The Problem of 12 Hour Shifts: A Literature Review
The 12-hour shift has become standard staffing for many hospitals and a large percentage of nurses in the Unites States are working these shifts. Some nurses prefer the longer hours since they are able to work a full-time week in only three days, while others find these shifts too physically and mentally exhausting, choosing to leave bedside nursing in favor of shorter hours. In 2011, the Joint Commission issued a sentinel alert report warning about the risks of healthcare worker fatigue and outlining suggested guidelines for facilities to consider when staffing longer hours (The Joint Commission, 2011). Their report encouraged administrators to begin considering whether 12-hour shifts were
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Those who favor longer shifts argue that this strain on nurses is balanced by a shorter work week. When a nurse works three 12-hour shifts a week, he or she still has four days in which to recover and spend time with family. In reality; however, many nurses are working more than three days a week, or their shifts are extending past 12 hours. When family commitments and home obligations are considered, nurses routinely put in 14, 15, or even 16-hour days. This leaves very little time for recovery. The Institute of Medicine recommends that nurses work no more than 12 hours in a 24-hour period and no more than 60 hours in a week, but when 2,273 nurses were surveyed about their work schedules, it was found that 17% of them exceeded these guidelines, not just occasionally, but on a regular basis (Trinkoff, Geiger-Brown, Brady, Lipscomb, & Muntaner, 2006). In another study, when 502 nurses were followed for a month and their cumulative 6,017 shifts were examined, 67% of those shifts exceeded 12 hours (Scott, Rogers, Hwang, & Zhang, 2006). More recently, Ma & Stimpfel (2018) found that 65% of the studied units scheduled 12-hour shifts, but 1 in 3 nurses worked longer than these scheduled hours, and nurses reported the need to do so is increasing. It is common for nurses to have to stay past the end of their shift to finish up their work. When that shift is 12 hours long, a nurse …show more content…
Nurses working extended shifts have a higher rate of needlestick injuries (Trinkoff, Le, Geiger-Brown, & Lipscomb, 2007) and a higher rate of musculoskeletal injuries (Trinkoff, Le, Geiger-Brown, Lipscomb, & Lang, 2006). Numerous studies have found that longer shifts have a significant impact on the sleeping habits of nurses and that nurses working these shifts have a higher level of fatigue. According to Saleh, Awadalla, El-masri, & Sleem (2013), people who work atypical shifts often suffer from circadian sleep disorders and this is associated with higher rates of fatigue and depression. When Owens, Allen, and Moultrie (2017) asked 138 nurses about sleep and 12-hour shifts, 81.75% of them reported that their long hours affected their sleep patterns and 91.3% reported that their sleep pattern adversely affected their quality of life. The nurses reported that they had to sleep more on their days off and that they suffered from poor attitudes and relationship strain due to their fatigue. When a group of 80 nurses were studied, it was found that they only got about 5.5 hours of sleep between consecutive 12-hour shifts. Not surprisingly, the nurses reported high levels of fatigue and poor recovery from shifts (Geiger-Brown et al., 2012). Chen, Davis, Daraiseh, Pan, & Davis (2014) also found high levels of fatigue and poor fatigue recovery in the 130 dayshift nurses they studied. Even nursing students, the
Inadequate rest which results in fatigue has major implications on the health and safety of registered nurses and can compromise patient care. Nurses often work three to four 12 hour shift a week without taking any breaks while on duty. They often have difficult workloads and challenges which can take a toll and impact patient care. I will be taking a look at nurse fatigue and the impact it has on the nurse’s wellbeing, work, and patient care.
Overall, 12 hours may seem long but it is relatively productive for a week. Nurses who work 12 hour shifts and being able to do something they like are more likely to want to work for 12 hours. They find it flexible and balance between work and families. It is a duty to the heart to help those in need if it requires more time. It is similar to anyone who really works hard to get better results. Nurses work hard to get to where they are now and therefore should have the right to choose 12 hour shifts. It is important for nurses to understand that all jobs have negative outcomes, but as long as they make the choice to maintain the level of their health and sleep by taking breaks and adequate exercise. They can further be energized in helping patients and finding work more effectively.
In a hospital patients are cared for around the clock, twenty-four hours a day and seven days a week. Hospital RN schedules are set up on rotation shifts meaning you might have to work night or days, holidays, and/or weekends (“Job…”). In a doctor’s office, school, or health center regular business hours are normally maintained (“Job…”). If an RN works for a home health care agency then their routine patient visits are mostly scheduled during business hours. However, if a nurse is on call they may be paged and required to make a visit on any day, at any time.
Over the past several years extended work shifts and overtime has increased among nurses in the hospital setting due to the shortage of nurses. Errors significantly increase and patient safety can be compromised when nurses work past a twelve hour shift or more than 40 hours a week. Hazardous conditions are created when the patient acuity is high, combined with nurse shortages, and a rapid rate of admissions and discharges. Many nurses today are not able to take regularly scheduled breaks due to the patient work load. On units where nurses are allowed to self-schedule, sixteen and twenty-four hour shifts are becoming more common, which does not allow for time to recover between shifts. Currently there are no state or federal regulations that restrict nurses from working excessive hours or mandatory overtime to cover vacancies. This practice by nurses is controversial and potentially dangerous to patients (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). Burnout, job dissatisfaction, and stress could be alleviated if the proper staffing levels are in place with regards to patient care. Studies indicate that the higher the nurse-patient ratio, the worse the outcome will be. Nurse Manager’s need to be aware of the adverse reactions that can occur from nurses working overtime and limits should be established (Ford, 2013).
