Twelve hour shifts for nurses is a big dilemma not just in the United States, but other countries around the world as well. Such shifts have an immense impact on nurses and patients; positive but mostly negative. Twelve hours shifts can cause nurses to have both negative physical and mental effects. Research shows that after long shifts like these, burnout, fatigue and a decrease in patient safety is a lot more common. This paper will outline the history, the negative physical and mental effects, patient outcome/safety effects, the advantages, and the ethical issues related to 12 hour shifts.
HISTORY:
The start of twelve hour shifts began in the 1980’s because of a nursing shortage. Hospitals had their nurses work longer hours (especially in the ER and critical care), because they did not have enough nurses to have the staff rotate working the “normal” 8 hour shifts. When this started, nurses were also paid overtime for the extra 4 hours that were added onto their schedule. This issue has slightly changed overtime only because nurses now do not get paid overtime for the extra 4 hours, because this is a normal shift now. As for the “cause” associated with the 12-hour shift issue, is again, the shortage of nurses that facilities had in the 1980’s. Also, because people in the 1980’s were not going to college because of the recession, so there were not many graduate nurses to employ. Although 4 more hours was a major change to a nurses schedule, Rose O. Sherman, EdD, RN, FAAN, the author of an article titled “The Dilemma with the 12 Hour Nursing Shift,” states that nurses were actually fond of the idea back then.
“Nurses quickly came to appreciate having more time off and the reduction in their commuting expenses. Nurses were able to increase their income by working overtime or Per Diem on their days off.”(Sherman 1).
Working only 3 days a week may seem like a blessing to nurses who have families, or nurses that are still in school to further their career, but a lot of nurses do not really think about nor understand the side effects of these long shifts.
PHYSICAL AND MENTAL EFFECTS:
“Burnout” is common terminology used to describe the “consequences of severe stress and high ideals experiences by people working in the ‘helping’ professions…or over worked employees.” (Johnson 1). For example, a nurse that has “burnout syndrome” would show signs of being exhausted, listless, and unable to cope.
A research article titled, “The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Dissatisfaction,” written by Amy Witkoski Stimpfel, Douglas M. Sloane, and Linda H. Aiken, studied the relationship between how many hours nurses worked to level of burnout, job dissatisfaction, and intention to leave the job. The research design used for this study is quantitative due to the fact that the researchers used surveys, and secondary analysis of cross-sectional data from other studies pertaining to this issue. During this study, researchers sampled more than 22,000 nurses in four different states, that only worked at hospitals on medical or surgical units and in intensive care units with reported shifts of 8-13+ hours. There were 4 different groupings of the shift hours: 8–9 hours, 10–11 hours, 12–13 hours, and more than 13 hours. During the study, they were investigating the relationship between hospital nurses’ shift length and three nurse outcomes: burnout, job dissatisfaction, and intention to leave the job.
The findings of this article were: They found that nurses working shifts of twelve hours or longer were found more in teaching, and high-technology hospitals. They also came to the conclusion that nurses working more than 12 hour shifts were mostly nonwhite males. Most of the nurses working in general were white, non-Latino, females with less than a BSN. They also found that 80% of nurses reported to be satisfied with being scheduled three, 12 hour shifts. As the shift lengths increased, the report of burnout and job dissatisfaction (intention to leave the job) increased. In fact, burnout, job dissatisfaction, and intention to leave the job increased for nurses working 12 hour shifts by two and a half compared to nurses who worked 8 hour shifts.
Also, as hours went on, researchers found that nurses reporting “burnout”, job dissatisfaction, and intent to quit, increased. Also, they found that, “Patients were less satisfied with their care when there were higher proportions of nurses working shifts of thirteen or more hours and were more satisfied when there were higher proportions of nurses working eleven or fewer hours.”(Stimpfel, Sloane, Aiken).
Another research study done by two employees of the University of Maryland, Geiger-Brown and Trinkhoff, closely studied the impact of productivity, quality and safety of patient care while nurses worked 12 hour shifts. They found that nurses working twelve hour shifts reported to only get 5.5 hours of sleep between each shift causing the likelihood of a nurse making a mistake to be three times greater than nurses working 8 hours.
“On blogs where nurses discuss 12-hour shifts, many are acknowledging their fatigue and mental exhaustion during these shifts. With an aging nursing workforce, these are important concerns. Nurse leaders have expressed concern for years that the increased issues with communication and fragmentation of care in acute care environments are partially attributable to 12-hour tours.”(Sherman 1).
PATIENT OUTCOME/SAFETY:
In the previous mentioned research study performed by Stimpfel, Sloane and Aiken, the correlation between nurses shift lengths and patient satisfaction was closely studied. They put together a survey where patients would rate how likely they are to recommend the hospital to others, and rate the hospital overall. “having higher proportions of nurses working shorter shifts—8–9 hours or 10–11 hours—resulted in decreases in patient dissatisfaction.” (Stimpfel, Sloane, Aiken 1).
ETHICAL ISSUE:
A big ethical issue that a lot of researchers talk about are the effects on patients’ and their care. The relates to what was stated earlier under patient outcome/safety. Jessica A. Douglass is an NP at Bronson Methodist Hospital in Kalamazoo, Michigan, and she wrote an article called ” Overextended: Fighting the fatigue of long shifts.” In this article she writes about a lot of ethical issues relating to 12 hour shifts such as: the impact on patient safety, the toll on nurses’ health, and how nurses can protect themselves. When she writes about the impact on patient safety she states:
“Nurses who are tired can have trouble paying attention and staying focused. Other consequences of fatigue include reduced motivation, irritability, memory lapses, impaired communication, diminished reaction time, slowed information processing and judgment, and loss of empathy. One study showed that the incidence of needlestick injuries, musculoskeletal injuries, medication errors, and blood administration errors in shifts of 12 hours or more was significantly increased compared with shifts of 8.5 hours.” (Douglass 1).
This could really effect patient care and patient safety… nurses might have more med errors and make more mistakes when taking care of patients. The research she shares just proves a point on why 12 hour shifts can be dangerous, not only to the nurse but to the patient as well.
