Determinants of Patient Satisfaction with Nursing Care during Night Shifts:  A Literature Review

Search strategy

This review process was conducted by systematically selecting and synthesizing literature that explores patient satisfaction with the care received from nurses, with particular focus on factors influencing satisfaction profiles during night shifts.

Relevant studies were identified through a systematic search of PubMed, CINAHL, Science Direct, and Cochrane Library. The search used specific keywords combined with Boolean operators AND and OR. The keywords included “patient satisfaction”, “nursing care”, “night shift”, “nursing performance”, and “hospital care”.

Inclusion and exclusion criteria

Studies were assessed for eligibility using the following predefined criteria: Studies were included if they focused on adult inpatients who stayed in the hospital for at least one night. Only studies from 2016 to 2026 were included to keep the research up to date. Peer-reviewed articles published in English were considered only, regardless of geographical location, including qualitative, quantitative, mixed-methods, and systematic reviews.

Papers that did not specifically report on patient satisfaction with nursing services, studies focusing only on outpatient or pediatric groups, and studies that were not directly relevant to the main research purpose were excluded.

Study description

The systematic search identified 35 eligible full-text articles discussing patient satisfaction with the quality of nursing care during night shifts. The study selection process is presented in the PRISMA flow diagram ( Figure 1). The articles included in this review are summarized in Table 1.

Figure 1. PRIZMA flow diagram.

The challenge of night shifts

The night-shift environment presents unique challenges for nurses, which, in turn, influence patient satisfaction. The literature shows that reduced staffing, quieter hospital conditions, and increased need for vigilance characterize nocturnal care. These factors can cause patients to view their care as less responsive compared to daytime shifts. Furthermore, night shifts often require nurses to balance attending to patients’ immediate needs with ensuring their comfort and rest, which are vital elements of patient satisfaction (Lotfi et al., 2019; Skaggs et al., 2018).

Night shifts take a toll on nurses’ well-being, affecting their performance and the quality of care they deliver. Disrupted sleep patterns and fatigue are particularly common among night-shift nurses. Studies have shown that these conditions lead to reduced cognitive effectiveness, slower reaction times, and diminished decision-making capabilities, all of which can negatively impact patient experiences. Research conducted among nurses working 12-hour night shifts found that poor sleep health directly correlates with lower performance levels, potentially compromising patient satisfaction (James et al., 2020). Furthermore, shift work sleep disorders are prevalent among night-shift nurses, emphasizing the need for better support systems to mitigate these issues (Books et al., 2017; D’ettorre et al., 2020).

In addition, nurses working at night often experience increased isolation and depressive symptoms. In Saudi Arabia, research highlighted that these psychosocial challenges affect nurses’ ability to provide consistent, empathetic care (Alsharari et al., 2021). Similarly, a study in China found that nurses working night shifts reported poorer sleep quality and higher rates of depressive symptoms, further underscoring the indirect effects of nurse well-being on patient experiences (Dai et al., 2019).

In Ethiopia, research on the effects of night shifts on nurses’ health and work performance found a significant reduction in nurse effectiveness associated with prolonged night hours. This decline in performance directly affects patient satisfaction, as reduced responsiveness and attentiveness are often observed during night care (Dires et al., 2023). Qualitative insights further reveal that nurses acknowledge night shifts as emotionally and physically taxing but recognize their importance in ensuring continuity of care and building relationships with patients (Weaver et al., 2023). Addressing these challenges is essential to improve nursing performance and ensure consistent patient-centered care (Alsharari et al., 2021).

Environmental conditions during night shifts also play a significant role in shaping patient satisfaction. The quality of lighting, noise levels, and overall ambience in hospital settings influence both nurse performance and patient perceptions of care. Research suggests that improved night lighting reduces nurse fatigue, enhancing their ability to attend to patient needs. These factors contribute to a safer, more supportive care environment, as reflected in higher patient satisfaction scores (Hoshi et al., 2022).

Night shifts create real challenges for nurses and can impact how patients feel about their care. With fewer staff, disrupted sleep, and fatigue, nurses may respond more slowly, make more medication errors, and find it harder to make decisions (Haile et al., 2025; Özsaban et al., 2026). Nurses also often feel isolated and stressed, which makes it harder to give consistent and caring support (Alsharari et al., 2021; Dai et al., 2019). Poor lighting and noise at night can make fatigue worse and affect how patients view the quality of their care (Hoshi et al., 2022). These issues show why it is important to have support systems in place to help nurses provide high-quality, patient-centered care during night shifts (LeBlanc Arrington et al., 2026; Weaver et al., 2023).