A considerable amount of literature has been published on the impact of working hours (8 vs. 12 hour shifts) on fatigue among the nurses. These studies revealed that twelve-hour shifts increase the risk of fatigue, reduce the level of alertness and performance, and therefore reduce the safety aspect compared to eight-hour shifts (Mitchell and Williamson, 1997; Dorrian et al., 2006; Dembe et al., 2009; Tasto et al., 1978). Mills et al. (1982) found that the risk of fatigues and performance errors are associated with the 12-hour shifts. Beside this, Jostone et al. (2002) revealed that nurses who are working for long hours are providing hasty performance with increased possibility of errors.
Harrington, J. M. (2001). Health Effects of Shift Work and Extended Hours of Work. OEM Education. Retrieved on December 3, 2013, from http://oem.bmj.com/content/58/1/68.full. doi: 10.1136.oem.58.1.68
This article has shown me that new strategies are needed to reduce sleep disturbances, improve sleep quality, and support the need for supplemental daytime sleep in hospitalized individuals. These strategies include monitoring patients’ sleep and assess quality of sleep and duration, resolving the problems of sleep disturbance, recognizing that nighttime noise, light, and other factors potentially interfere with patient sleep, minimize lighting in shared patient rooms and turn off lights earlier at night, frequently assess for pain and administer prescribed pain medications to minimize sleep disruption. This article taught me more about sleep cycles and disturbances in hospitalized patients. As a future nurse, I have to accurately assess the patients’ personal characteristics and health education needs, and share this knowledge with my classmates.
...hological preparation. After a nurse is done working their regular shift being forced to work overtime can out them a greater right of medical mistake in part due to fatigue and tiredness consequently putting the patient at high risk of complications.
Witkoski Stimpfel, Amy , Douglas M. Sloane, and Linda H. Aiken. "The Loger the shifts for hosital nurses, the higher the levels of burnout and patient disstisfaction." Health Affairs 31.11 (2012): 2501-2509. Proquest. Web. 11 Mar. 2014.
In the recent past, nursing has come to the forefront as a popular career amongst students across the globe. The demand for nurses has kept increasing gradually over the years. In fact, the number of registered nurses does not meet the demand of the private and public health sector. This phenomenon has resulted in a situation where the available registered nurses have to work extra hours in order to meet the patients’ needs. With this in mind, the issue of nurse fatigue has come up as a common problem in nursing. According to the Canadian Nurses Association (CNA), nurse fatigue is “a feeling of tiredness” that penetrates a persons physical, mental and emotional realms limiting their ability to function normally. Fatigue does not just involve sleepiness as has been assumed before. It involves utter exhaustion that is not easily mitigated through rest. When nurses ignore the signs of fatigue, they risk the development of chronic fatigue and other health problems that may not be easily treated. Additionally, fatigue may cause nurses to lose more time at work as they may have to be away from work for several days to treat it. The issue of nurse fatigue has permeated the nursing profession to the extent of causing errors in the work performed by nurses. Fatigue causes a decrease in a nurse’s ability to make accurate decisions for themselves and their patients. It is therefore important to find ways to curb nurse fatigue such that it is no longer a problem. Nurse fatigue is a danger to the patients, organizations and to the nurses themselves and must be mitigated adequately.
Notably, having higher proportions of nurses working shorter shifts—8–9 hours or 10–11 hours—resulted in decreases in patient dissatisfaction” (Stimpfel et al.). This is essentially saying that the longer the shift length, the more negative outcomes result. This study proves that eight to nine-hour shifts are more effective, and should, in turn, be worked more than longer shifts. This is a problem because hospitals are likely to continue to schedule nurses for twelve hours shifts out of
Working in a fast-paced environment and being on their feet can really take a toll on a person. In addition they have to be prepared for anything to happen during their shift. A study of overworked and stressed nurses found that nurses are overworked suffered from physical sickness like type two diabetes (Stress and overworked 2006). For most nurses, their work week consists of more than sixty hours. Working that many hours can double their chances of sicknesses. When they compare the working week hours of nurses who worked the normal 21 to 40 hours with those that work more than 40 or 60 hours a week, they found that in comparison the ones who worked 40 hours or more a week increased the risk by almost 50 percent for type 2 diabetes (Stress and overwork 2006). If nurses were to work their normal work hours without mandatory overtime, then their health would improve.
When hospitals do not have enough staff to care for patients, nurses are required to work overtime and because of that, 50% of nurses quit their job (Martin). This is not healthy for nurses and not safe for patients because if nurses are constantly working overtime, they can become tired and dissatisfied with their job. Moreover, when nurses are dissatisfied with their job because of always working overtime, it lead nurses to quit their job which can become a problem for hospitals because it is hard to keep training new nurses all the time. This can cost money and effort. In addition, it will affect patients because it nurses are tired from working overtime, quality of care for patients can suffer. According to Sung-Heui Bae, author of “Nursing Overtime: Why, How Much, and Under What Working Conditions?”, When a nurse works for over 12 hours or more than 60 hours a week, nurses are more prone to making medical errors which can compromise a patient’s safety (Bae). Like what Fackelmann says, “Overworked nurse may not get to a patient quickly enough to catch a subtle sign of a potentially deadly complication”. This can be one of the reason of 20,000 death of patients each year because of overworked nurses
Heart disease: The Nurses’ Health Study proved that women who slept 9-11 hours per night were 38% more likely to have coronary heart disease as compares to women who slept 8 hours.
Nurses generally work out of hospitals or doctors offices. Some nurses work out of schools or the patient´s homes. The work hours for nurses in hospitals can vary from 2 a.m to 2 p.m but nurses the