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There is a large proportion of health- and community-care personnel working part-time in Norway. It is suggested that part-time work may have a negative impact on the quality and continuity of care, but also that it may allow for a better work-life balance. However, little is known with certainty about the consequences of part-time work. The key findings from this scoping review, which was commissioned by the Directorate of Health, are as follows:
- A majority of the 23 included studies were cross-sectional. Two studies were qualitative, and two were literature reviews. There were no effect studies, and thus information on the effects of part-time work is lacking.
- Outcomes reported were mostly related to the personnel (e.g. job satisfaction, work status incongruence, psychological well-being, access, continuity and quality of care). Less than half of the studies reported any patient outcomes. Patient satisfaction, was only reported in studies of physicians. Many outcomes were reported in single studies only. No study reported any of the outcomes listed in our protocol (e.g. infections, information failure, medication errors, malpractice).
- The definitions of part-time work varied widely across studies. Most studies included nurses, or physicians. Two studies included home-care personnel. Studies of nurses were typically hospital-based, while studies of physicians mainly were set in primary care. Eighteen of the included studies were from North America, and Australia. Four studies were from different European countries, and one study was from Israel.
- The problems of part-time work addressed varied across studies and occupational groups, e.g. forced part-time work, communication practices, and ‘disconnection’ in studies of nurses, while in studies of physicians common problems concerned access, quality and continuity of care. A mutual problem addressed was commitment to the patients and the profession.
Conclusion: This scoping review shows a field with a total lack of effect studies, a large variation in the definitions of part-time work used, the concepts/problems addressed, as well as in the outcomes reported.
There is a shortage of nurses in Norway as well as globally. Adding to this problem is the large number of healthcare personnel who work part-time. It has been suggested that part-time work may have a negative impact on users’ and patients’ perceived quality of care, and on the healthcare personnel. On the other hand, research shows that part-time work may allow healthcare personnel to better balance life and career interests. However, we know little for certain, about the consequences of part-time work on patients and healthcare personnel.
To explore and map the available evidence of part-time (PT) work (including studies of effects and experiences) in the health- and community care services.
More specifically we aimed to explore:
- What kind of publications are reporting effect and experiences of PT work, and what are the main outcomes reported?
- What kind of PT work (definitions included) and which occupational groups have been studied, and in which locations and settings have the studies been conducted?
- Have any limitations or challenges of PT work been reported in the published literature?
We conducted a scoping review in accordance with the methodology manual published by the Joanna Briggs Institute. We searched for literature in 14 databases from 2000 and up to January 2019, with no study design, or language restrictions. We excluded conference papers, editorials and letters. Two authors independently screened titles and abstracts, and assessed full text studies. One review author extracted data onto a standardised and piloted data extraction form, and a second review author checked the accuracy of the extracted data. We synthesised the results narratively in text, and mapped and charted the data using tables and graphics (e.g. bar-charts, bubble-plots, and mind-maps).
We considered any study that provided relevant information regarding part-time work (including effect and experiences) in the healthcare- or in the community care services that was in accordance with our pre-defined PICCO (population, intervention, comparison, context, and outcomes) criteria, which were as follows:
Any patient, or user, with any health condition(s), receiving care in a healthcare setting, in the community (e.g. residents in care homes), or in their own home, and the relatives or caregivers.
Any type of personnel providing care directly to patients (e.g. nurses, physicians, assisting personnel, physiotherapists).
Any evaluation study concerned with PT work, independently of study design, duration of intervention and follow up (or no intervention).
Any comparator (e.g. settings with higher/lower proportion of part-time personnel), or no comparator.
Any health- or community-care setting in any high-income country.
Any objective patient or user outcome related to quality of care and patient safety (e.g. infections, pressure ulcers, falls), as well as outcomes related to the experiences of patients or users (e.g. satisfaction with care, quality of life).
Any objective outcome related to the quality of care delivered by the personnel (e.g. information failure, medication errors, malpractice), as well as outcomes related to the experiences of the personnel (e.g. job satisfaction, work engagement, motivation, burnout).
We included 23 studies of which a majority were cross-sectional. Two studies were qualitative, and two were literature reviews. None of the studies were effect studies.
Studies targeting nurses, and physicians dominated. Only one study included participants with any other occupation (home care personnel, i.e. nurses, therapists, and personal support workers). Studies of nurses typically took place in hospitals, while studies of physicians mainly were set in primary care. Two studies of home care workers was set in the community. A majority of studies were conducted in North America, and Australia. Four studies were conducted in Europe, of which one in Scandinavia. One study was from Israel. A majority of the included studies used surveys (self-report) as their main method of investigation, and a few studies used other types of data (e.g. administrative data). A wide variety of definitions of part-time work was used across included studies. Many of the studies of nurses, and some of the studies of physicians, did not provide any definition of part-time work. The included studies addressed a number of different concepts/problems, and a number of different outcomes related to them, for example: work incongruence (e.g. forced part-time work), communication practices, ‘disconnection’ in the workplace, access, continuity and quality of care, staff shortages and more staff choosing to work part-time, clinical competence, and trust relationships. Work status incongruence was only addressed in studies of nurses. Clinical competence was only addressed in studies of physicians. Commitment to patients and occupation was addressed in both studies of nurses and of physicians. A majority of the reported outcomes were related to the healthcare personnel, while a minority of the included studies reported any patient outcomes. Patient satisfaction, which was the most commonly reported patient outcome, was only reported in studies of physicians. Many outcomes were reported in single studies only. None of the included studies reported any of the outcomes related to quality of care and patient safety that we had listed in our protocol (e.g. infections, pressure ulcers, falls, information failure, medication errors).
A majority of the included studies were cross-sectional, and therefore cause and effect relationships cannot be inferred from the results. Few studies reported on the experiences of patients, and personnel. No standardized definition of part-time work was used, which hampers comparisons across studies. Since studies of nurses and physicians conducted in hospitals and in primary care dominated, we have little information about how part-time work may influence other types of personnel, or personnel working in other settings (e.g. community care). A majority of the included studies were conducted outside Europe, and only one old study in Scandinavia. It may be questioned whether the results can be generalized to Norwegian conditions. The included studies were heterogeneous also in terms of concepts/problems addressed, and outcomes reported. Outcomes of special relevance for quality of care and patient safety (as those listed in our protocol), were not reported in any of the included studies. Many studies also suffered from a number of other limitations (e.g. use of old data, data based on self-report).
This scoping review shows a field totally lacking effect studies, a large variation in the definitions of PT used, concepts/problems addressed, and in the outcomes reported. Heterogeneous studies and a lack of a standardised definition of part-time work, hampers any attempt to pool, or compare, results across studies. Future studies should aim to use a standardized definition of part-time work to enable comparisons across studies. They should use robust study designs to assess the effects of part-time work on patients and personnel. Further, they should also assess the effects and experiences of part-time work in the community care services, where the proportion of part-time personnel is the highest, and assess outcomes directly related to quality of care and patient safety.