Patient satisfaction with nursing care

A cross-sectional study was used to evaluate the patients’ satisfaction with the quality of nursing care delivery and its determinants in Saudi Arabia. A total of 502 patients were included in the study, and information was collected using a satisfaction assessment questionnaire verified for authenticity. The findings showed that only 70% of patients in the study were satisfied with the nursing care they received. This percentage reflected patient satisfaction with night-shift care, which is lower than day-shift care, both of which are relatively low in the realm of healthcare. The highest level of patient satisfaction was found with interpersonal skills/Emotional Support. These results raised awareness of the need to develop measures that facilitate better communication between the nurse and the patient and help achieve the improved patient care standard (Alharbi et al., 2022).

A systematic review and meta-analysis examined patient satisfaction with nursing care at night shift in the Middle East Region by synthesizing data from multiple studies. The analysis included 27 articles and revealed an overall satisfaction rate of 68.4%. (Hosseini et al., 2023). In the Turkish context, the quality of nursing care and its predictors determining patient satisfaction were assessed in a study conducted among 378 inpatients. The survey was structured and primarily focused on indicators of responsiveness, communication, and professionalism. 80% of patients expressed satisfaction with the quality of care, citing nurses’ availability to patients and their understanding of patients’ feelings as critical factors. The study also showed that information provision and education are important factors affecting patient satisfaction (Karaca & Durna, 2019).

In the same vein, a cross-sectional descriptive study using a self-administered questionnaire was conducted among 423 adult patients in the Amhara region of Ethiopia to identify factors influencing satisfaction with nursing care in public hospitals. The study employed a standardized survey to assess patients’ satisfaction with separately identified aspects of care experience, which include: care process, information sharing, and attentiveness. Of the respondents, only 67% reported satisfaction with the amount and quality of nursing care they received. Patient’s literacy level, the hospital experience, and the nurse’s workload were among the predictors of satisfaction. On this, the findings underscore that greater emphasis should be placed on enhancing structural and organizational characteristics to enhance satisfaction outcomes (Kasa & Gedamu, 2019).

In the realm of COVID-19, patients’ satisfaction with nursing care was assessed in Saudi Arabia during the pandemic. Of the 320 patients involved, satisfaction was assessed using a specific questionnaire. Of these, 70% reported being satisfied with the nursing care they received. High satisfaction ratings were associated with professionalism as well as flexibility or versatility in adverse conditions among the nurses. Nonetheless, participants indicated they would have liked the service to offer more emotional support and a faster response time. In the same study, the author found that when nurses receive specific training in pandemic care, their satisfaction levels increase (Alhowaymel et al., 2022).

Moving across the globe to the US, survey data from 1,024 hospitalized patients in the United States were used in a study to establish the experiences of older adults with the quality of nursing care provided on the night shift. Final findings disclosed that the satisfaction level at night shift is still below the average of the day shift, highlighting the need to overcome the issue (Chumbler et al., 2016).

In conclusion, studies show that patients are less satisfied with nursing care during night shifts than during the day, with satisfaction rates between 67% and 80% (Alharbi et al., 2022; Hosseini et al., 2023; Karaca & Durna, 2019; Kasa & Gedamu, 2019; Alhowaymel et al., 2022; Chumbler et al., 2016).

Determinants and predictors of patient satisfaction

Satisfaction levels varied based on factors such as nurses’ communication, professionalism, and responsiveness. Subgroup analyses identified significant predictors, including the availability of nurses, the quality of patient education, and the emotional support provided. Enhancing nurse-patient interactions and addressing organizational challenges could improve satisfaction outcomes across diverse healthcare settings (Hosseini et al., 2023).

Satisfaction predictors in inpatient healthcare were examined in a cross-sectional study conducted in Slovakia. One thousand two hundred patient records were analyzed, and a multivariate regression analysis was performed. The findings highlighted that patients’ perceptions of care quality were strongly influenced by communication, emotional support, and promptness. The study also found that satisfaction levels were lower in units with higher nurse workloads, emphasizing the importance of adequate staffing to improve patient satisfaction (Gavurova et al., 2021).

A correlational study examined the relationships among nurse managers’ work activities, nurses’ job satisfaction, patient satisfaction, and medication errors at the unit level. Emotional work in Finland involved 1500 nurses and 10000 patients. The results indicated that supportive managerial actions are positively associated with higher patient satisfaction. Improved management practices were also found to directly enhance nurse satisfaction and reduce medication-related errors. Based on these findings, leadership was identified as a strong predictor of both nurse engagement and patient satisfaction (Nurmeksela et al., 2021).

