Time Management: Organisational and Individual Deadlines get thrown down by senior management at very short notice, for example you get an email at 5pm and they want an answer by 9am& . (Directorate Manager) There is a view that if you can t do your job in the time then you are lacking in ability. This means people lie about how long tasks take. (Senior Staff Nurse) /(2 2(2 2(2 2/  6, W )A Long Hours Culture?H  0޽h ? ̙33___PPT10j+mOtD' (= @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B+checkerboard(across)*<3<*+8+0+0 + ; 0 L0 (  v  0ɺ ,$ 0 Pressure from Colleagues: Direct and Indirect There s a new manager, a women with childcare commitments, she comes in at nine and leaves at five. People are already making negative comments and I ve had to stop myself because I hate that sort of thing. I just wish I had an excuse to go home on time. (Operations Manager) Our manager, who I think the world of, she s set a precedent by working all the hours God sends & It s hard when your manager is like that  she s chosen to do it but it cascades down to other staff. It s a tricky situation but for the sake of myself and my family I should say no. (Team Lead) /- xRwxH  0޽h ? ̙33___PPT10j+PD' (= @B D' = @BA?%,( < +O%,( < +D' =%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B+checkerboard(across)*<3<*+8+0+0 + ^ 0 L0 :2` (      S 4M9   , \H   0޽h ? ̙3380___PPT10.+ _ 8 0 L0 D(  l  C \y     C \z]<<$ 0  H  0޽h ? ̙33___PPT10.+=DN' (= @B D ' = @BA?%,( < +O%,( < +D' =%(D' =%(DT' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B'blinds(horizontal)*<3<*D' =%(D' =%(DT' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B'blinds(horizontal)*<3<*D' =%(D' =%(DT' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*%(D' =-6B'blinds(horizontal)*<3<*D' =%(D' =%(DT' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*[%(D' =-6B'blinds(horizontal)*<3<*[D' =%(D' =%(DT' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*\%(D' =-6B'blinds(horizontal)*<3<*\D' =%(D' =%(DT' =A@BBB B0B%(D' =1:Bvisible*o3>+#.<*H%(D' =-6B'blinds(horizontal)*<3<*H+8+0+0 +Z 0 L0 0(  x  c $\p  x  c $4qp`   H  0޽h ? ̙33y___PPT10Y+D=' (= @B + 0 x( )pM@ R  3 (   $~  C \#$( @  $  H  0޽h ? ̙33M 0 x$(  $R $ 3 (   $~ $ C $)$( @  $  H $ 0޽h ? ̙33F 0 x0(  0R 0 3 (   $~ 0 C .$( @  $  H 0 0޽h ? ̙33L 0 4'(  4R 4 3 (   $ 4 C 3$( @  $ 5!Part of cultural element of long working hours - two sides. 1. Many were felt they were accused, not least by themselves, of not being able to manage their time - workload problems become a personal not an organisational problem. 2. The organisation (entire NHS from Health Department down) had problems with time management. Flow of communication poor, time scales unrealistic - leads to an unsatisfactory working life if jobs are never completed. Problem with tackling time management problems is that it takes time to do it properly. H 4 0޽h ? ̙33E 0 8^(  8R 8 3 (   $ 8 C $?$( @  $ lXFor line managers finding time to fulfil the clinical and management roles was difficult.  Paper bits of the job tended to get pushed into their own time. This issue has been addressed by the Workload and Workforce Planning Group - one day a week. Is this going to be enough? Problems associated with working environment. My perception is that the focus is on coping with workload rather than questioning it. See later the administrative and managerial content of the G grade role is having a profound influence on the career choices of junior staff. H 8 0޽h ? ̙33> 0 < ( # <R < 3 (   $ < C N$( @  $ .Actual causes are too many to mention and the research only touched on them. What I ve tried to do is identify a handful of generic issues. H < 0޽h ? ̙33= 0 @n( @ X@ @R @ 3 (   $ @ C X$( @  $ |hVery few worked short hours - less than 1% worked under 15 hours and less than 15% worked part-time according to ILO definition. G, H/I a more continuous problem.  majority of interviewees and survey respondents in this group NOT satisfied with their working hours  usually the length. Those who had shorter hours tended to work shorter hours, had greater autonomy over their working hours and/or be able to take time off in lieu. H @ 0޽h ? ̙33$ J 0   Dt ( 'lA' DR D 3 (   $ D C d$(   $ Many nurses with substantive posts were also registered with private agencies or the  Nurse Bank an in-house agency. Huge reliance in the Trust on this type of flexible employment but not, in the main, because of clever supply/demand models. Were used simply to fill staff shortages. Incredibly expensive  15% were did shifts that paid them MORE for doing the same job in their normal workplace and a further 5% worked elsewhere in the Trust. 9% employed by other Healthcare providers  CARDIO-VASCULAR nurses  M8 D and E grades the most likely to do these hours, usually for financial reasons. Taking contracted hours, overtime and additional hours I ve tried to estimate average total weekly hours. Fluctuations in shift patterns mean these represent an average over a four weekly period so some weeks of very long hours will be contrasted with weeks of shorter hours. Also reliant on respondents own estimates  potential error Average is a useful indicator nonetheless. Z H Q 72 ! -H D 0޽h ? ̙33I 0 pH>(  HR H 3 (   $ H C $( @  $ LOvertime defined as Any extra hours worked as part of your main job, even the odd half hour. NOT just hours that might attract enhanced payments. 63% - compared to 53% in the UK workforce generally but LOWER than studies in the wider NHS (England)  75% D = 1.4 E = 1.9 F = 3.1 G = 4.7 H/I = 6.9 How are you usually compensated for overtime? Represents a serious under-costing of labour. Likely to be a conservative estimate as it doesn t include unsocial hours, working through unpaid breaks (reportedly quite common) and only counts those who said they were never compensated for these hours& @hI-H H 0޽h ? ̙33< 0 `L0( @ X@ LR L 3 (   $ L C 0$( @  $ >* USING SURVEY RESPONSES: 1/3 of respondents worked part-time  the average contract was for 24 hours per week Remaining 2/3 had standard 37 hour per week contracts although these fluctuated because of 12 hour shift system (60%)  some weeks could do four shifts, others two. H L 0޽h ? ̙33 0 xp(  pR p 3 (   $~ p C  $( @  $  H p 0޽h ? ̙33] 0 (  X  C (   $  S 4$( @  $  H  0޽h ? ̙33 ^ 0   , (  ^  S (   $   c $$( @p  $XP___PPT92*  TOIL - some areas of good practice where staff were positively encouraged to submit OT claims and take time back - always attributed to the attitudes of the senior manager. It was organisational policy that all staff should, in some way, be compensated for hours worked but in some areas it was difficult for nurses to assert this right. For senior nurses  lack of adequate substitute for their absence. For clinical side might be OK but not admin/managerial tasks  these would simply mount up therefore making the problem which caused overtime in the first place worse. Taking time off in lieu being  frowned on by senior managers. Despite being expected to take responsibility for staffing budgets, many G-grade managers had low autonomy over the management of their own time. Going through senior nurse managers for approval was a barrier  cost of replacement likely to shape negative attitudes but also reflect an expectation of unconditional commitment of time to work. 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