The preliminary impact of nursing care intensity and shift patterns on postoperative patient outcomes in medical-surgical units: A multicenter pilot observational study

Nurse workload and shift patterns influence postoperative patient outcomes in medical-surgical units. Understanding their impact is essential for optimizing care quality and patient safety. This study examined the relationships between nurse workload, shift patterns, surgical procedure type, patient age, nurse experience, and postoperative outcomes. A quantitative, multicenter, observational pilot study was conducted across three hospitals in River Nile State, Sudan. The analytic dataset comprised ten unit-level aggregated observations (N = 10), each representing a medical–surgical unit-shift combination drawn from a larger pool of 150 nurse–patient encounters that were aggregated to the unit-shift level to permit ecological analysis. Descriptive statistics, Pearson correlations, and an exploratory multiple linear regression model (interpreted with caution given the small sample) were performed to assess associations and predictors of patient outcomes. In this exploratory analysis, nursing care intensity (workload score) demonstrated a strong positive correlation with patient outcomes (r = 0.956, p < 0.01) and was the only apparent predictor in the regression model (β = 1.005, p = 0.001); given the very small sample size, these effect estimates are likely inflated and should be interpreted as hypothesis-generating rather than confirmatory. Length of stay was also positively correlated with both care intensity and patient outcomes, a finding most plausibly explained by reverse causation (sicker patients require more intensive nursing input). Shift patterns, surgical procedure type, age, and nurse experience were not statistically significantly associated with patient outcomes. In this pilot dataset, nursing care intensity emerged as the variable most strongly associated with postoperative patient outcomes; however, the small sample, the lack of confounder adjustment, and the potential for reverse causation preclude a firm causal interpretation. The findings are best regarded as hypothesis-generating and underscore the relevance of nurse staffing and workload distribution to the quality of postoperative care. Adequately powered, prospective, multicenter studies using validated workload instruments (e.g., NASA-TLX, NAS) and objective staffing metrics (e.g., patient-to-nurse ratios) are needed to confirm these preliminary signals and clarify the role of shift patterns in patient safety.