Additionally, a quantitative, descriptive, non-experimental study was conducted in England to compare nurse staffing levels with patients’ satisfaction with hospital care. Data from 30000 patients across 46 hospitals were included. Several studies have shown that the standard level of patient satisfaction increased in healthcare organizations where the scope of nurses’ staffing was more favorable. The patient surveys indicated improvements in four specific aspects of the communication climate in these hospitals: perception of communication, perception of staff attentiveness, perception of staff responsiveness, and perception of overall staff responsiveness. According to the study, the most important factor in maintaining high-quality nursing standards and patient satisfaction was staffing levels (Aiken et al., 2021).

A cross-sectional survey was conducted to examine the association between missed nursing care and patient satisfaction in US hospitals. A randomized controlled trial was developed based on reports from patients and nurses from 409 adult, non-federal acute care hospitals to measure the frequency of missed care tasks and their impact on patient assessment. As expected, the results showed a negative correlation between missed care and patient satisfaction. In units where care was most frequently missed, patients expressed dissatisfaction with the care received, highlighting the importance of staffing levels and carrying out care activities (Lake et al., 2016). Additionally, missed nursing care was studied as a predictor of patient satisfaction in a cross-sectional study involving U.S. hospitals. Data from 10,000 patients were analyzed to examine the relationship between missed nursing care tasks and satisfaction scores. Results showed that higher rates of missed care were directly linked to lower patient satisfaction. The findings emphasized the importance of addressing staffing issues and prioritizing essential nursing tasks to enhance patient experiences (Lake et al., 2016).

Patient satisfaction and related factors were examined in referral hospitals in Addis Ababa, Ethiopia. The study involved 600 patients, and a structured questionnaire was used to assess satisfaction levels. Patients reported a satisfaction rate of 70%, with overall satisfaction most influenced by communication and engagement. Ultimately, this research demonstrated that increasing interaction between the nurse and the patient is vital for improving satisfaction outcomes (Abebe et al., 2024).

Patient satisfaction with the quality of nursing care received was evaluated in a cross-sectional study conducted in Ibadan, Nigeria, involving 450 patients. We found that satisfaction depended on professionalism, timeliness, and the nurses’ attitude. These findings suggest that patients who received quick responses and good communication with their caregivers rated their care as excellent. These objectives heavily focused on promoting patient-centered care to increase satisfaction levels (Nasir et al., 2024).

In Chennai, South India, 320 patients from medical wards took part in a cross-sectional survey evaluating the quality of nursing care and patient satisfaction. Studies have indicated that patient satisfaction is influenced by nurses’ working conditions, availability, and responsiveness. It was also found that patient satisfaction increased when nurses displayed effective communication and empathy. This study recommended implementing ongoing education programs to enhance interpersonal relationships and nurses’ care delivery (Kannan et al., 2020).

Patients’ satisfaction with nursing care was surveyed in five large departments of a tertiary care hospital in Nepal. This study adopted a descriptive cross-sectional research design with a sample of 400 inpatients. It confirmed differences in perceived satisfaction across departments, with surgical departments recording the highest satisfaction levels. Most patients appreciated the attention provided by nurses, the quick responses, and the appropriate behavior. Therefore, the findings emphasize the need for an approach that considers departmental differences in patient satisfaction (Acharya et al., 2019).

Perceived inpatient satisfaction with nursing care and related factors in Chinese tertiary hospitals was investigated through a cross-sectional survey. Data from 800 patients were gathered via self-completed questionnaires using a validated tool. The results indicated that improvements in satisfaction were linked to nurses’ psychological communication, their responsiveness to patient needs, and emotional support. They concluded that trust in nursing staff was a key factor influencing overall satisfaction and recommended strengthening the patient-care relationship (Yan et al., 2022).

In Jordan, a study aimed to examine predictors of patient satisfaction with nursing care at night shift using a national sample. Results from two thousand five hundred patients were tested for significant predictors by employing regression models. The findings revealed that satisfaction was influenced by nurse-patient communication, perceived empathy, and responsiveness. Staffing levels and nurse workload also emerged as important organizational predictors. The results indicated that improvements in these predictors through intervention could lead to significant changes in patient satisfaction (Al-Hammouri et al., 2024).

