• autonomy;
  • job-related tasks;
  • leader support;
  • quality of care;
  • shiftwork;
  • social support


  • This article reviews the literature on shiftwork in nursing and relates this to quality of care issues.
  • The implications of a fully rotational shift system are discussed.
  • The biological effects of working shifts are reviewed, but there appear to be other factors, such as social circumstances and autonomy, which moderate these effects.
  • It is suggested that tasks, formal and informal structures, and staff needs vary widely between nursing shifts, and that this should be taken into account when quality initiatives are introduced.
  • It is concluded that claims that increasing the number of nurses who work fully rotating shifts results in an improved quality of care for patients are premature, as quality issues in nursing have not been addressed on a 24-hour basis.