Development of a scale to assess nurses' difficulties in collaborating with physicians in responding to clinical deterioration during night shifts.

Aims: To develop a scale to assess difficulties that nurses experience when collaborating with physicians in responding to clinical deterioration during night shifts and identify factors associated with scoring using the developed scale.

Methods: A web-based questionnaire with a draft scale, the Nighttime Collaboration Difficulties between Nurses and Physicians for Nurses (NCDNP-N), was distributed to nurses working night shifts in acute-care hospitals across Japan. Data were collected between July and October 2023. Of 435 responses, 405 were examined for the NCDNP-N's psychometric validation, including structural validity, criterion-related validity, and reliability assessments. Multiple linear regression analysis was performed for 385 responses excluded by listwise methods to identify factors associated with NCDNP-N scores.

Results: The NCDNP-N has 10 items and three domains: Domain 1, dissatisfaction with physicians' actions; Domain 2, burden of working with night-shift physicians; and Domain 3, barriers to reporting during night shifts. Estimated reliability coefficients exceeded the recommended values. Multiple regression analyses demonstrated that more years of experience in the current ward and frequency of calling the covering physician at night were markedly associated with higher scores, whereas more nursing experience was associated with lower scores.

Conclusion: We developed the NCDNP-N and confirmed its validity and reliability. The study results suggest that the responsibilities and competence of nurses working night shifts and communication with the night-covering physician are associated with difficulties in nighttime collaboration. The NCDNP-N may help identify challenges in clinical settings as well as can be utilized in the evaluation study for improving nighttime collaboration.