Nurses’ Experiences and Perspectives on the Shift System Improvement Pilot Project: A Structural Topic Modeling Analysis

Purpose: This study explored nurses’ experiences and perspectives regarding the shift system improvement pilot project, as well as their recommendations for shift work policies, and examined variations according to nurse and hospital characteristics. Methods: Structural topic modeling was applied to open-ended survey responses from 208 nurses. Topic prevalence was examined according to career length, marital status, education, hospital location, and bed capacity. Findings: Six topics emerged: experiences with implementing a pilot project for shift system improvement; shift system improvements for sustainability; physical burden and challenges of fixed night shifts; the impact of shift system improvement on personal life; nurse staffing levels for providing safe nursing care; and nursing workforce expansion and work distribution for quality care. Workforce adequacy showed the highest prevalence and was the dominant theme across all career lengths. The prevalence of system improvement was higher among nurses with ≤3 years and >10 years of experience, whereas nurses with 3–10 years of experience focused more on project participation. Smaller hospitals prioritized system improvements, whereas larger hospitals emphasized the physical burden. Conclusion: Nursing workforce adequacy emerged as nurses’ primary concern, surpassing concerns related to shift system design. Policy should prioritize legally mandated nurse staffing ratios as the foundation for sustainable shift systems, with interventions tailored to organizational capacity and career length.