The debate about the length of nursing shifts has been going on for more than 100 years. In 1919, a nursing professor at Columbia University published an article in the American Journal of Nursing (AJN) calling for 8-hour work shifts for nursing students. At the time, nursing students accounted for most of the hospital nursing staff, and they worked very long hours
The professor claimed the long nursing workdays, coupled with the time spent on their studies, caused the students to be fatigued and more likely to make mistakes. The nurses got what they wanted. Until the mid-1970s, the 8-hour nursing shift was the norm.
Twelve-hour shifts emerged when nurses determined they liked working longer days in exchange for more days a week off work. Working three 12-hour shifts a week results in four consecutive days not working, allowing nurses to spend more time with their families.
Hospitals also like this arrangement. It makes scheduling easier and allows them to assign fewer shifts to each nurse.
This has long been controversial, with evidence that longer shifts lead to increased burnout, an increase in nursing errors, and concerns about patient safety. However, recent studies show the pros and cons of each type of schedule. And, for nurses, no matter how long the shift is scheduled for, it often goes into overtime.
Benefits of the 8-Hour Shift
Eight-hour shifts are really becoming a thing of the past. Even so, evidence shows there are benefits to this type of schedule. Some important ones are:
- Reduces fatigue. Nursing is demanding, both physically and emotionally. Even eight hours on the job can be exhausting.
- Decreases burnout. A study conducted a few years ago showed that nurses who work more than 10-hour shifts are two and a half times more likely to experience burnout and leave nursing than those who work shorter shifts.
- Decreases errors. Nurses who work the routine shorter 8-hour shifts are less tired and less stressed, which translates to a decrease in errors.
- No negative impact on health. Working a regular 8-hour shift causes no undue stress and does not damage the nurse’s health.
- Increases patient satisfaction. Patient surveys are conflicting. Some patient surveys indicate that patients are more satisfied with the nursing care provided by nurses who work fewer hours.
In the AJN article published in 1919, Professor Isabel Stewart, in her argument for 8-hour shifts for nurses, wrote: “We know that in nursing where concentrated attention and alertness are so necessary, the patient’s life is often endangered by the mistakes or oversight of an over-tired nurse.”
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Benefits of the 12-Hour Shift
Despite the focus on the benefits of the 8-hour shift, 80 percent of acute care nurses prefer the 12-hour shift. Some of their reasons include:
- They feel they provide better care when they can spend more time with their patients and are able to become more involved in their care.
- It increases the nurse’s work-life balance. Nurses who work the longer shifts generally work three days a week, amounting to full-time work for 36 hours. This means they have four non-working days to spend with their family or do activities they would not have time for if they worked 8-hour shifts five days a week.
- They have fewer commuting days, so it saves on transportation expenses.
- During their hospital stay, patients appreciate being cared for by fewer nurses. With 12-hour shifts, patients only have two nurses a day caring for them.
Disadvantages of 12-Hour Shifts
Whether a nurse works an 8-hour shift or a 12-hour shift, it is common for nurses to be involved in an activity that requires them to stay past the end of the shift. Studies show that nurses who work long hours three days in a row generally show fatigue which slows down their reaction time.
Nursing fatigue. A few years ago, the Joint Commission issued an alert concerning health care workers, fatigue, and patient safety. The alert was recently updated. It focused on addressing the “effects and risk of an extended workday and cumulative days of extended work hours.” It found that the impact of exhaustion due to inadequate sleep, or insufficient quality of sleep, over an extended period leads to:
- Decreased attention and inability to stay focused
- Reduced motivation
- Compromised problem-solving
- Memory lapses
- Impaired communication
- Slowed information processing and judgment
- Diminished reaction time
- Indifference and loss of empathy
The majority of nursing errors involved the administration of medications. A report published in Relias in September 2020 stated, “even the smallest error can directly impact a patient’s health and well-being.”
Nurses who work shifts of 12.5 hours or longer are three times more likely to make errors in patient care. When nurses work more than 12 hours, they also have more occupational injuries.
Burnout. Burnout is defined in the Relias article as “a state of physical, emotional, and mental exhaustion as a result of prolonged stress” and is a “major issue within nursing.” A study by the National Institute of Nursing Research (NINR) revealed that nurses who work 10-hour shifts or longer are two and a half times more likely to experience burnout and job dissatisfaction.
Burnout results in a high turnover rate and a loss of nurses in the workforce. This may be crucial in the future. According to the Bureau of Labor Statistics (BLS) Occupational Outlook Handbook (OOH), nearly 220,000 more nurses will be needed by 2029. In addition, some sources predict that a million nurses will be retiring by 2025. Couple that with those who will quit due to burnout, and the nursing shortage could become critical.
Health complications are more common in nurses working longer shifts. Studies have shown that nurses who regularly work long hours have more occupational injuries, like needle sticks and muscle strains.
Time off is spent recuperating. Many nurses are so exhausted after working 12-hour shifts on three consecutive days that they often must spend some of their time off recovering.
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Tips for Nurses Who Work Long Hours
It appears the 12-hour shift is here to stay. Nurses generally report they like it despite reports that it results in more nursing errors, burnout, and fatigue. Hospitals like it because it helps with scheduling. Patients appreciate having fewer nurses to deal with, so many are more satisfied with 12-hour shifts.
You may not have a choice between 8-hour and 12-hour shifts. Here are some tips for adjusting to 12-hour shifts.
- Wear comfortable shoes. Forget fashion and find shoes that are sturdy and practical. Some nurses recommend taking a second pair and changing shoes during the shift.
- Plan for healthy meals and snacks. Pack snacks for your breaks. If the cafeteria is closed during your shift, pack a healthy meal. Do not depend on unhealthy vending machine snacks. Bananas, granola bars, and nuts provide slow-releasing energy as opposed to a quick sugar fix.
- Keep hydrated. Water is the best. Some nurses need to be reminded that it is time to take a drink. Set your alarm or get an app that reminds you it is time to drink some water. Drinking tea or coffee at your break is good if you do not like water and if the caffeine will not interfere with your later attempt to sleep. Dehydration can leave you tired.
- Leave the unit during your break. If possible, take a walk or a drive. Sit outside. Listen to music. Read a book. Take your mind off work, even if for only a few minutes.
- Make the most of your time off. Run errands—schedule appointments. Enjoy leisure activities. Take a hike. Do anything that provides you pleasure and relaxation. Also, do your around-the-house chores so when you come home from one of your long days, your environment will be a comfortable, clean place to rest.
- Get enough rest. Be sure that before your shift starts, you get plenty of sleep. The night before the start of three days of 12-hour shifts is not the night to go partying and staying up late.
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