The evidence shows that patient satisfaction depends a lot on communication, responsiveness, emotional support, professionalism, and having enough staff (Aiken et al., 2021; Gavurova et al., 2021; Hosseini et al., 2023). Factors like nurse workload, support from managers, and leadership also play a key role, affecting both how satisfied patients are and how well nurses perform (Al-Hammouri et al., 2024; Nurmeksela et al., 2021). Missed nursing care is often linked to lower satisfaction, which highlights the need to focus on essential care tasks and make sure there are enough staff members (Lake et al., 2016). These findings show that while personal skills and empathy are important for patient experiences, organizational factors matter too. To improve patient-centered outcomes, healthcare systems should use structured nursing care models that address staffing, communication, and leadership issues.

Nursing care models and practices

Numerous single cross-sectional studies have been conducted to evaluate nurse or patient satisfaction with the quality of nursing care at night shift, but long-term evidence on improving these outcomes remains limited. The High-Quality Care Project, a nationwide initiative in China, was implemented to enhance nurse and patient satisfaction with nursing care at night shift by adopting primary nursing practices. To assess long-term changes in nurse and patient outcomes, data from two cross-sectional studies conducted in 2009 (pre-implementation) and 2016 (post-implementation) were analyzed. Surveys were completed by 1,376 nurses and 904 patients from 40 units across 10 tertiary hospitals, using reliable and validated instruments to measure outcomes. Multilevel modelling was employed as the primary analytical method. Results indicated that nurses in 2016 reported greater satisfaction with most aspects of their work environment and overall job satisfaction than nurses in 2009, although no significant improvements were observed in burnout, global job satisfaction, or intention to leave their jobs. Furthermore, nurses in 2016 reported higher quality of patient care and patient safety, while patients in 2016 expressed increased satisfaction with nursing care at night shift. These findings, supported by existing evidence, suggest that primary nursing may be an effective strategy for improving nurse work environments and patient outcomes. Further research using rigorous study designs is recommended to explore the direct effects of primary nursing on these outcomes (Chen et al., 2020).

The methods used to conduct the research involved a pre- and post-comparison of primary nursing care patterns on satisfaction levels. Surgical patients in an Italian hospital were the subjects of this study, which compared patient satisfaction after the implementation of primary nursing with that beforehand, assessing a total of 250 patients. The changes were highly significant across all categories compared; the largest increase was seen in communication, continuity of care, and emotional support. The study also highlighted that strong satisfaction results stem from adopting primary nursing models, as these promote positive working relationships between community nurses and patients (Dal Molin et al., 2018).

A search of Medline-PubMed, CINAHL, BNI (British Nursing Index), and Web of Knowledge for quantitative studies investigating primary nursing care models and nursing-sensitive objectives was conducted to perform a systematic review and a narrative synthesis. Of the 15 studies included in the review, the authors found that primary nursing care leads to improved satisfaction, fewer adverse events, and better emotional well-being for patients. The results emphasized the importance of patient-centered and stable care processes to foster the right perceptions (Gonçalves et al., 2023).

Research shows that communication, responsiveness, staffing, and emotional support are key factors in patient satisfaction. Nursing care models like primary nursing help address these issues by promoting continuity of care, building stronger nurse-patient relationships, and reducing missed tasks. These approaches address the organizational barriers that can lower satisfaction during night shifts. Studies highlight that primary nursing and similar patient-centered models improve both nurse work environments and patient outcomes, making them important strategies for better satisfaction and quality of care at night (Chen et al., 2020; Gonçalves et al., 2023).

Summary of evidence

A review of the selected literature indicates that most studies employed quantitative methods, with over half using only the cross-sectional approach (Abebe et al., 2024; Alharbi et al., 2022; Karaca & Durna, 2019). These designs were suitable for evaluating patient satisfaction at a specific point in time and thus provided valuable insights into the relationship between nursing care and patient satisfaction, understand the determinant, and report the most effective model to improve patients’ satisfaction with nursing care at certain occasion.

The number of participants in the studies also varied significantly, from fewer than 100 (Dal Molin et al., 2018) to over 10,000 (Lake et al., 2016), which raises another important concern. We found that increasing the sample size boosted statistical sensitivity and yielded results relevant to a broader population, especially in multi-hospital or multi-region studies (Aiken et al., 2021). The literature review also revealed variability in settings and populations, with a focus on patient satisfaction across cultural, systemic, and organizational aspects. Research conducted in Saudi Arabia by Alharbi et al. (2022), Ethiopia by Kasa & Gedamu (2019), and Nepal by Acharya et al. (2019) demonstrated how culture and healthcare systems influence patients’ perceptions of nursing care (Acharya et al., 2019; Alharbi et al., 2022; Kasa & Gedamu, 2019). Additionally, several studies highlighted the needs of specific subgroups, including the elderly (Chumbler et al., 2016) and patients during the COVID-19 pandemic (Alhowaymel et al., 2022). This focus added depth to the literature and emphasized the importance of developing interventions tailored to specific patient groups.

