# Transition from 24-Hour Shifts to Safer Work Schedules for Nurses in Latvian Healthcare: Policy Analysis and Recommendations

## TL;DR

This paper analyzes the shift from 24-hour nursing shifts in Latvia to safer schedules, recommending policy changes to improve nurse well-being and patient safety.

## Contribution

The study proposes specific policy options and prerequisites for transitioning to safer nursing schedules in Latvia.

## Key findings

- Latvian nursing relies on 24-hour shifts despite evidence of harm to staff and patients.
- Most OECD/EU countries use 8–12 hour shifts with mandated rest, leading to better outcomes.
- Four policy options and seven prerequisites are proposed for feasible shift reform in Latvia.

## Abstract

In Latvia, extended shifts, including 24 h duties, remain common inpatient care settings despite extensive international evidence on their adverse effects on staff well-being and patient safety. We conducted an evidence-informed policy analysis combining a structured review of national legislation and institutional reports with comparative policy mapping across OECD/EU countries. The interpretation was guided by three theoretical frameworks: the Job Demands–Resources model, Effort–Recovery theory, and the Work–Life Interface framework. Latvian practice shows high reliance on long shifts amid workforce shortages and incomplete overtime/rest accounting. In contrast, most OECD and EU countries have implemented 8–12 h multi-shift systems with mandated rest, which are associated with lower error rates, reduced burnout, and higher staff satisfaction. We synthesised four policy options (12 h transition model; 16 h cap; modular 2 × 6 h/3 × 8 h; flexible unit-profiled schedules) and identify seven prerequisites for feasible implementation (regulatory alignment; staffing; financing; management training; digital scheduling; pilot projects; monitoring). A phased transition from 24 h shifts to structured schedules appears both feasible and desirable, with pilot implementation and monitoring aligning with WHO/ILO recommendations. Implications for policy and practice: Reform is a system-level intervention to improve staff well-being, patient safety, and workforce sustainability in Latvia.