Working a 12 hour shift is normal for most nurses working in hospitals and inpatient settings. This cross-sectional study gave a 118 question survey to 31,627 nurses from 487 hospitals in 12 European countries to “examine the association between registered nurses’ shifts of 12 hr or more and presence of continuing educational programs; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers (page 53).”
They first performed descriptive analyses of outcomes then used generalized linear mixed models. The researchers then added potential confounding variables to the models.
The researchers found “no evidence for beneficial effects of shifts of 12 hours or more in terms of continuity of care or reduced patient information being lost during handover. Shifts of 12 hours or more are associated with reduced opportunities to discuss care and participate in continuing education activities. As well as negatively impacting quality of care, there may be more insidious effects of shifts of 12 hours or more, especially when considering the long term and cumulative impact of not being able to participate in educational activities and discuss patient care (page 58).”
This research article should cause employers and nurse managers to question the implementation of long shifts and investigate alternatives or safe guards to put into place to ensure the patient is receiving safe and effective care and nurses are receiving the education needed.
Dall’Ora, C., Griffiths, P., Emmanuel, T., Rafferty, A. M., & Ewings, S.; On behalf of the RN4CAST Consortium. (2020). 12-hr shifts in nursing: Do they remove unproductive time and information loss or do they reduce education and discussion opportunities for nurses? A cross-sectional study in 12 European countries. Journal of Clinical Nursing, 29, 53–59. doi: DOI: 10.1111/jocn.14977
Nursing hours can be controversial. There is the 8-hour shift, 10-hour shift, or 12-hour shift available for nurses. It has been reported that 12-hour shifts lead to poor performance due to physiological strain, fatigue, burn-out, and job dissatisfaction, which consequently negatively impacts patient care and safety (Battle & Temblett, 2018). Nurses working shifts of 12 hours, those working overtime, or working more than 40 hours per week, reported increased risk of making an error, lower quality and safety, and decreased nurses’ vigilance (Battle & Temblett, 2018). However, many nurses favor 12-hour shifts because it allows greater flexibility for personal endeavors outside the workplace, contribute to staff satisfaction, increased work satisfaction, and increased continuity of patient care. If eight hours seems too short and 12-hours seems too long, maybe the best shift to work is 10-hours. What do you think?
Battle, C., & Temblett, P. (2018). 12-hour nursing shifts in critical care: a service evaluation. Journal of the Intensive Care Society, 19(3), 214-218.
I have always worked 12 hour shifts and just recently switched jobs and now work 8 hour shifts. I must say I have way more energy now than I used to. My husband has also seen an improvement in my mood! I’m sure it is a different preference for everyone and some nurses do not know any difference because they’ve always worked 12 hour shifts. Thank you for your research and input!
I worked 12 hour shifts for many years which we all know is more like a 13 or 14 hour shift. In my experience my first day “off” was always a recovery day. I was so exhausted from working 36-72 hours without a day off that I had to spend that entire first day off resting. That kind of defeats the purpose of having more days off. I always said 12 hour shifts are a love – hate relationship. According to BMC Nursing (2017), the odds of poor quality care were 1.64 times higher for nurses working ≥12 hr shifts. The rate of care left undone was 1.13 times higher for nurses working ≥12 hr shifts. Job dissatisfaction was higher the longer the shift length: 42.9% with ≥12 hour shifts. These findings add to the growing international body of evidence reporting that ≥12 shifts are associated with poor ratings of quality of care and higher rates of care left undone.
Reference:
Ball, J., Day, T., Murrells, T., Dall’Ora, C., Rafferty, A. M., Griffiths, P., & Maben, J. (2017). Cross-sectional examination of the association between shift length and hospital nurses job satisfaction and nurse reported quality measures. BMC nursing, 16, 26. https://doi.org/10.1186/s12912-017-0221-7
Kristen this is a great topic that I have recently covered in my Issues & Trends Facing Healthcare class. I was tempted to continue my research about this topic into this assignment but felt I would be undercutting the whole experience of a new topic. I have always found the 12 hours shifts to be an interesting schedule as I am used to a 24 hour schedule. I feel that even if I work 12 hours in a busy ER or hospital I might as well be on a 24 hour shift at the Fire Station because even thought I may go home after a 12 hour shift the rest I need to recuperate and be productive the next day is equivalent to a full 24 hour shift. In my research I found that 12 hours, actually between 11 and 13 hours was the cutoff for quality of work being produced. Any time spent nursing after 13 hours has an extreme jump in percentage by as much as 40% for patient dissatisfaction and nurse burnout(Stimpfel, A et al. 2012). Even though the results of the study you presented from the Journal of Clinical Nursing found no benefits to the 12 hour shift in terms of continuity of care and the opportunities of information being lost with more transfers of care, little change if any has occurred in the last 10 years to change 12 hour shifts (Rosenburg 2019). Administration still claims less shift changes leads to less errors and allows the workflow to continue smoothly with only two shift changes in a 24 hour period. Starting and stopping time, settling in and departing, also known as adaptation time, from an administrator’s point of view of 3 times a day, would take too much time off the clock that could be contributed to production and patient care(Circadian, 2020). Even nurses are loyal to the 12 hour shift although they understand the research being presented says shifts over 11 hours lead to burnout and dissatisfied patients, nurses are devout to the 12 hour shift. Why? Working 3 days a week leaves them available for the rest of the week to tend to their families or work another job. 12-hour shifts offer 91 fewer shifts per year than a 8 hour shift and double the weekend time off to 26 days from 13 (Circadian, 2020). What I found most interesting from my prior research was that patients report that longer shifts caused nurses to communicate less or even stop communicating, pain was rarely or never controlled, and that it was difficult to find help or assistance when needed(Stimpfel, A et al.,2012). If patients truly are our number one priority than administration and our own selfish schedules should come second or third to quality care.