Challenges of night shifts

Research shows that night shifts bring unique challenges for both nurses and patients. Issues like fewer staff, environmental factors, lightening, administrative factors, disrupted sleep, fatigue, and slower response times can lower care quality and affect patient satisfaction (Haile et al., 2025; Özsaban et al., 2026). These problems make patients feel care is less responsive at night, while nurses often face isolation, burnout, and trouble making decisions. We see these challenges as signs of deeper problems in healthcare systems that need urgent attention.

Patient satisfaction and determinants

Studies from different settings show that patient satisfaction is usually lower during night shifts than during the day, with rates between 67% and 70% (Alharbi et al., 2022; Hosseini et al., 2023). Factors like good communication, quick responses, emotional support, professionalism, and enough staff are strong predictors of satisfaction (Al-Hammouri et al., 2024; Gavurova et al., 2021). On the other hand, missed care and heavy workloads are linked to worse patient experiences (Lake et al., 2016). Leadership and support from managers also have a big impact on both nurse engagement and patient satisfaction (Nurmeksela et al., 2021). We believe these results show that patient satisfaction depends on more than just individual nurses. It is shaped by complex organizational and system-wide factors. To improve satisfaction, we need to address both personal interactions and larger structural issues.

Primary nursing care model as a possible solution

Primary nursing care models offer strong solutions to these problems. Research from China, Italy, and systematic reviews shows that primary nursing improves care continuity, builds better nurse-patient relationships, and increases satisfaction during night shifts (Chen et al., 2020; Dal Molin et al., 2018; Gonçalves et al., 2023). We think this model works well because it lets nurses give personalized care and helps fix issues like missed tasks and poor communication. As someone researching healthcare in Jordan, we believe using primary nursing could lead to lasting improvements in patient satisfaction and care quality at night. This approach also fits the urgent need to fix system-wide problems in Middle Eastern healthcare, where cultural expectations, staff shortages, and organizational issues often hurt patient-centered care.

Future research should move beyond cross-sectional designs and employ longitudinal or experimental approaches to capture the long-term impact of nursing care models on patient satisfaction, particularly during night shifts. Stronger designs such as randomized controlled trials or multi-center cohort studies would provide more robust evidence on causal relationships between determinants—like staffing levels, communication, and managerial support—and patient outcomes.

Additionally, studies should prioritize context-specific investigations that account for cultural expectations, systemic barriers, and organizational structures unique to different healthcare systems. Exploring the implementation of primary nursing models across diverse hospital settings could generate valuable insights into their feasibility and effectiveness. Such work would not only advance academic knowledge but also guide policymakers and healthcare leaders in designing evidence-based interventions that sustainably improve patient satisfaction and nursing care quality.

Limitations

While this review covers a wide range of studies, some limitations should be acknowledged. Restricting the search to publications in English might have excluded important research published in other languages. The included studies also employed various approaches, especially in how they measured patient satisfaction, which hindered a meta-analysis. Most of the studies were cross-sectional, making it difficult to establish causal relationships between nursing interventions and satisfaction outcomes.

Implications

Research shows that patients are less satisfied during night shifts than during the day. This is mostly because of issues like fewer staff, missed nursing care, and less emotional support. Factors such as communication, responsiveness, professionalism, and support from managers strongly influence satisfaction. This means that patient experiences depend on both individual nurses and the way organizations are run. These results highlight the need for healthcare systems to include patient satisfaction in their quality improvement plans and to focus on fixing staffing and workload problems.

Primary nursing care models can help solve these problems by making care more consistent, building stronger nurse-patient relationships, and improving communication. Studies from China, Italy, and systematic reviews show that these models improve patient satisfaction during night shifts (Chen et al., 2020; Dal Molin et al., 2018; Gonçalves et al., 2023). As researchers, we believe that using primary nursing in Jordan and the Middle East could lead to lasting improvements in patient-centered care. Adding these models to national health policies would boost patient satisfaction and set a new standard for nursing and healthcare quality in the region.