References
Circadian. (2020). 8 Major Advantages of 12-Hour Shifts: A Managers Perspective. Retrieved April 2, 2020, from https://www.circadian.com/blog/item/14-8-major-advantages-of-12-hour-shifts-a-manager-s-perspective.html
Rosenburg, K. (2019, June). Little Change in RNS’ Work Schedules in a 10-Year Period : AJN The American Journal of Nursing. https://journals.lww.com/ajnonline/Fulltext/2019/06000/Little_Change_in_RNS__Work_Schedules_in_a_10_Year.33.aspx
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012, November). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608421
Thank you for your great input! I always thought I would be working 12 hour shifts and now that I’m working 8 hour shifts, I’m not sure I could ever go back! It is very nice to not need a recovery day and have evenings and weekends off. I thought that working several 12 hour days in a row was the way to go but it ended up being more 14 hours so I wasn’t getting to see my kids for several days in a row! It is hard on families also to have one or both parents working long shifts. Working 24 hours seems crazy to me, but I’m sure you get used to it after awhile.
Yes, you kind of get used to it after a while. I am interested on finding other schedules that could work in the hospital for nurses and presenting them for another project I am working on. 10 hour shifts seem a good compromise to me. Also, I would be interested in making the 10 hours overlap instead of the way shift change is handled now. One hour overlap of the 10 hours where nurses work together for that last and first hour in between. I have always enjoyed working with another nurse as a team and it seems a lot gets done real fast. I just don’t know how to handle the 7 left over hours, maybe that would be PT. So FT1 would be 7a-5p, FT2 would be 4p-2a, and PT1 would be 1a to 8a. The goal behind overlapping shifts with an hour would be to defeat the belief that 3 shifts would cause to much error in transfer of care by miscommunication and eliminate the start and stop time known as adaptation time by a continuous smooth transition. Nurses should be able to leave on time and even early if cleared. Sure administration will have to pay and extra 3 hours each day from 24 to 27 hrs with the overlapping but I feel they already pay that most of the time. How else can we make shorter shifts, less mistakes, increase patient satisfaction, and keep nurses happy? Any ideas?
That is a great idea to have the overlap. It seems like when I was working 12 hour shifts, most of the time we would struggle to get out of there on time. Having some overlap might allow for nurses to get of shift on time so ideally there would be less overtime pay!
Kristen,
I think this is a debate that will continue to go on until changes are made. Many nurses prefer a 3 12-hr shifts but in reality shifts can be unpredictable and can lead to longer hours. With longer hours come nurse burnout, job dissatisfaction and can also hurt patient satisfaction. In a study completed by Stimpfel, A. W., Sloane, D. M., & Aiken, L. H., 2012, “for many patient outcomes, dissatisfaction decreased as the proportion of nurses working shifts of 8-9 hours or 10-11 hours increased.” The study also found that nurses working shifts of 12-13 hours were more likely to intend to leave than nurses who work less hour shifts. Changes are definitely needed to avoid these negative outcomes. There already is a nursing shortage in the country and this is only adding to the shortage. There are also a lot of nurses that have left the field entirely. In a study done by RNnetwork, “49% of nurses have considered leaving the profession in the last 2 years.” This would make a huge impact in the shortage.
References:
Gooch, K. (n.d.). 49% of nurses have considered leaving the profession in the last 2 years, study finds: Nurses continue to consider leaving their profession amid complaints of burnout, overwork and harassment, according to a new study by RNnetwork, a travel nurse staffing agency. Retrieved from https://www.beckershospitalreview.com/workforce/49-of-nurses-have-considered-leaving-the-profession-in-the-last-2-years-study-finds.html
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-9. doi:http://dx.doi.org.ezproxy.fhsu.edu:2048/10.1377/hlthaff.2011.1377
The use of 12 hours shifts is beneficial for staffing reasons but besides that it is unclear who 12 hour shifts benefit. An article by Li, H. et al found “Napping is beneficial to the well‐being of nurses and could improve their psychomotor vigilance and performance.” Maybe if nurses were allowed a 28 minute nap during their 12 hour shift it would reduce burn out and increase productivity. Is napping an option that was discussed in the research you found?
Li, H., Shao, Y., Xing, Z., Li, Y., Wang, S., Zhang, M., Ying, J., Shi, Y., & Sun, J. (2019). Napping on night‐shifts among nursing staff: A mixed‐methods systematic review. Journal of Advanced Nursing (John Wiley & Sons, Inc.), 75(2), 291–312. https://doi-org.ezproxy.fhsu.edu/10.1111/jan.13859
Napping is not something the article mentioned but there are days (at least in the job I worked at) that it would impossible to take a nap. There just isn’t enough coverage if it is busy. Even if there is proven benefits to napping, I don’t see many employers allowing it!
This is a survey that I feel as if will forever be conditional to each person. Every nurse is going to be able to find their opinion on it. Although the 12 hours may be more beneficial against some people there is always going to be someone else who says its not as beneficial to them. I can see doing the three 12 hour in a row. I do see how doing more than the three in a row can often cause more problems and more room for errors.
Yes it is definitely different for everyone and what works for them and their family. I also think you get “used” to working a certain way. At one job I worked at, the DON would not allow nurses so work more than four 12 hour shifts in a row due to lack of sleep and increased possibility of errors to patient care. I’ve also seen facilities that allow nurses to not have a limit to the amount of shifts a nurse can work in a row, which I think is not right. I haven’t met a nurse that by their 4th or 5th shift in a row aren’t a bit cranky and tired!